bluuebunny/crossref_metadata_2025 huggingface dataset:
Update on Drug-Eluting Stents for Prevention of Restenosis
Authors: Lee Chi-Hang , Tan Huay-Cheem , Lim Yean-Teng
Published: May 2013

Despite the success of coronary stent implantations in the last decade, in-stent restenosis due to neointimal hyperplasia remains a problem to overcome. Neointimal hyperplasia is a vascular response to stent injury and mainly consists of proliferation of smooth muscle cells and deposition of extracellular matrix. Recently, local drug delivery has been advocated as a potential strategy to prevent in-stent restenosis. Unprecedented results have been obtained in early clinical studies on sirolimus-eluting and paclitaxel-eluting stents. Trials using various pharmaceutical coatings on different coronary stents are ongoing. More types of drug-eluting stents are expected on the market in the near future. Meanwhile, the evaluation of drug-eluting stents is entering the second phase in which the safety and efficacy in more complex lesion subsets and different clinical presentations are being investigated. Results including cost-benefit analyses are expected to have a tremendous impact on the practice of interventional cardiology in the next decade.
Mediastinal Tumors: A Clinicopathological Analysis
Authors: Shrivastava Chandra P , Devgarha Sanjeev , Ahlawat Vikas
Published: May 2013

Between January 1993 and June 2003, 106 patients underwent surgical treatment of a mediastinal mass. Ages ranged from 6 months to 62 years, with peak incidence in the third and fourth decade of life (56%). The male to female ratio was 1.9:1. The anterosuperior mediastinum was involved in 76 patients (72%), middle mediastinum in 13 (12%), and posterior mediastinum in 17 (16%). Myasthenia gravis was present in 27% of cases. Complete surgical excision was possible in 68% of patients. Histopathologically, 41 (39%) patients had thymic pathology, 31 (29%) had lymphoma, 14 (13%) had germ cell tumors, 12 (11%) had neurofibroma, 4 (4%) had ganglioneuroma, 2 (2%) had bronchogenic cyst, and 1 each had thymic cyst and mesothelioma. The overall mortality was 3.8%.
Minimal Access Heart Surgery via Lower Ministernotomy: Experience in 460 Cases
Authors: Sun Han-Song , Ma Wei-Guo , Xu Jian-Ping , Sun Li-Zhong , Lu Feng , Zhu Xiao-Dong
Published: May 2013

Minimally invasive cardiac surgery has captured the interest and attention of cardiac surgeons throughout the world. We reviewed our experience of minimal access cardiac operations performed through a lower median ministernotomy. Between January 1997 and August 2003, 100 congenital, 178 valvular, 168 coronary, 12 aneurysmal, and 2 other operations were performed via a 6 to 9 cm lower ministernotomy in 460 consecutive patients. No special instruments were required. Four patients died, and 2 re-operations were necessary. Complications occurred in 28 patients (6.1%). The mean cardiopulmonary bypass time was 88.50 ± 65.16 min, crossclamp time was 55.81 ± 31.89 min, time to extubation was 14.71 ± 29.33 h, and total chest drainage was 7.28 ± 5.07 mL·kg−1. Blood transfusions of 951.42 ± 642.34 mL were needed in 282 patients. Postoperative hospital stay was 11.6 ± 6.0 days. Our experience shows that many types of cardiac operations can be performed through a lower ministernotomy. This technique results in less trauma, quick recovery, and reduces the risk of infection and blood loss. It is a safe and easy procedure that can bring about favorable early outcomes in a wide range of cardiac operations.
Holt-Oram Syndrome with Hemiazygous Continuation of Inferior Vena Cava
Authors: Varma Praveen K , Padmakumar Ramachandran , Harikrishnan Sivadasanpillai , Koshy Thomas , Neelakandhan Kurur S
Published: May 2013

A rare and previously unreported combination of Holt-Oram syndrome, atrial septal defect, patent ductus arteriosus, isolated left atrial isomerism and inferior vena caval interruption with hemiazygous continuation to the left superior vena cava is described.
Carcinoid Tumors of the Thymus
Authors: Kale Suresh B , Saksena Devendra S , Kole Shrikant D , Agnihotri Yeshwant C
Published: May 2013

Twenty-five cases of neuroendocrine carcinoma of the thymus associated with Cushing's syndrome have been reported since 1972. 1 We report two new cases of thymic carcinoid, one of which presented with Cushing's disease. These patients were successfully treated and were asymptomatic at the time of first follow-up.
Operative Indications for Lung Cancer with Satellite Lesions
Authors: Kushibe Keiji , Kawaguchi Takeshi , Nishimoto Yuko , Takahama Makoto , Tojo Takashi , Taniguchi Shigeki
Published: May 2013

In deciding the surgical treatment for lung cancer, it is important to differentiate between a small satellite lesion that is probably benign, a pulmonary metastatic lesion, or a double cancer. The operative indications for lung cancer with small satellite lesions detected on preoperative helical computed tomography were retrospectively examined. We collected 43 small nodules ≤1 cm in diameter from 32 patients. A definitive diagnosis was made by follow-up computed tomography in 3 of 19 ipsilateral lesions and in 9 of 24 contralateral lesions. The final diagnosis of the satellite lesions was malignant in 13 and benign in 30. The 13 malignant lesions consisted of 2 pulmonary metastases and 11 double cancers. Two patients with stage IIb and IIIb disease on clinical staging of the main tumor had pulmonary metastases. Patients with clinical stage I disease had a higher probability that the small lesions were benign or double cancers than those with advanced disease beyond clinical stage I.
Unusual Structural Valve Degeneration in a Cloth-Covered Starr-Edwards Valve
Authors: Kuduvalli Manoj , Ghotkar Sanjay V , Fabri Brian M
Published: May 2013

Structural valve degeneration in a mechanical ball and cage prosthesis is a well-described entity. Here we describe an unusual case of structural valve degeneration of a cloth-covered composite-seat Starr-Edwards ball and cage valve prosthesis in the mitral position, where degeneration of the cloth covering of the seat of the valve led to significant intravalvular mitral regurgitation.
Mitral Valve Annuloplasty with Carpentier-Edwards Physio Ring: Mid-term Results
Authors: Chan Daniel TL , Chiu Clement SW , Cheng Lik-Cheung , Au Timmy WK
Published: May 2013

The mid-term results of mitral valve repair with the Carpentier-Edwards Physio annuloplasty ring were assessed in 97 consecutive patients in a single tertiary-referral cardiothoracic surgical center. The mean follow-up time was 3.9 years (range, 1 month to 8.9 years). Most patients were in functional class II and III before the operation. Ejection fraction was < 40% in 8 patients. Causes of mitral regurgitation included degenerative disease (66%), infective endocarditis (13.4%), rheumatic disease (10.3%), and ischemic heart disease (9.3%). Thirty-day mortality was 2.1%. Actuarial survival and freedom from re-operation at 8 years were 91% and 90.8%, respectively. The only significant risk factor for re-operation was residual mitral regurgitation. Four patients suffered thromboembolic complications, giving an overall event-free survival of 93% ± 3.7% during the follow-up period. The Carpentier-Edwards Physio ring provides safe and effective repair of mitral regurgitation on mid-term follow-up.
Malignant Peripheral Nerve Sheath Tumor of the Heart
Authors: Rahman Mesbah , Cook Deborah S , Ellis Gethin , O'Keefe Peter A
Published: May 2013

A 32-year-old man presented with dyspnea, chest pain, palpitations and ankle edema and was found to have a tumor involving the heart. This was diagnosed as malignant peripheral nerve sheath tumor, a rare sarcoma of the heart. Immunohistochemistry was utilized to establish the diagnosis. The details of the patient's clinical course, and imaging findings with morphological and immunohistochemistry data are reported.
Poorly Differentiated Primary Monophasic Synovial Sarcoma of the Lung
Authors: Cascales Pedro , Gómez-Caro Abel A , Ferri-Ñíguez Belen , Roca María José , Torres Juan , Parrilla Pascual
Published: May 2013

Primary monophasic synovial sarcoma of the lung is rarely seen in clinical practice. We report the case of a 60-year-old male who underwent a left lower lobectomy for lung sarcoma. The patient received adjuvant therapy after surgery. Diagnosis was confirmed with SYT-SSX2 translocation detection.
Antithrombin and Protein C in Systemic Inflammatory Response Syndrome
Authors: Massad Islam , Abu-Ali Hamdi , Biron-Andreani Christine , Picot Marie-Christine , trinh-Duc Philippe
Published: May 2013

Coronary artery bypass grafting with cardiopulmonary bypass can induce systemic inflammatory response syndrome. To assess the prevalence of preoperative antithrombin and protein C deficiencies in relation to the incidence of this syndrome, antithrombin and protein C levels were measured in 130 patients undergoing coronary artery bypass grafting with cardiopulmonary bypass. Systemic inflammatory response syndrome developed in 36 (27.7%) patients who were predominantly male, had a lower EuroSCORE, longer cardiopulmonary bypass time, higher pre-bypass temperature, and shorter activated coagulation time. Logistic regression showed that predictive factors included bypass duration and pre-bypass temperature; however, low antithrombin levels appeared to be a negative predictive factor. Antithrombin levels were < 80% in 33.8% of patients, and 11.6% had protein C levels < 80%. Postoperative antithrombin and protein C deficiencies are not uncommon in adults undergoing cardiac surgery with cardiopulmonary bypass, but detection of these deficits did not identify patients at increased risk of systemic inflammatory response syndrome.
Resection of Right Atrial Metastatic Large-Cell Neuroendocrine Carcinoma
Authors: Yap Cheng-Hon , Hair Christopher , Foy Stephan , Sewak Sanjeev , Francis Michael , Kenny James F
Published: May 2013

The incidence of cardiac metastases is rising due to increasingly sensitive diagnostic investigations and longer patient survival as a result of improved treatment for malignancies. We report a rare case of right atrial metastasis from a large cell neuroendocrine carcinoma successfully resected with cardiopulmonary bypass. The surgical management of advanced cardiac malignancy is discussed. In appropriately selected cases surgical resection of cardiac metastases can be beneficial, allowing improvement in quality of life, and prolongation of life.
Effect of the Cardiac Cycle on the Coronary Anastomosis Assessed by Ultrasound
Authors: Ibrahim Khalid S , Løvstakken Lasse , Kirkeby-Garstad Idar , Torp Hans , Vik-Mo Harald , Haaverstad Rune
Published: May 2013

Anastomosis of the left internal mammary artery to the left anterior descending artery was performed in 9 pigs to evaluate the effect of changes in the cardiac cycle and the choice of ultrasound mode on assessment of graft morphology. The length of the anastomosis and the diameters of the left anterior descending artery at the toe and heel of the anastomosis, as well as downstream, were measured in end-systole and end-diastole with both B-mode and color Doppler imaging. None of the diameters were influenced by the cardiac cycle using either ultrasound mode. B-mode yielded larger diameters at all points except the toe of the anastomosis. It was concluded that provided the scanning is perpendicular to the vessel, the morphology of an anastomosis can be assessed without paying much attention to the phase of the cycle or the mode of ultrasound applied.
Juvenile Rheumatic Mitral Stenosis with Multiple Ventricular Septal Defects
Authors: Krishna Cheemalapati Sai , Babu Vedangi Ramesh , Mohan Kanteti Ram , Baruah Dibya K , Kumar Palli V Naresh
Published: May 2013

Congenital heart disease is related to events occurring in the embryonal stage, while rheumatic heart disease is a sequela of immune-mediated damage following streptococcal infection. We report an unusual association of multiple ventricular septal defects and severe pulmonary arterial hypertension with rheumatic mitral stenosis in a 7-year-old girl. This case highlights the need for careful examination for coexisting rheumatic disease in late presentations of congenital heart disease.
Orthotopic Heart Transplantation through Minimally Invasive Approach
Authors: Navia Jose L , Roselli Eric E , Atik Fernando A , Gonzalez-Stawinski Gonzalo V , Smedira Nicholas G
Published: May 2013

Minimal access approaches are a trend in cardiothoracic surgery. Gained experience in these minimally invasive techniques have allowed its application to more complicated procedures, such as heart transplantation. Both classic and bicaval techniques of cardiac transplant were performed through a partial lower sternotomy in 10 end-stage heart failure patients with no previous cardiac surgery. The procedure was considered safe with adequate exposure, minimal postoperative pain medication requirements, acceptable operative times, and good long-term outcome.
Cardiac Troponin I Concentrations during On-Pump Coronary Artery Surgery
Authors: Capuano Fabio , Simon Caterina , Roscitano Antonino , Sclafani Gianluca , Tonelli Euclide , Sinatra Riccardo
Published: May 2013

Perioperative myocardial infarction remains a frequent complication after coronary artery bypass grafting, and is associated with a poor prognosis. This retrospective study compared cardiac troponin I concentrations after on-pump bypass grafting in 2 groups of patients: 100 operated on using a single-clamp technique to perform anastomoses, and 80 operated on using a double-clamp technique. Postoperative cardiac troponin I levels were not significantly different between groups. It was concluded that the double-clamp technique did not reduce the incidence of myocardial infarction after elective on-pump coronary artery bypass grafting, and use of a single clamp is safe with no adverse effect on postoperative outcome.
Chordal Replacement with Temporary Alfieri Stitch for Anterior Leaflet Prolapse
Authors: Morimoto Hironobu , Tsuchiya Koji , Nakajima Masato , Mitsumori Yoshitaka , Kato Kaori
Published: May 2013

In mitral valve regurgitation due to anterior leaflet prolapse and other complicated lesions, chordal replacement with expanded polytetrafluoroethylene is widely practiced. The most troublesome aspects of this procedure are the determination of the necessary length of the artificial chorda and the tying of the knot. We describe a simple technique for artificial chordal replacement using an Alfieri stitch, that has been successfully applied to 10 patients with anterior leaflet prolapse.
Procedural Outcome and Midterm Result of Carotid Stenting in High-Risk Patients
Authors: Kojuri Javad , Ostovan Mohammad A , Zamiri Nima , Asli Abdolali Zolghadr , Hashemi Mohammad A Bani , Haghighi Afshin Borhani
Published: May 2013

Carotid endarterectomy is the standard treatment for carotid stenosis, but carotid artery stenting has emerged as a potential alternative. Elective carotid artery stenting was performed in 42 patients aged 42 to 79 years (mean, 67.05 ± 8.67 years) after ultrasonography, computed tomography, magnetic resonance angiography and a neurological evaluation. There was bilateral carotid stenosis in 23 patients (55%), with > 90% stenosis in 18 vessels. All patients had significant associated coronary lesions. An emboli protection device and self-expanding stents were used. One year later, the patients were evaluated by Doppler sonography and selective angiography. Technical success was achieved in all procedures. During follow-up, 1 (2.4%) patient died from myocardial infarction, 1 underwent coronary artery bypass and 14 (40%) had minor complaints including occasional dizziness. No other neurological events were noted. Restenosis was found in one case, but selective angiography ruled out a significant lesion. One patient suffered embolization, but recovered completely within 24 hours. In 7 (17%) patients with type C arch interruption and a tortuous carotid course, stenting was successful and they had no embolization or restenosis. Carotid artery stenting is recommended in high-risk patients.
Cardiac Troponin I vs EuroSCORE: Myocardial Infarction and Hospital Mortality
Authors: Simon Caterina , Capuano Fabio , Roscitano Antonino , Benedetto Umberto , Comito Cosimo , Sinatra Riccardo
Published: May 2013

Perioperative myocardial infarction is the most common cause of morbidity and mortality in cardiac surgery. It occurs in 8% to 35% of patients. The primary aim of this prospective study was to determine the level of cardiac troponin I that indicates perioperative myocardial infarction in patients undergoing coronary artery bypass. A secondary goal was to establish the best independent predictor of hospital death. There were 180 consecutive patients undergoing isolated coronary artery bypass surgery enrolled in this study. Values of cardiac troponin I > 12.9 ng·mL−1 at 8 hours postoperatively predicted perioperative myocardial infarction with a sensitivity of 100% and a specificity of 93.2%. Compared to patients who survived, those who suffered hospital death were significantly older (74 ± 7 vs 63 ± 10 years), had significantly higher levels of cardiac troponin I at 24 hours (9 ± 17 vs 27.3 ± 16 ng·mL−1) and 48 hours (6.9 ± 19 vs 30.3 ± 24 ng·mL−1) postoperatively, and a significantly higher EuroSCORE (9 ± 2 vs 4 ± 3). At 8 hours postoperatively, cardiac troponin I led to an earlier diagnosis of perioperative myocardial infarction, while EuroSCORE was the strongest independent predictor of hospital death.
Survival after Surgery with Cardiopulmonary Bypass in Low Weight Patients
Authors: Miyamoto Takashi , Sinzobahamvya Nicodème , Photiadis Joachim , Brecher Anne M , Asfour Boulos
Published: May 2013

To evaluate risk factors for hospital death in patients weighing < 2.5 kg undergoing open-heart surgery, records of 34 consecutive low-weight patients operated on between December 1997 and November 2004 were reviewed. Mean weight was 2.152 ± 0.237 kg (range, 1.600 to 2.460 kg). Biventricular repair was achieved in 28 patients. The most frequent procedures were the arterial switch operation in 9 children, ventricular septal defect closure in 6, repair of total anomalous pulmonary venous connection in 5 and truncus arteriosus repair in 5. There were 8 early deaths. Mortality was strongly associated with the Comprehensive Aristotle Complexity Score: mortality was low (2/27; 7.4%) with a score < 19, and high (6/7; 85.7%) with a score ≥ 19. Higher mortality was encountered after univentricular repair (4/6; 67%). Hyperlactatemia at the end of cardiopulmonary bypass was also associated with poor survival. A Comprehensive Aristotle score < 19 was the strongest predictor of survival in low-weight patients undergoing open-heart surgery. Biventricular repair, when feasible, should be promoted to improve outcome.
Postinfarction Ventricular Septal Defect: Patch Repair with Infarct Exclusion
Authors: Sajja Lokeswara R , Mannam Gopi C , Gutti Rama S , Goli Nagasaina R , Sompalli Sriramulu , Penumatsa Raghava R
Published: May 2013

Postinfarction rupture of the interventricular septum is usually fatal without prompt surgical intervention. Repair of postinfarction ventricular septal rupture by an endocardial patch technique with infarct exclusion is associated with less morbidity and mortality. The results of this repair in 22 consecutive patients were analyzed retrospectively. After myocardial infarction, 16 patients were operated on within 7 days, 3 at 8–21 days, and 3 at 3–6 weeks. 2D-echocardiography, color Doppler studies and coronary angiography were performed in all patients prior to surgery. The mean age of the patients was 57.46 ± 5.31 years and 20 were male; 15 were in cardiogenic shock or congestive heart failure at the time of operation. There were 5 (22.7%) operative deaths. Postoperative complications included low cardiac output, renal failure and respiratory failure. Preoperative cardiogenic shock, severe right ventricular dysfunction, residual ventricular septal defect, and preoperative renal failure were predictors of operative mortality. There were 2 late deaths. A rapid diagnosis, aggressive medical management and prompt surgical intervention are required to optimize survival and recovery in patients who present with septal rupture complicating myocardial infarction
Estimation of Pulmonary Vascular Resistance with Doppler Diastolic Gradients
Authors: Atiq Mehnaz , Tasneem Habiba , Aziz Kalimuddin
Published: May 2013

This study was undertaken to determine the diastolic Doppler echocardiographic correlates of pulmonary vascular resistance calculated on cardiac catheterization in patients with secondary pulmonary arterial hypertension. Thirty-eight consecutive patients with congenital heart disease, pulmonary artery hypertension and pulmonary regurgitation were studied. Continuous-wave Doppler-derived pulmonary artery diastolic gradients were measured at 3 points on the pulmonary regurgitant diastolic velocity slope: peak diastolic, end-diastolic (at the R wave on the electrocardiogram), and mid-diastolic (midway between the peak and end-diastolic points). Catheterization data included oximetry, measurements of pressure in the cardiac chambers and great arteries, and calculation of pulmonary vascular resistance index. Doppler-derived peak, mid, and end-diastolic pulmonary regurgitation gradients correlated best with catheterization-measured pulmonary artery systolic, mean and diastolic pressures, respectively. The best Doppler correlate of pulmonary vascular resistance index was the pulmonary artery end-diastolic gradient. Clinically useful information can be obtained from Doppler pulmonary artery diastolic gradients measured on the pulmonary regurgitant diastolic velocity slope, which can estimate the pulmonary arterial pressure as well as pulmonary vascular resistance obtained on cardiac catheterization.
Pathophysiology of Aortocoronary Saphenous Vein Bypass Graft Disease
Authors: Hassantash Seyed-Ahmad , Bikdeli Behnood , Kalantarian Shadi , Sadeghian Maryam , Afshar Haleh
Published: May 2013

Aortocoronary saphenous vein bypass grafting relieves anginal pain in patients with coronary artery disease. However, its effectiveness is limited due to graft failure; the 10-year patency rate is 50%–60%. Early, 1-year and late graft failure may be due to thrombosis, fibrointimal hyperplasia and atherosclerosis, respectively. There is general agreement that vein graft atherosclerosis differs from arterial lesions in terms of temporal and histological changes. Vein graft atherosclerosis is more rapid, with diffuse concentric changes and a less noticeable fibrous cap, making venous plaques more vulnerable to rupture and subsequent thrombus formation. Despite progress in understanding the pathophysiology, some aspects of vein graft atherosclerosis need to be clarified. This review focuses on the pathophysiologic aspects of this widespread, costly and disabling disease, with emphasis on late graft occlusion and distinctions between arterial and venous atherosclerosis in terms of histology, pathophysiology and risk factors.
Factors Influencing Survival in Patients after Bidirectional Glenn Shunt
Authors: Silvilairat Suchaya , Pongprot Yupada , Sittiwangkul Rekwan , Woragidpoonpol Surin , Chuaratanaphong Suphachai , Nawarawong Weerachai
Published: May 2013

Clinical characteristics, echocardiographic values, and catheterization data of 45 patients with a functional univentricular heart who had a bidirectional Glenn shunt instituted between November 1994 and October 2006 were retrospectively reviewed. Median age at operation was 20 months (range, 9 months to 19 years). Median follow-up time after the bidirectional Glenn operation was 4 years (range, 1 day to 11 years). The early mortality rate was 4/45 (8.9%); overall mortality was 24.4%. Actuarial survival after a bidirectional Glenn shunt was 73% ± 8% at 5 years and 55% ± 17% at 10 years. In multivariate Cox proportional hazards analysis, heterotaxy syndrome and systemic right ventricle were independent predictors of mortality after the bidirectional Glenn shunt. Age at operation, oxygen saturation, previous surgery, a pulsatile Glenn shunt, cardiopulmonary bypass, postoperative pulmonary artery pressure, bilateral superior venae cavae, and Nakata index were not predictive of mortality. The presence of heterotaxy syndrome and systemic right ventricle in patients with a functional univentricular heart should lead to aggressive investigation and management strategies.
Postinfarction Heart Rupture of Posterior Wall Repaired by Covering Patch
Authors: Kimura Naoyuki , Yamaguchi Atsushi , Tanaka Masashi , Okamura Homare , Adachi Hideo , Ino Takashi
Published: May 2013

A 46-year-old man underwent emergency surgery for heart rupture after acute infarction of the posterior wall. Echocardiography revealed limited myocardial thinning, so rather than sutureless repair, a covering patch was used in view of the risk of recurrent rupture. Postoperative echocardiography showed the myocardial thinning had progressed to a wide defect, and computed tomography demonstrated that the covering patch had prevented a repeat rupture.
Aprotinin for Patients Exposed to Clopidogrel before Off-Pump Coronary Bypass
Authors: Nurözler Feza , Kutlu Tolga , Küçük Güngör
Published: May 2013

To verify whether low-dose aprotinin reduces blood loss and blood product usage in patients with clopidogrel exposure within 5 days before off-pump coronary artery bypass, 51 patients with clopidogrel exposure were randomized in a double-blind fashion to receive low-dose aprotinin (25 patients), or placebo (26 patients). The baseline characteristics and number of distal anastomoses in the patients in each group were comparable. Time between the last dose of clopidogrel and start of the operation was similar in both groups, as was mean left ventricular ejection fraction. Chest tube drainage, blood product usage, and reoperation rate were significantly higher in the placebo group. In patients with unstable angina and recent clopidogrel exposure who are undergoing off-pump coronary artery bypass, intraoperative administration of low-dose aprotinin is recommended to reduce blood loss and transfusion requirements.
Primary Right Atrial Angiosarcoma
Authors: Santo Kirkpatrick , Dandekar Uday
Published: May 2013

A rare case of right atrial angiosarcoma is described in a 55-year-old man who was admitted with acute chest pain. Electrocardiography, cardiac enzymes, and chest radiography were negative. His pain settled and he was discharged, but readmitted 15 days later with clinical features of cardiac tamponade. Computed tomography demonstrated a large pericardial effusion. Emergency surgery was performed to excise a right atrial tumor, which histology confirmed to be an angiosarcoma.
Syncope and Facial Blushing Due to Giant Intrapulmonary Bronchogenic Cyst
Authors: Ramos-Izquierdo Ricard , Escobar-Campuzano Ignacio , Llatjos-Sanuy Roger , Moya-Amorós Juan
Published: May 2013

A 43-year-old man presented with dizziness, head instability, and facial reddening, always in relation to body posture and without fever or systemic manifestations. Chest radiography revealed a large cavity with an air-fluid level in the right upper hemithorax. A right upper lobectomy was performed to remove a large bronchogenic cyst. The presentation with cardiac but no respiratory symptoms is uncommon but should be considered in the differential diagnosis of patients with intrathoracic cysts.
Preserving Middle Lobe to Improve Lung Function in Non-Small-Cell Lung Cancer
Authors: Ludwig Corinna , Morand Philippe , Schnell Jost , Stoelben Erich
Published: May 2013

When a lung tumor arises in segment 6, the close anatomical relationship to the middle lobe bronchus may make a lower bilobectomy necessary. Sleeve lobectomy may be an alternative. These procedures were compared retrospectively in 36 patients operated on between January 2005 and December 2006 with non-small-cell lung cancer (stage I-IIIB) of the right lower lobe. Sleeve lobectomy was performed in 21 patients and bilobectomy in 15 (41%). Preoperative lung function was comparable in both groups. Radical resection was achieved in 34/36 patients. Operation time was 121 min for sleeve lobectomy and 144 min for bilobectomy. Chest tubes were removed after 5 days in both groups. Postoperative lung function was better after sleeve lobectomy than bilobectomy (forced expiratory volume in 1st sec: 78% vs. 69%). Preservation of the middle lobe by sleeve lobectomy is feasible. There was no evidence that this resection was less radical, and complication rates were similar in both groups.
Improved Combined Superior-Transseptal Approach to the Mitral Valve
Authors: Nguyen Huu Uoc
Published: May 2013

In mitral valve surgery, the combined superior-transseptal approach gives excellent exposure of the mitral valve, but it is lengthy and complex. A modified version of this approach was made without cutting the right atrial appendage and the dome of the right atrium. This shorter procedure was evaluated in 30 patients aged 4–61 years undergoing complex mitral valve operations including mitral repair (33.3%), reoperation (30%), and small left atrium (30%). The mitral valve was exposed well in all cases. Because of the shorter incision, closure was relatively easy. The aortic crossclamp time was 117 ± 29.9 min (range, 53-173). There were no major complications. Cardiac rhythm resumed spontaneously after release of the aortic clamp in 93.3% of patients, including 36.7% who regained sinus rhythm from arrhythmia preoperatively. There was no heart block, bleeding, or mortality. Results at 3 months were good. Despite a decreased operative field, this modified approach provided adequate exposure for all the required techniques. The benefits of this approach are a shorter incision in the atrial muscle, and simplified closure technique.
Video-Assisted Surgery for Lung Cancer. State of the Art and Personal Experience
Authors: Loscertales Jesus , Jimenez-Merchan Rafael , Congregado Miguel , Ayarra Francisco Javier , Gallardo Gregorio , Triviño Ana
Published: May 2013

This paper reviews the role of videothoracoscopy in lung cancer, highlighting its utility in definitive staging, diagnosis, and treatment. We show exploratory videothoracoscopy to be the perfect technique for last-minute staging, looking for tumor invasion, especially parietal T3 and vascular T4 (due to videopericardioscopy), management of solitary pulmonary nodules, and the possibility of radical treatment with video-assisted thoracoscopic lobectomy. We perform an overview of the literature and analyze our experience of 1,381 patients with lung cancer. In 1,277 of them, the final decision on resectability was made by exploratory videothoracoscopy, including 91 by videopericardioscopy (only 30 were considered non-resectable on videopericardioscopy). Solitary pulmonary nodules were diagnosed in 382 cases (190 were cancer), and we performed 260 major lung resections by video-assisted thoracoscopic surgery (22 pneumonectomies, 238 lobectomies/bilobectomies).
Surgical Repair of Mitral and Tricuspid Valves after Cardiac Transplantation
Authors: Yoshikawa Masaharu , Tomari Shirou , Usui Akihiko , Ueda Yuichi
Published: May 2013

A 43-year-old man underwent mitral valve repair for mitral valve insufficiency due to infective endocarditis, and tricuspid valve repair for iatrogenic chordal rupture due to multiple endomyocardial biopsies after orthotopic cardiac transplantation. Valve repair using no artificial material is feasible, instead of valve replacement, to decrease the risk of recurrent infective endocarditis and enable further biopsies.
Is 6% Hydroxyethyl Starch 130/0.4 Safe in Coronary Artery Bypass Graft Surgery?
Authors: Min Joanna Ooi Su , Ramzisham Abdul Rahman Mohd , Zamrin Mohd Dimon
Published: May 2013

The aim of this study was to compare 6% hydroxyethyl starch 130/0.4 with 4% succinylated gelatin for priming the cardiopulmonary bypass circuit and as volume replacement in patients undergoing coronary artery bypass, in terms of postoperative bleeding, blood transfusion requirements, renal function, and outcome after surgery. Forty-five patients received 6% hydroxyethyl starch 130/0.4 (Voluven) and another 45 were given 4% succinylated gelatin (Gelofusine) as the priming solution for the cardiopulmonary bypass circuit as well as for volume replacement. Postoperative bleeding was quantified from the hourly chest drainage in the first 4 h and at 24 h postoperatively. The baseline characteristics of both groups were similar. In the hydroxyethyl starch group, the total amount of colloid used was 1.9 ± 1.0 L, while the gelatin group had 2.0 ± 0.7 L. There was no significant difference in hourly chest drainage between groups. Blood transfusion requirements, estimated glomerular filtration rate, extubation time, intensive care unit and hospital stay were similar in both groups. It was concluded that 6% hydroxyethyl starch 130/0.4 is a safe alternative colloid for priming the cardiopulmonary bypass circuit and volume replacement in patients undergoing coronary artery bypass surgery.
Current Practice and Outcomes of Off-pump Multivessel Coronary Artery Bypass
Authors: Sun Xiumei , Lim Roger Michael , Hill Peter C , Haile Elizabeth , Corso Paul J , Garcia Jorge M
Published: May 2013

Outcomes of off-pump multivessel coronary artery bypass were compared with those of the on-pump procedure. From July 2001 to June 2006, 3,637 patients with multivessel coronary disease underwent off-pump coronary artery bypass, and 3,586 patients had on-pump coronary artery bypass in our center. The rates of operative mortality, permanent stroke, renal failure and perioperative myocardial infarction were significantly lower in the off-pump group, and these patients required fewer blood transfusions, shorter durations of ventilatory support, and shorter hospital stays. However, the patients who underwent on-pump coronary artery bypass were considered more high-risk and tended to have more complex procedures.
Surgery for Chronic Total Occlusion of the Left Main Stem: A 10-Year Experience
Authors: Akhtar Raja Parvez , Naqshband Mumraiz Salik , Abid Abdul Rehman , Tufail Zafar , Waheed Abdul , Khan Jawad Sajid
Published: May 2013

Chronic total occlusion of the left main stem coronary artery is rare. This retrospective study was conducted to evaluate outcomes of coronary artery bypass grafting between June 1998 and June 2008 in patients with chronic left main stem total occlusion. There were 17 (0.025%) cases detected in 67,082 coronary angiograms. The 14 men and 3 women had a mean age of 55.32 ± 9.2 years. Risk factors included diabetes in 8, hypertension in 6, and smoking in 6. Of 54 grafts applied, 15 were arterial and 39 were venous; 14 patients had 3-vessel disease, and 3 had 4-vessel disease. Three patients required intraaortic balloon counterpulsation perioperatively. The mean intensive care unit stay was 2.1 ± 1.2 days, and hospital stay was 7.1 ± 1.5 days. Postoperatively, one patient suffered myocardial infarction, another had a transient ischemic attack with spontaneous recovery, and 2 developed atrial fibrillation. There was no operative or hospital death. Surgical revascularization is considered appropriate treatment for chronic total occlusion of the left main stem.
Pulmonary Artery Leiomyosarcoma Successfully Treated by Right Pneumonectomy
Authors: Stella Franco , Davoli Fabio , Brandolini Jury , Dolci Giampiero , Sellitri Francesco , Bini Alessandro
Published: May 2013

A 79-year-old woman had a primary tumor of the pulmonary artery, which was initially diagnosed as chronic pulmonary thromboembolism. Multislice angio-computed tomography showed a solid mass in the right pulmonary artery. Radical resection of the tumor was achieved by right pneumonectomy via a transsternal transpericardial approach. The patient was alive and free of disease 36 months after surgery.
Cardiac Bioassist: Results of the French Multicenter Cardiomyoplasty Study
Authors: Chachques Juan C , Jegaden Olivier , Mesana Thierry , Glock Yves , Grandjean Pierre A , Carpentier Alain F ,   for the French Cardiomyoplasty Investigators
Published: May 2013

The French multicenter experience (6 centers) of dynamic cardiomyoplasty was analyzed for long-term survival and functional outcome, the most important endpoints in congestive heart failure therapy. Cardiomyoplasty was performed in 212 patients with symptoms of chronic heart failure despite maximal pharmacological therapy. The etiology was ischemic (48%), idiopathic (45%) or other (7%). Cardiomyoplasty was performed using the latissimus dorsi muscle which was electrostimulated after surgery. During follow-up, 88% of patients improved clinically. Hospital death occurred in 29 (14%) patients and was related to the severity of preoperative heart failure symptoms. Late mortality occurred in 99 patients due to heart failure (44%), sudden death (37%), or noncardiac causes (18%). Combined dynamic cardiomyoplasty and implantation of a cardiac rhythm management system was safely achieved in 22 patients, and 26 underwent heart transplantation for recurrent heart failure. Long-term functional improvements were observed in most patients, and the best outcome was achieved in those with isolated right ventricular failure. Dynamic cardiomyoplasty can be considered as a destination therapy or a mid- to long-term biological bridge to heart transplantation.
Off-Pump Coronary Artery Bypass Surgery in Severe Left Ventricular Dysfunction
Authors: Azarfarin Rasoul , Pourafkari Leili , Parvizi Rezayat , Alizadehasl Azin , Mahmoodian Roghaiyeh
Published: May 2013

Our aim was to examine hospital outcomes of coronary artery bypass surgery in patients with and without left ventricular dysfunction, with regard to the surgical technique (off- or on-pump). Between March 2007 and March 2008, 689 consecutive patients underwent isolated first-time coronary artery bypass; 127 had ejection fractions ≤30% (group 1) and 562 had ejection fractions >30% (group 2). Data of preoperative risk profiles and hospital outcomes were collected prospectively. Off-pump operations were performed in 49 (38.6%) patients in group 1 and 196 (34.9%) in group 2. The incidences of infectious, neurologic, and cardiac complications postoperatively were significantly higher in group 1. In multivariate analysis, preoperative ejection fraction ≤30% was found to be an independent risk factor for postoperative complications and hospital mortality. The subgroup of patients undergoing off-pump surgery in both groups had a significantly lower rate of total complications than those undergoing conventional on-pump operations, but no significant difference in mortality was observed between those undergoing off-pump or conventional surgery in either group. Off-pump surgery helped to limit the increased morbidity rate after coronary bypass in patients with ventricular dysfunction.
Primitive Neuroectodermal Tumor of the Thoracic Wall in a 48-Year-Old Man
Authors: Krassas Athanasios , Mallios Dimitrios , Kalkandi Patra , Boulia Stavroula , Reveliotis Constantinos , Sepsas Evangelos
Published: May 2013

We describe a rare case of primitive neuroectodermal tumor arising from the thoracic wall in a 48-year-old man. He underwent extensive resection of the tumor en bloc with the diaphragm and the thoracic wall, followed by adjuvant chemoradiotherapy. Primitive neuroectodermal tumor may be included in a multidisciplinary protocol incorporating neoadjuvant chemotherapy, surgery, and adjuvant chemoradiotherapy.
Bicuspid Aortic Valve Replacement with Stentless Autologous Pericardial Valve
Authors: Gupta Anubhav , Gharde Parag , Kumar Arkalgud Sampath
Published: May 2013

Bicuspid aortic valve is a common congenital cardiac anomaly that poses a surgical challenge in young patients. We describe replacement of a bicuspid aortic valve with a stentless glutaraldehyde-treated autologous pericardial prosthesis in a 16-year-old girl.
Tricuspid valve repair in Ebstein’s anomaly by posterior annular plication
Authors: Waikittipong Somchai
Published: May 2013

Two girls, aged 14 and 11 years, with Ebstein’s anomaly, were treated by simple posterior annular plication of the functional annulus, without plication of the atrialized right ventricle. At follow-up after 15 and 12 months, both patients were in functional class I with no tricuspid regurgitation on echocardiography. This technique looks simple, safe, and effective, particularly for mild forms of Ebstein’s anomaly, but the longevity of this repair remains to be determined.
Preoperative embolization of aberrant systemic artery in sequestration of lung
Authors: Saxena Pankaj , Marshall Martin , Ng Lydia , Sinha Alka , Edwards Mark
Published: May 2013

A 40-year-old man presented with left lower lobe pneumonia that failed to resolve on antibiotic therapy. Computed tomography revealed intralobar sequestration of the left lower lobe supplied by a large artery from the descending aorta. The aberrant artery was embolized using polyvinyl alcohol particles. The sequestered tissue was resected 3 weeks later. Identification and control of the aberrant artery is essential to avoid inadvertent injury and massive hemorrhage.
Malignant granular cell tumor of the posterior mediastinum with dissemination
Authors: Nakao Masayuki , Hishida Tomoyuki , Ishii Genichiro , Yoshida Junji , Nishimura Mitsuyo , Nagai Kanji
Published: May 2013

A 66-year-old man presented with severe back pain. Imaging studies revealed a well-circumscribed mass in the left posterior mediastinum. Because of pleural dissemination observed at thoracotomy, palliative resection was performed to relieve his back pain. Histologically, the tumor was composed of cells with large eosinophilic and granular cytoplasm, which were strongly positive for S-100. Mediastinal malignant granular cell tumor with pleural dissemination is extremely unusual.
Large sinus of Valsalva aneurysm causing myocardial infarction
Authors: Honda Kentaro , Nakamura Yoshitsugu , Tagusari Osamu , Nakano Kiyoharu
Published: May 2013

A 41-year-old man was urgently admitted with sudden onset of chest pain. Emergency coronary angiography revealed a large aneurysm of the sinus of Valsalva and reduced blood flow in the left coronary artery. A modified Bentall operation and coronary artery bypass were performed successfully. A large sinus of Valsalva aneurysm should be regarded as a critical problem that could cause coronary insufficiency.
Typical carcinoid arising in mature teratoma of anterior mediastinum
Authors: Gupta Pallav , Singh Shubhra , Yadava Kamlesh , Kumari Niraj
Published: May 2013

Teratoma is the second most common mediastinal neoplasm, but malignant transformation in mature teratomas is uncommon at both gonadal and extragonadal sites. A 35-year-old woman presented with an anterior mediastinal mass. Computed tomography suggested a teratoma. Meticulous pathological examination helped in detecting a neuroendocrine neoplasm (carcinoid) within the mature teratoma. Malignant transformation in a teratoma is difficult to diagnose on clinical and radiological assessment; histopathology is essential to detect the malignant nature of these neoplasms.
Successful removal of expandable metallic stent in a patient with lung cancer
Authors: Ose Naoko , Inoue Masayoshi , Minami Masato , Sawabata Noriyoshi , Kadota Yoshihisa , Okumura Meinoshin
Published: May 2013

A 64-year-old man, who had received chemoradiation therapy for stage IIIB non-small-cell lung cancer, underwent stent insertion with a covered expandable metallic stent for post-radiation bronchial stenosis. Stenosis due to formation of granulation tissue at the distal stent site resulted in critical respiratory failure. The stent was removed after 43 months, using rigid bronchoscopy.
Quantification of diagnostic accuracy using nitrate enhanced Tc-99m sestamibi gated myocardial SPECT in assessing myocardial viability: prospective analysis
Authors: Khan Zahid Rahman , Syed Aitizazuddin , Noor Lubna , Shah Syed Sadiq , Hafizullah Mohammad
Published: May 2013

The aim of this prospective study was to assess myocardial viability with nitrate-enhanced Tc-99m sestamibi gated single-photon emission computed tomography in patients with known coronary artery disease. We enrolled 48 consecutive patients (39 men, 9 women) aged 24–82 years, with coronary artery disease and history of myocardial infarction. A Tc-99m sestamibi study was conducted at rest as baseline, followed by a nitrate-enhanced study the next day. Of 960 segments analyzed, 244 of 480 in the left anterior descending coronary artery territory showed viability on the baseline study, and 276 were viable according to the nitrate-enhanced study. Similarly, of 192 right coronary segments analyzed, 148 showed viability on the baseline study compared to 153 on the nitrate study. Of 288 left circumflex territory segments analyzed, 206 showed viability on the baseline study compared to 241 on the nitrate study. The overall improvement of viability with the nitrate study was 12.04%. On the gated studies, the overall improvement with nitrate was 2.02%. The gated study also allowed grading of wall motion and thickness. It was concluded that nitrate-augmented Tc-99m sestamibi myocardial imaging significantly improved the detection of hibernating myocardium, with gated images further improving the accuracy of detection in borderline cases.
Double aortic arch masquerading as bronchial asthma for five decades
Authors: Lone Ghulam Nabi , Rathore Shyam Singh , Malik Javed Ahmad , Ashraf Hakim Zubair , Qadri Asrar Ahmad
Published: May 2013

A 60-year-old man treated for chronic bronchial asthma for more than 5 decades, presented in a debilitated condition. Chest radiography showed mediastinal widening, electrocardiography revealed left anterior hemiblock, magnetic resonance imaging and angiocardiography confirmed double aortic arch. He underwent excision of the anterior arch and release of the trachea and esophagus. Double aortic arch should be considered in the differential diagnosis of chronic asthma when a patient fails to respond to medical treatment.
Risk factors and outcomes of acute renal failure after open cardiac surgery
Authors: Hashemzadeh Khosrow , Hashemzadeh Shahryar , Dehdilani Mahnaz
Published: May 2013

The incidence, risk factors, and outcome of acute renal failure following open cardiac surgery were assessed prospectively in 5,164 consecutive patients undergoing open heart surgery between March 2006 and February 2011. Acute postoperative renal failure (creatinine >1.5 mg·dL−1 within 3 days after surgery) developed in 64 (1.2%) patients with normal preoperative renal function (study group). A control group of 238 cardiac surgery patients who had postoperative creatinine levels ≤1.5 mg·dL−1 were selected randomly during the study period. A prospective case-control analysis of these 302 patients was performed. The mean age was 56.3 ± 12.5 years; 191 (63.2%) were men and 111 (36.8%) were women. Pre-, intra- and postoperative risk factors for acute renal failure were evaluated. Of the patients who developed acute renal failure, 12 (18.8%) died postoperatively, which was significantly higher than the 2.1% mortality among those without acute renal failure. Five of the 10 patients (50%) who needed dialysis died. The most significant prognostic factor for mortality was cardiac dysfunction. This study confirmed that impairment of renal function after cardiac surgery is uncommon without preoperative renal impairment, but carries an increased mortality rate.
Myasthenia gravis complicated with lung cancer and middle mediastinal thymoma
Authors: Takizawa Masaya , Oda Makoto , Matsumoto Isao , Waseda Ryuichi , Tanaka Nobuyoshi , Watanabe Go
Published: May 2013

Myasthenia gravis complicated by lung cancer is rare, and the association between myasthenia gravis and lung cancer is unclear. Thymoma located in the middle mediastinum is very rare. We describe a case of myasthenia gravis complicated with lung cancer and middle mediastinal thymoma in a 69-year-old woman.