bluuebunny/crossref_metadata_2025 huggingface dataset:
Primary Left Atrial Leiomyosarcoma: Literature Review and Lessons of a Case
Authors: Malyshev Michael , Safuanov Alexander , Gladyshev Igor , Trushyna Vladlena , Abramovskaya Lydia , Malyshev Anton
Published: May 2013

Primary cardiac sarcoma is an uncommon disease. In particular, leiomyosarcoma of cardiovascular origin is extremely rare. Half of all cardiac leiomyosarcomas are located in the left atrium. Due to the extreme rarity of left atrial leiomyosarcoma, there is no great experience in its management. This review includes a report of a case of left atrial leiomyosarcoma followed up over 45 months. The literature review examines the distribution of left atrial leiomyosarcoma, the physiological reasons for the tendency of cardiac leiomyosarcoma to be localized to the left atrial cavity, the clinical and physical appearance of this disease, and the key differences between left atrial leiomyosarcoma and the most common left atrial tumor, myxoma. The morphological features, using light and electron microscopy and immunochemical staining, are discussed. Treatment modalities including adjuvant therapy and surgical resection are examined and their effectiveness compared. Opinions regarding the results and optimal treatment of leiomyosarcoma are not always in agreement. This highlights the need for inter-hospital comparison to determine the optimal treatment regimen.
Extension of Pulmonary Adenocarcinoma into the Left Atrium
Authors: Vojáček Jan , Burkert Jan , Pafko Pavel , Mates Martin , Špatenka Jaroslav , Pavel Petr
Published: May 2013

A 62-year-old man presented with pulmonary adenocarcinoma that penetrated through the pulmonary vein into the left atrium. The tumor in the left atrium was removed via a right lower lobectomy under cardiopulmonary bypass. In selected cases, radical removal of a tumor in patients without mediastinal lymph node involvement may improve the prognosis. The use of cardiopulmonary bypass extends the possibilities of radical tumor removal.
Valved Patch for Ventricular Septal Defect with Pulmonary Arterial Hypertension
Authors: Afrasiabi Abbas , Samadi Mahmoud , Montazergaem Hossein
Published: May 2013

From March 1998 to December 2004, 16 acyanotic patients aged 2 to 22 years (mean, 7 ± 5.7 years) with a large ventricular septal defect and elevated pulmonary vascular resistance (9.6 ± 3.8 Wood units) underwent surgery. A Gore-Tex patch with a 5–8 mm longitudinal slit in the center was used. A piece of pericardium was sewn around the slit on one side of the patch, except for the upper quarter. In all patients, the defect was closed with a trimmed patch and the pericardial aspect was placed on the left ventricular side to allow right-to-left shunting. Echocardiography on the day of operation revealed a right-to-left shunt in 6 cases. Two patients (12.5%) died in the early postoperative period due to frequent episodes of pulmonary hypertensive crisis and persistent severe pulmonary hypertension. In 3 years of follow-up, pulmonary vascular resistance gradually decreased in all but one patient in whom it increased with a right-to-left shunt and cyanosis. Insertion of a valved patch seems to be a promising technique to decrease morbidity and mortality in severe pulmonary arterial hypertension.
Subcutaneous Metastasis from Esophageal Cancer
Authors: Hedeshian Mohir H , Wang Xiaofei , Xu Bo , Fontaine Jacques P , Podbielski Francis J
Published: May 2013

Cutaneous metastases from esophageal adenocarcinoma are exceedingly rare. With the institution of multimodality treatments and surgical resection for esophageal adenocarcinoma, loco-regional disease recurrence has been dramatically reduced. In this report, we present a 59-year-old white male with adenocarcinoma of the distal esophagus that was treated with neoadjuvant chemotherapy and radiation therapy, followed by surgical excision. After a disease free interval of two years the patient presented with cutaneous metastatic disease.
MRI-Based Safety Evaluation of the Ventrica Magnetic Coronary Anastomotic System
Authors: Klima Uwe , Beilner Janina , Bagaev Eric , Fischer Stefan , Kofidis Theo , Lotz Joachim
Published: May 2013

The Ventrica Magnetic Vascular Positioner system is a novel automatic anastomotic coupling device for distal coronary artery anastomosis. There is concern that enormous magnetic fields may negatively affect graft anastomosis or coronary artery blood flow, or that they may lead to disconnection of the magnetic ports. Forty-five domestic swine (26.6 ± 5.9 kg) underwent magnetic resonance imaging after a single Ventrica anastomosis of the left internal mammary artery to the left anterior descending artery. Group A ( n = 15) underwent magnetic resonance imaging immediately after surgery, group B ( n = 15) was studied after 1 week, and group C ( n = 15) after 2 weeks. The animals were sacrificed and the anastomotic sites were examined. All animals survived the imaging procedure. Mean imaging time was 25 ± 6 min. Although imaging artifacts occurred in the area surrounding the Ventrica port, there were no disconnections or electrocardiographic signs of ischemia during the study period. Upon sacrifice, all anastomoses were patent without alterations in the alignment of the magnetic components. Clinically relevant tests such as cranial magnetic resonance imaging may be safe after use of the Ventrica system for coronary artery revascularization.
Clinical Significance of p53 Gene Mutation in T1-2N0 Non-Small Cell Lung Cancer
Authors: Gebitekin Cengiz , Bayram Ahmet S , Tunca Berrin , Balaban Şadiman A
Published: May 2013

In the early stage, long-term survival with non-small cell lung carcinoma has never been ideal. The aim of this study was to compare pathologically proven N0 lymph nodes obtained during mediastinoscopy with p53 gene mutation, and to correlate these with postoperative recurrence. Thirty patients undergoing mediastinoscopy for staging of non-small cell lung carcinoma were studied prospectively. Standard cervical mediastinoscopy was performed in all cases, and the specimens were divided into two pieces for histopathological and genetic investigations. All but one of the patients were male, and the mean age was 61.2 years (range, 42–74 years). Although the histopathology was negative in all cases, p53 gene mutation was observed in 6 (20%) patients. Recurrence was detected in 3 patients who had negative histopathology but were positive for p53 mutation, and in one who had negative histopathology and no p53 mutation. Patients with pathologically N0 disease and p53 gene mutation must be carefully monitored for local recurrence or distant metastasis. Neoadjuvant and/or adjuvant therapies may be considered in this group of patients.
Intimal Cardiac Sarcoma in a Pregnant Woman
Authors: Son Ho Sung , Sun Kyung , Jung Jae Seung , Park Sung Min , Lee Sung Ho , Kim Kwang Taik
Published: May 2013

A 29-year-old female patient in the 28th week of pregnancy was diagnosed with a cardiac tumor. We performed tumor excision and mitral valve replacement, and her baby was born successfully with cesarean section on the 9th day after cardiac surgery. After this event, 8 cycles of chemotherapy were administered. After 10 months, metastatic intimal sarcoma of the right ovary developed, and a right salpingo-oophorectomy and omentectomy was performed. However, the patient died of sudden onset of intractable ventricular fibrillation.
Subclavian Cannulation Improves Outcome of Surgery for Type a Aortic Dissection
Authors: Nouraei Seyed M , Nouraei SA Reza , Sadashiva Anand K , Pillay Thasee
Published: May 2013

Acute type A aortic dissection is a major emergency that continues to cause significant morbidity and mortality. Given the anatomy of the lesion, different circulatory configurations achieved during cardiopulmonary bypass using different arterial inflow sites can influence outcome. Patients who had subclavian artery cannulation were compared with those who had femoral artery cannulation. Forty-nine consecutive patients (mean age, 60 ± 14 years) undergoing emergency surgery for acute type A aortic dissection between 1999 and 2004 were reviewed. Data on presentation, preoperative characteristics, operative details, hospital mortality, and neurological outcome were analyzed. Twenty-nine patients had femoral artery cannulation, and 20 had subclavian artery cannulation. The groups were comparable in terms of preoperative characteristics. The mean follow-up was 29 months. Subclavian artery cannulation conferred significant advantages in respect of hospital death (10% vs. 44%) and neurological impairment. Significantly fewer patients required re-operation following subclavian artery cannulation.
Aortic and Mitral Prosthetic Valve Replacement in Age Groups 61–65 & 66–70 Years
Authors: Prasongsukarn Kriengchai , Jamieson WR Eric , Germann Eva , Chan Florence , Lichtenstein Samuel V
Published: May 2013

Prosthesis choice for aortic and mitral valve replacements in patients aged 61–70 years is difficult. We evaluated prostheses in age groups 61–65 and 66–70 years. Freedom from major thromboembolism and hemorrhage was greater for bioprostheses than mechanical prostheses in both age groups after aortic valve replacement, but only in the younger age group after mitral valve replacement. Freedom from valve-related re-operation was greater after mitral valve replacement with mechanical prostheses in both age groups, but no difference after aortic valve replacement. Valve type was predictive of major thromboembolism and hemorrhage, except in older patients undergoing mitral valve replacement. Bioprostheses are favored for aortic valve replacement in both age groups, but the risk of re-operation with a bioprosthesis in the mitral position in patients aged 61–65 years favors a mechanical prosthesis. Prosthesis choice is less definite in those aged 66–70 years.
Emergency Stent-Grafting for Patients over 85 Years of Age with Thoracic Aortic Rupture
Authors: Morishita Kiyofumi , Kurimoto Yoshihiko , Kawaharada Nobuyoshi , Osawa Hisayoshi , Maeda Toshiyuki , Abe Tomio
Published: May 2013

Conventional open repairs of thoracic aortic ruptures carry a high mortality and morbidity in patients over 85 years of age. Less invasive procedures may therefore be required to treat such elderly patients. An 87-year-old woman and 92-year-old man who had undergone emergency endovascular stent-grafting for thoracic aortic ruptures survived to discharge, despite critical conditions on admission.
Partial Obstruction of the Inferior Vena Cava after Surgery for Left Atrial Myxoma
Authors: Di Manici Gino , Di Lazzaro Davide , Bardelli Giuliana , Grasselli Francesco , Da Col Uberto , Ragni Temistocle
Published: May 2013

We present a case of iatrogenic partial obstruction of the inferior vena cava after removal of a left atrial myxoma. The closure occurred subsequent to repair of a discontinuity between the right atrium and inferior vena cava caused by excessive traction on frail tissues.
Minimally Invasive Aortic Valve Replacement in Left Ventricular Dysfunction
Authors: Tabata Minoru , Aranki Sary F , Fox John A , Couper Gregory S , Cohn Lawrence H , Shekar Prem S
Published: May 2013

The safety and benefit of minimally invasive aortic valve replacement in patients with left ventricular dysfunction has not been well investigated. We conducted a retrospective review of 140 patients with ejection fraction ≤ 40% who underwent isolated aortic valve replacement between July 1996 and March 2005. Aortic valve replacement was performed via an upper hemisternotomy in 73 patients and via a full sternotomy in 67. Two matched cohorts of 41 patients each were constructed using propensity score analysis, and the outcomes were compared. There was no significant difference in operative mortality (hemisternotomy, 2.4% vs 4.8% for full sternotomy), incidence of postoperative complications, blood transfusion requirement, length of hospital stay, or discharge to home rates. Aortic valve replacement via an upper hemisternotomy can be performed safely, even in patients with left ventricular dysfunction, with morbidity and mortality outcomes similar to those of a full sternotomy.
Lupus Anticoagulant and Off-Pump Coronary Bypass: Dilemma of Anticoagulation
Authors: Maddali Madan M , Albahrani Maher J
Published: May 2013

Confronted with a persistently elevated activated partial thromboplastin time due to circulating lupus anticoagulant in a patient undergoing emergency off-pump coronary artery bypass surgery, the dilemma of providing adequate anticoagulation for a short cardiac surgical procedure is highlighted.
Strategy for Adult Aortic Coarctation Complicated by Coronary Artery Disease
Authors: Fujisawa Yasuaki , Morishita Kiyofumi , Fukada Johji , Hachiro Yoshikazu , Saito Tatsuya , Abe Tomio
Published: May 2013

Aortic coarctation in adults is sometimes associated with a fragile aortic wall and may be complicated by coronary artery disease and ascending aortic dilation. Successful management of aortic coarctation in a 45-year-old man with coronary artery disease is described. Tube graft replacement was carried out without cross clamping, under circulatory arrest with axillary artery and graft inflow.
Factors Influencing Radial Artery Size
Authors: Loh Yee Jim , Nakao Masakazu , Tan Wei Ding , Lim Chong Hee , Tan Yong Seng , Chua Yeow Leng
Published: May 2013

Size matching of radial artery conduits to coronary arteries is important as it affects the long-term patency. However, factors affecting radial artery size have not been adequately investigated. We retrospectively reviewed 327 consecutive patients who had duplex ultrasonography of their radial arteries over a 2-year period. There were 225 men and 102 women. The mean radial artery size was 2.45 ± 0.54 mm. The factors found to positively affect the size of the radial artery were sex, hypertension, and hyperlipidemia. Diabetes mellitus and age were found to negatively affect radial artery size. Renal disease, race, and smoking did not significantly influence the size of the radial artery. However, as the R squared of this model was insignificant, further studies need to be undertaken to determine other factors that may influence radial artery size.
Repair of Anomalous Origin of Right Coronary Artery from the Pulmonary Artery
Authors: Guo Hong-Wei , Xu Jian-Ping , Song Yun-Hu , Sun Han-Song , Shen Xiang-Dong , Hu Sheng-Shou
Published: May 2013

Anomalous origin of the right coronary artery from the pulmonary artery is a rare cardiac malformation. Between July 2002 and July 2005, we operated on 4 patients with this defect. There were 2 males and 2 females, aged from 18 months to 42 years. Three patients underwent direct re-implantation of the right coronary artery into the aorta, and one had an intrapulmonary tunnel repair (intrapulmonary artery baffle with an autologous pericardial patch for tunneling to the anomalous right coronary ostium). Cardiopulmonary bypass was used in 2 patients, and an off-pump technique in the other 2. One patient had an atrial septal defect that was closed with an Amplatzer septal occluder through the right atrium under transesophageal echocardiography, without cardiopulmonary bypass. All patients survived and recovered uneventfully. Follow-up ranged from 3 to 39 months (mean, 17 months). All patients were doing well and free from symptoms, with normal exercise tolerance. Surgical correction of anomalous right coronary artery shows good early and midterm results.
Benefits of a β-Blocker for Intractable Hemolysis Due to Paraprosthetic Leakage
Authors: Aoyagi Shigeaki , Fukunaga Shuji , Tayama Eiki , Nakamura Eiji , Egawa Noriko , Hosokawa Yukio
Published: May 2013

We describe a 58-year-old man who was successfully treated with a β-adrenergic receptor blocking agent for intractable hemolysis due to paraprosthetic leakage. After replacement of a mitral prosthetic valve with another mechanical valve, the patient suffered intractable intravascular hemolysis resulting from recurrent paraprosthetic leakage. With oral administration of a β-adrenergic receptor blocker, betaxolol hydrochloride, for 3 months, the hemoglobin value increased from 9.7 g·dL−1 to 12.4 g·dL−1, although glutamic oxaloacetic transaminase and lactic dehydrogenase values remained elevated.
Endobronchial Sclerosing Hemangioma: A Rare Presentation of a Parenchymal Tumor
Authors: Boudaya Mohamed-Sadok , Falcoz Pierre-Emmanuel , Alifano Marco , Camilleri-Broet Sophie , Régnard Jean-François
Published: May 2013

Endobronchial localization of sclerosing hemangioma is extremely rare. Exact localization of lesion at preoperative work-up allows parenchymal-sparing procedures. We report a case of endobronchial sclerosing hemangioma diagnosed preoperatively and treated by lingular-sparing upper lobectomy with nodal dissection.
Multiple Pulmonary Metastases from Benign Pleomorphic Adenoma
Authors: Sit Ko Yung , Chui Wing Hung , Wang Elaine , Chiu Shui Wah
Published: May 2013

Metastasizing pleomorphic adenoma is a rare condition of metastasis from a histologically benign salivary gland tumor. We report a case of metastasizing pleomorphic adenoma presenting with multiple bilateral lung metastases, and discuss the clinical aspects of this disease.
Pyogenic Vertebral Osteomyelitis after Surgery for Rupture of the Aortic Arch
Authors: Nogami Yashiro , Isoda Susumu , Shimizu Masafumi , Kimura Tamizo , Suzuki Kimihiro , Maehara Tadaaki
Published: May 2013

Vertebral osteomyelitis is a very rare and intractable complication after vascular surgery. We describe a case of pyogenic vertebral osteomyelitis induced by methicillin-resistant Staphylococcus Aureus sepsis following surgery for traumatic rupture of the aortic arch, successfully managed with long-term antibiotic therapy for 75 weeks.
Esophageal Stethoscope in Thoracoscopic Interruption of Patent Ductus Arteriosus
Authors: Kahrom Mahdi , Kahrom Hadi
Published: May 2013

There is a significant rate of residual or recurrent ductal patency after video-assisted thoracoscopic closure of patent ductus arteriosus. Between February 2000 and October 2004, this procedure was carried out on 145 consecutive patients in whom heart sounds were monitored intraoperatively with an esophageal stethoscope. Changes in continuous cardiac murmurs were recorded after placing the 1st and 2nd vascular clips. There was no ductal flow after clipping twice in 138 (95%) patients; in the other 7, residual flow was abolished at the 3rd attempt. All patients left the operating room with no residual ductal patency on echocardiography. After 6 months, there was no incidence of residual patency. Intraoperative esophageal stethoscopy provides remarkably loud and clear heart sounds for direct monitoring and reliable evaluation of the entire course of thoracoscopic patent ductus arteriosus closure, without interrupting the surgical procedure, thus avoiding re-intervention and complications associated with residual ductal flow.
Current Incidence of Peripheral Arterial Embolism and Role of Echocardiography
Authors: Mohammadi Tofigh Arash , Karvandi Mersedeh , Coscas Raphaël
Published: May 2013

We reviewed the incidence and outcome of all cases of upper and lower limb embolism surgically treated in our vascular unit, from January 2001 to June 2006, to assess the role of transthoracic and transesophageal echocardiography in defining the source of the embolus. Transthoracic echocardiography was carried out postoperatively, and patients in whom the embolic source was not found underwent transesophageal echocardiography. There were 85 patients (mean age, 69 years) who underwent embolectomy: 58 for lower and 27 for upper limb ischemia. The source or potential source of thrombus was demonstrated in 17 (20%) patients after transthoracic echocardiography. Fifty-three patients had transesophageal echocardiography, the source of embolism was found in 85%, and the subsequent management was changed in 47% of them. Arterial limb emboli are still prevalent in developing countries. Transthoracic echocardiography is a good screening tool for detecting a potential cardiac source of peripheral embolism, with transesophageal echocardiography being reserved for specific indications.
Modified Muscle-Sparing High Approach to the Thoracoabdominal Aorta
Authors: Belov Iuri V , Stepanenko Anna B , Gens Andrei P , Savichev Dmitri D , Komarov Roman N
Published: May 2013

A modified muscle-sparing high approach to the thoracoabdominal aorta is described, which improves surgical access for thoracoabdominal aortic aneurysm repair. Since 2000, 16 patients with type I and II thoracoabdominal aortic aneurysms have undergone aortic graft replacement using this approach via the 3rd intercostal space. There were no hospital deaths. Three (18.8%) patients had severe postoperative pain requiring prolonged analgesia. This approach is a good alternative to the standard approach via the 6th intercostal space.
Off-Pump Coronary Artery Bypass in Severe Left Ventricular Dysfunction
Authors: Pande Shantanu , Agarwal Surendra K , Kundu Anirban , Kale Niraj , Chaudhary Amit , Dhir Udgeath
Published: May 2013

The outcome of multivessel off-pump coronary artery bypass grafting in cases of severe left ventricular dysfunction was studied in 58 consecutive patients with ejection fraction ≤35% who were followed up for a median of 15 months. Patients with ejection fractions ≤25% (group 1) had the largest left ventricular dimensions preoperatively, with gradual increases during follow-up; those with ejection fractions of 26%-35% (group 2) had smaller preoperative ventricular dimensions, with left ventricular regression postoperatively. There was more improvement in ejection fraction in group 2 than group 1 (33% vs. 10%). Mitral regurgitation improved from moderate to mild in group 2; whereas in group 1, mild mitral regurgitation progressed to moderate or severe during follow-up. Ejection fraction was a predictor of more frequent use of intraaortic balloon pumping, longer duration of inotropic use, a higher mean pulmonary artery-to-systemic arterial pressure ratio, and increased postoperative drainage.
Pulmonary Angiosarcoma Presenting as Spontaneous Recurrent Hemothorax
Authors: Campione Andrea , Forte Giuseppe , Luzzi Luca , Comino Alberto , Gorla Alberto , Terzi Alberto
Published: May 2013

An incidental diagnosis of pulmonary angiosarcoma was made after surgical exploration for repeated episodes of bleeding in an 85-year-old woman. Spontaneous hemothorax is uncommon and deserves detailed investigation.
Seasonal Variation in Thrombogenicity of Blood: A Word of Caution
Authors: Narang Sumit , Banerjee Amit , Satsangi Deepak K , Geelani Mohammad A
Published: May 2013

Thrombogenicity of blood is known to have seasonal variations. The clinical implications of seasonal variations in the anticoagulation profile of patients with mechanical valves was assessed. Data of patients implanted with a mechanical heart valve for more than 3 months were collected at follow-up or on presentation to the emergency department. The mean time from the previous follow-up examination was 3.6 ± 0.3 months. The number of patients with an international normalized ratio >3.5 and the incidence of hemorrhagic events peaked in hottest part of the year (June-July), with 128 cases of prolonged clotting and 43 hemorrhagic events in this period. The number of patients with rapid clotting and the incidence of embolic events peaked in coldest part of the year (December-January), with 120 cases of international normalized ratio <1.5 and 37 embolic events in this period. There was a significant correlation between temperature and thrombogenicity in patients with prosthetic heart valves on long-term anticoagulation.
Adult Patent Ductus Arteriosus: Successful Surgery with Mitral Valvuloplasty
Authors: Hobo Kyoko , Hanayama Naoji , Umezu Kentaro , Shimada Naohiro , Toyama Akihiko , Takazawa Arihumi
Published: May 2013

The development of left ventricular dysfunction is a serious complication of longstanding patent ductus arteriosus. An 80-year-old woman who underwent patent ductus arteriosus ligation 13 years previously developed congestive heart failure and mitral regurgitation. She underwent surgical repair with transpulmonary ductus closure and mitral valve annuloplasty under cardiopulmonary bypass. She made a full recovery with improved left ventricular function.
Door-to-Needle Times in Acute Myocardial Infarction
Authors: Yaylali Yalin Tolga
Published: May 2013

Thrombolytic therapy is still the fastest and most accessible treatment for patients presenting with acute ST-elevation myocardial infarction. The time to treatment is a pivotal parameter in reperfusion. We examined the effects of implementing a better organized team approach to reduce door-to-needle times in patients with acute myocardial infarction. Fully trained emergency department personnel with special equipment facilitated direct communication between offsite cardiologists and prehospital emergency personnel, allowing for patient triage directly to the coronary care unit. Demographic, laboratory, and time interval data were prospectively collected and compared with data from previous years. From April to December 2007, 60 patients with acute ST-elevation myocardial infarction were triaged to the coronary care unit and enrolled in this study. Improvements were seen in mean door-to-needle time (reduced from 80 to 30 min during regular hours, and 85 to 33 min outside regular hours) compared with 2005–2007 data. A better organized team-based approach with specifically trained personnel and equipment for early evaluation and triage of patients with suspected myocardial infarction decreased intervention times, with the potential to be broadly applied in clinical practice and to improve patient survival.
Aortic Replacement via Median Sternotomy with Left Anterolateral Thoracotomy
Authors: Yamashiro Satoshi , Kuniyoshi Yukio , Arakaki Katsuya , Inafuku Hitoshi , Morishima Yuji , Kise Yuya
Published: May 2013

Prevention of cerebral injury is an important consideration during repair of aortic arch aneurysm, and the major goal of cerebral protection techniques. We describe our surgical strategy for treatment of extended thoracic aortic aneurysms. Between January 2001 and June 2008, 17 men and 6 women, with a mean age of 67.9 ± 8.3 years, underwent total replacement of the arch and descending aorta. Six (26.1%) patients required emergency surgery. A median sternotomy with a left anterolateral thoracotomy provided a good visual field, and bilateral axillary arteries were preferentially used for systemic as well as selective cerebral perfusion. Two (8.7%) patients died in hospital. Prolonged mechanical ventilation was required for 7.3 ± 8.4 days after surgery in 17 patients who all recovered uneventfully. Permanent neurological dysfunction developed in 1 (4.3%) patient who died of sepsis 2 years after the operation. Our results suggest that total arch replacement through a median sternotomy plus a left anterolateral thoracotomy is helpful for extended replacement of the thoracic aorta as well as distal reoperation for dissecting type A aortic aneurysm. Perfusion via bilateral axillary arteries may improve cerebral protection.
Emergency Computed Tomography for Aortic Valve Vegetation Mimicking Disruption
Authors: Weininger Markus , Yildirim Cagatay , Ritter Christian , Leyh Rainer , Hahn Dietbert , Beissert Matthias
Published: May 2013

A 47-year-old man presented with symptoms typical of infective endocarditis and history of streptococcal meningitis 8 months previously. Echocardiography showed a large aortic valve vegetation that was interpreted as disruption of the noncoronary cusp. This was ruled out by 64-slice cardiac computed tomography. Valve replacement was performed successfully.
Malignancy of Congenital Cystic Adenomatoid Malformation of Lung in Aged
Authors: Benouaich Vincent , Marcheix Bertrand , Begueret Hugues , Brouchet Laurent , Velly Jean François , Jougon Jacques
Published: May 2013

Congenital cystic adenomatoid malformation is rare in adults, and often asymptomatic. We describe a case of malignant degeneration of a congenital cystic adenomatoid malformation in a 77-year-old man. Congenital cystic adenomatoid malformation must be considered a premalignant lesion, even in older patients. Rigorous preoperative staging must be undertaken. Anatomic resection with extensive lymphadenectomy remains the treatment of choice.
Timing of Revascularization after Acute Myocardial Infarction
Authors: Abd-Alaal Mohammed M , Alsabban Mostafa A , Abbas Osama A , Alshaer Ahmad A , Al-Saddique Ahmed , Fouda Mohammed
Published: May 2013

The optimal timing of surgical revascularization after acute myocardial infarction remains controversial. Higher mortality after emergency coronary artery bypass has been documented. We retrospectively reviewed 278 patients who underwent coronary artery bypass between 2005 and 2007. The time from onset of myocardial infarction to surgical revascularization was the basis for dividing patients into 3 groups: surgery was performed within 24 h in group 1, at 24–72 h in group 2, and after 14 days in group 3. There was a definite relationship between the timing of revascularization and the outcome of surgery. Group 1 had a mortality rate of 11.7%, group 2 had 7% mortality, and group 3 had 2.5% mortality. Group 1 had the highest incidence of postoperative complications. Surgical revascularization within 24 h of acute myocardial infarction was associated with significantly higher risks of mortality and morbidity than procedures performed after 72 h.
Survival after Surgery following Chemotherapy for Non-Small-Cell Lung Cancer
Authors: Molnár Tamás F , Balikó Zoltan , Sárosi Veronika , Horváth Peter Örs
Published: May 2013

A retrospective study was carried out on 74 patients with advanced non-small-cell lung cancer (52 in stage IIIA, 22 in stage IIIB) who received platinum-based induction chemotherapy in doublets and triplets, followed by tumor resection. Thirty-day postoperative mortality was 5.4% (4 patients); 5 patients in stage IIIB and 17 in stage IIIA did not respond, but the other 47 (63.5%) were downstaged to < IIIA (26 were downstaged to stage I, 20 to stage II, and 1 had complete remission). There was no change in T factor in 22 (30%) patients, nor in N factor in 21 (28%). The actuarial 5-year survival rate for patients in postoperative stages IIIA and IIIB was 0.496; survival was significantly longer in patients who responded to therapy. Parallel improvement in both T and N status predicted worse survival than a multistage regression in any single factor. N status was found to be a stronger survival indicator than T status. Cell type did not influence the response rate or outcome. Induction chemotherapy significantly improved survival in patients who responded, despite a poor prognosis.
Repair of Type a Aortic Dissection in Nonagenarian
Authors: Woo Y Joseph , Kozin Elliott D
Published: May 2013

Without emergency surgical management, acute type A aortic dissection carries a high risk of death. Controversy exists as to whether extreme age remains a contraindication to surgery. We describe successful repair of type A aortic dissection with ascending aortic graft replacement, aortic valve repair, hemiarch reconstruction, and ablation of atrial fibrillation in a 93-year-old man.
Aprotinin Confers Neuroprotection by Reducing Apoptotic Cell Death
Authors: Iwata Yusuke , Nicole Olivier , Okamura Toru , Zurakowski David , Jonas Richard A
Published: May 2013

Aprotinin has been used in pediatric cardiac surgery for its antiinflammatory and hemostatic benefits. We have reported that aprotinin has a direct cellular neuroprotective effect through reduction of excitotoxicity. The purpose of this study was to investigate whether aprotinin is neuroprotective against apoptotic cell death. Near-pure neuronal cultures containing <5% astrocytes were obtained from fetal mice. Serum deprivation was initiated at 7 days by transferring the cultures, which are dependent on serum for survival, into growth medium lacking serum for 24 h. Neuronal cell death was assessed by phase-contrast cell counting after staining with 0.4% trypan blue dye. Aprotinin at a clinically relevant concentration of 100 KIU·mL−1 significantly reduced apoptotic neuronal cell death from 84.4% to 51.8%. This result suggests that aprotinin has the potential to reduce brain injury resulting from apoptotic cell death induced by an ischemic insult. Additional studies are needed to evaluate the potential of aprotinin to reduce neurological injury in patients at high risk of cerebral injury, including those undergoing circulatory arrest.
Primary Cardiac Valve Tumors
Authors: Georghiou Georgios P , Vidne Bernardo A , Sahar Gideon , Sharoni Erez , Fuks Avi , Porat Eyal
Published: May 2013

To assess the prevalence, characteristics, and outcome of surgical treatment of primary cardiac valve tumors in a single center, we reviewed our experience in 6 women and 1 man, aged 49 to 76 years (mean, 64.7 years) who presented between 1999 and 2006. In one patient, the diagnosis of cardiac valve tumor was made incidentally on transesophageal echocardiography during aortocoronary bypass surgery. The others had clinical symptoms: angina or myocardial infarction in 3, congestive heart failure in 2, dyspnea and cerebrovascular ischemia in 1 patient each. Four of the 7 tumors were benign, and 3 were malignant. All patients survived the operation and recovered uneventfully. Midterm follow-up was available in all patients. Two patients with malignant tumors were considered unsuitable for adjuvant therapy by the oncologist; both died during follow-up from local tumor recurrence. All 5 survivors were categorized at the last follow-up as functional class I, with normal exercise tolerance. Excellent early and midterm surgical results can be obtained in patients with benign cardiac valve tumors, but the prognosis for those with a malignant tumor is poor.
Surgical Treatment of Ruptured Metastatic Pleomorphic Leiomyosarcoma
Authors: Giv Mahmoud Jafari , Kenny James F , Opeskin Kenneth K , Elahi Maqsood M , Alam Naveed Z
Published: May 2013

A rare case of primary cardiac leiomyosarcoma was diagnosed in a 21-year-old man who presented with a groin mass thought to be a sebaceous cyst. Histopathology revealed a high-grade pleomorphic leiomyosarcoma. Combined positron-emission and computed tomography showed a large metabolically active left atrial mass with multiple metastases. Major debulking resection was undertaken, followed by radiation and chemotherapy. At 13 months postoperatively, limited spread has been detected, and the patient had no limitation in daily life.
Thoracic Empyema in High-Risk Patients: Conservative Management or Surgery?
Authors: Bar Ilan , Stav David , Fink Gershon , Peer Amir , Lazarovitch Tsilia , Papiashvilli Michael
Published: May 2013

We retrospectively analyzed the data of 119 patients who were treated for empyema thoracis from 1999 to 2007. There were 87 men with a mean age of 63.9 years (range, 19–79 years) and 32 women with a mean age 55.2 years (range, 26–78 years). The empyema was right-sided in 73 patients and left-sided in 46. The etiology was parapneumonic in 43.7% of cases, postoperative in 42.0%, posttraumatic in 11.8%, and due to other causes in 2.5%. Eight (6.7%) patients underwent surgery on admission because of unstable clinical status; all 8 survived. Fibrinolysis was used in 111 (93.3%) patients; of these, 88 (73.9%) were successfully treated by intrapleural urokinase instillation, and 23 (19.4%) failed treatment and underwent surgery. All 88 patients who had successful fibrinolytic therapy survived, they accounted for 1.8% of the morbidity. In the 23 patients who underwent surgery after failed treatment, there were 3 deaths, accounting for 2.7% overall mortality and 6.3% morbidity. Treating thoracic empyema in patients with significant comorbidities is challenging. Intrapleural urokinase administration might be beneficial in high-risk patients, but in those without significant comorbidities, early surgery may be considered.
Is Epidural Analgesia Necessary after Video-Assisted Thoracoscopic Lobectomy?
Authors: Kamiyoshihara Mitsuhiro , Nagashima Toshiteru , Ibe Takashi , Atsumi Jun , Shimizu Kimihiro , Takeyoshi Isumi
Published: May 2013

Most studies have shown that thoracic epidural analgesia reduces postoperative pain, but it carries potential risks. Recently, video-assisted thoracoscopic surgery has become an established technique that causes minimal postoperative pain. This report shows that thoracic epidural analgesia is not always necessary after video-assisted thoracoscopic lobectomy. From January to December 2007, 30 consecutive patients who underwent video-assisted thoracoscopic lobectomy were examined retrospectively. We analyzed the necessity for routine thoracic epidural analgesia. The continuous subcutaneous analgesia catheter for morphine (2 mg in 48 h) was removed from 15 patients on postoperative day 1, and from the other 15 on day 2. We administered loxoprofen sodium hydrate, diclofenac sodium suppository, pentazocine hydrochloride, and mexiletine hydrochloride for postoperative analgesia, as needed. The mean pain score was no more than 1.0. The maximum score was 3.0 on day 0, and 2.0 on day 14; subsequently, no pain score exceeded 2.0. The postoperative hospital stay was 8.7 ± 0.8 days. All patients made uneventful postoperative recoveries. There is no need for thoracic epidural analgesia after every video-assisted thoracoscopic lobectomy because our patients recovered with no serious complication. Less invasive surgical approaches should require simpler postoperative pain management.
Novel Silicone Stent to Treat Tracheobronchial Lesions: Results of 35 Patients
Authors: Saueressig Maurício G , Sanches Paulo RS , Neto Amarilio V Macedo , Moreschi Alexandre H , Oliveira Hugo G , Xavier Rogerio G
Published: May 2013

We describe a case series of 35 patients with either benign (14) or malignant (21) tracheal stenosis who were treated using a novel silicone stent, the HCPA-1, designed to prevent migration. Between March 2001 and September 2008, 13 women and 22 men received 41 HCPA-1 stents. The median duration of stenting in benign cases was 457 days (range, 4–2, 961 days). Successful stent removal with curative results was accomplished in 2 patients with tracheomalacia and 1 with post-intubation stenosis. In malignant cases, the median duration of stenting was 162 days (range, 1–1, 279 days). Five patients had tumor progression with obstruction requiring repeated laser resection, dilatation, or additional stents. Two patients died due to airway obstruction despite bronchoscopic intervention. Twelve patients with malignant lesions died with the stent in place. At the end of the study, 3 patients with malignant disease remained alive; 2 were lost to follow-up. The HCPA-1 stent proved to be safe, with no severe complications during the study period, and effective in improving quality of life with relief of dyspnea.
Local suture annuloplasty for posterior mitral valve repair: 18-year experience
Authors: Soon Jia-Lin , Du Xin , Shine Brian , Jin Xu-Yu , Janas Shirley , Pillai Ravi
Published: May 2013

We retrospectively reviewed 128 consecutive patients who underwent quadrangular resection of a prolapsed posterior mitral leaflet and local suture annuloplasty. The median age was 68.1 ± 10.0 years (range, 30–84 years) and 63.3% were male. Mean left ventricular ejection fraction was 63.8% ± 10.2% (range, 25%–80%). The etiology of mitral regurgitation was fibroelastic degeneration in 94 (73.4%) patients, myxomatous degeneration in 26 (20.3%), myxomatous infective endocarditis in 7 (5.5%), and post-infarction papillary rupture in one. There was 1 (0.8%) hospital death. The median follow-up was 4.7 ± 4.7 years (range, 0.01–18.29 years). The freedom from reoperation was 98%, 94%, 87%, and 79% at 1, 5, 10, and 15 years, respectively, improving for the most recent 107 patients, subsequent to technical modification, to: 100%, 96%, 94%, and 90% at 1, 5, 10, and 14 years, respectively. Ten- and 15-year freedom from severe mitral regurgitation was 91%, and 88%, respectively. The overall actuarial 1-, 5-, 10-, and 15-year survival rates were 98%, 90%, 70%, and 52%, respectively, similar to that of the age- and sex-matched United Kingdom population. The long-term results of this technique in selected patients with prolapsed posterior leaflet were considered acceptable.
Surgical repair of double-chambered right ventricle in adulthood
Authors: Kottayil Brijesh P , Dharan Baiju S , Pillai Vivek V , Panicker Varghese T , Gopalakrishnan Shyamkrishnan K , Jayakumar Karunakaran
Published: May 2013

The aim of this study was to investigate a rare subset of adult patients with double-chambered right ventricle, pertaining to clinical presentation, rhythm disturbances, surgical approach, and results of surgical repair. A retrospective review of our records revealed that 14 adults had undergone surgical repair of double-chambered right ventricle from 1990 to 2010. Their median age was 25.5 years, and their median weight was 50 kg. Patients presented with various symptoms, the most common being dyspnea on exertion. The mean systolic pressure gradient across the obstruction was 69.8 ± 23.1 mm Hg. The most common associated anomaly was ventricular septal defect. Significant rhythm disturbances were present in 4 patients. Transatrial repair was undertaken in 5 patients, a combined transatrial and transpulmonary approach was used in 4, and a right ventriculotomy in 5. There was no mortality at a median follow-up of 5.1 years. A mild right ventricular outflow tract gradient was noted in 2 patients. Medical management was required for rhythm disturbances in 2 patients. Double-chambered right ventricle can present in adulthood, often with vague symptoms. The midterm results of surgical correction are satisfactory. Long-term follow-up is necessary to detect late arrhythmias.
Coronary ischemia due to subclavian stenosis after arterial revascularization
Authors: Zebele Carlo , Özdemir H Ibrahim , Hamad Mohamed A Soliman
Published: May 2013

We describe a case of coronary-subclavian steal in a 60-year-old man who presented with progressive ischemia 16 years after coronary artery bypass with in-situ bilateral internal thoracic artery grafts. Angiography revealed completely patent arterial grafts, but subtotal stenosis of the left subclavian artery. On reoperation, a vein graft was used to connect the aorta to the left internal thoracic artery which was proximally disrupted. No coronary ischemia was found postoperatively.
N1 non-small-cell lung cancer. A 20-year surgical experience
Authors: Casali Christian , Stefani Alessandro , Morandi Uliano
Published: May 2013

N1 non-small-cell lung cancer has heterogeneous prognosis in relation to node descriptors. There is no agreement on the ideal type of resection. A new classification of N1 descriptors was proposed in the 7th edition of the TNM staging system. A retrospective study was conducted on 384 patients with T1-T3N1 non-small-cell lung cancer who underwent complete pulmonary resection. The prognostic role of N1 descriptors according to the current and new staging systems and type of resection was investigated. The 5-year survival rate was 46%. Involvement of hilar node stations, multiple stations, and multiple nodes were poor prognostic factors (5-year survival, 33%, 21%, and 30%, respectively), as well as involvement of the hilar zone and multiple zones (5-year survival, 27% and 23%, respectively). Pneumonectomy showed significantly better survival rates compared to lobectomy or bilobectomy (5-year survival, 60% vs. 29%). Multivariate analysis showed that the number of N1 zones and type of resection were independent prognostic factors. Patients with hilar nodal, multiple-level, or multiple-zone involvement had poor prognosis. Standard lobectomy remains the procedure of choice, but in cases of fixed nodes in the hilar zone, sleeve resection or even pneumonectomy should be considered.
A high-volume heart transplantation center in an Islamic country
Authors: Canver Charles C , Al Buraiki Jehad A , Saad Elias , Yousafzai Sajjad M , Al Ahmadi Mamdouh D , Al Sanei Aly M
Published: May 2013

Cardiac transplants are performed sporadically or not at all in the majority of predominantly Muslim countries in the Middle East. We examined our experience in 76 patients who underwent heart transplantation between January 2005 and May 2010 in our center in Saudi Arabia. Excluded were 50 transplants performed between 1989 and 2004, due to incomplete data. Primary outcomes were complications, 30-day and late mortality rates, and 1-year survival. The heart transplant activity between 2005 and 2010 (15.0 per year) was 4.5-fold higher than that between 1989 and 2004 (3.3 per year). There were 61 (80%) men and 15 (20%) women, with a mean age of 35 years (range, 13–57 years). The mean waiting list time was 64 days (range, 1–262 days), and hospital stay was 30 days (range, 12–166 days). Major complications were infection (10), low-grade rejection (9), reoperation for hemorrhage (8), and sternal dehiscence (2). The 30-day mortality was 7.8% (6/76). Actuarial survival was 87.4% at 1 year and 81.5% at 3 years. A hospital in a Muslim country can increase cardiac transplant activity with excellent 30-day mortality and early survival comparable to that in worldwide counterparts.
Chordal transfer in rheumatic mitral regurgitation: early experience
Authors: Lohchab Shamsher Singh , Laller Kuldeep Singh , Taxak Susheela , Johar Sanjay
Published: May 2013

Chordal transfer and chordal replacement techniques have been quite successful for repair of anterior mitral leaflet prolapse in degenerative disease, but largely unexplored in rheumatic patients. To extend the scope of valve repair, we assessed the chordal transfer technique for correction of anterior mitral leaflet prolapse in 57 patients with rheumatic mitral regurgitation, who were treated between October 2008 and March 2010. There were 36 women and 21 men with a mean age of 25 ± 7.4 years. Normal chordae and a strip of leaflet tissue were transferred from the posterior leaflet to the free edge of the anterior leaflet; the posterior leaflet was repaired in the same manner as after quadrangular resection. Additional procedures were commissurotomy in 19 patients, aortic valve replacement in 1, tricuspid repair in 5, and cryo maze operations in 21. There was no hospital mortality. One (1.7%) patient had acute renal failure but recovered fully. There was moderate regurgitation in one patient who had undergone simultaneous aortic valve replacement. At a mean follow-up of 6.2 ± 2 months, 56/57 (98.2%) patients were asymptomatic with no significant mitral regurgitation.
Percutaneous iatrogenic coronary fistula closure in heart transplant recipient
Authors: Bruschi Giuseppe , Oreglia Jacopo , Colombo Paola , De Marco Federico , Frigerio Maria , Martinelli Luigi , Klugmann Silvio
Published: May 2013

A 61-year-old man with ischemic cardiomyopathy underwent orthotopic heart transplantation. On routine coronary angiography 1 year later, a huge fistula was seen between the left anterior descending coronary artery and the right ventricle. When the patient developed symptoms of ischemia 8 years later, the fistula was successfully closed percutaneously, using a covered stent.
Stentless bioprosthesis for treatment of traumatic aortic valve rupture
Authors: Cuttone Fabio , Saplacan Vladimir G , Buklas Dimitrios , Massetti Massimo
Published: May 2013

Aortic valve rupture after blunt trauma to the chest is an infrequent complication that should be considered at the outset in examination of an accident victim. The presence of aortic regurgitation with hemodynamic instability is an indication for surgery. We implanted a stentless bioprosthesis after aortic valve rupture due to chest trauma in a 31-year-old man with schizophrenia.