bluuebunny/crossref_metadata_2025 huggingface dataset:
Pulmonary Artery Sarcoma Mimicking Massive Pulmonary Embolus: A Case Report
Authors: Alsoufi Bahaaldin , Slater Matthew , Smith Pamela P , Karamlou Tara , Mansoor Atiya , Ravichandran Pasala
Published: May 2013

Intimal sarcomas of the pulmonary artery are rare tumors that are often difficult to distinguish from pulmonary thromboembolic disease, complicating accurate diagnosis and timely therapy. We report the case of a gentleman with a primary pulmonary artery sarcoma who presented with a massive pulmonary embolism and complete right ventricular outflow tract obstruction. The patient's condition was successfully managed with urgent pulmonary artery thromboendarterectomy, pulmonary valve replacement, and tricuspid valve annuloplasty.
Multivalvular Heart Failure Improvement after Successful Kidney Transplantation
Authors: Asgari Majid A , Dadkhah Farid , Tara Ahmad , Noshad Hamid , Akhavizadegan Hamed , Birashk Gity
Published: May 2013

Chronic renal disease is responsible for various cardiac complications. After renal transplantation many of these complications improve. However the extent to which cardiac failure is reversible post transplant is not known. We report two cases of end stage renal disease (ESRD) and severe heart failure characterized by left ventricular ejection fraction (LVEF) less than 20%. Three months after kidney transplantation, the LVEF rose to more than 50%. Successful renal transplantation can significantly improve cardiac function compromised as a result of ESRD.
Mitral Valve Surgery for Dilated Cardiomyopathy with Mitral Regurgitation
Authors: Toyama Masashi , Usui Akihiko , Abe Tomonobu , Oshima Hideki , Akita Toshiaki , Ueda Yuichi
Published: May 2013

Outcomes of surgery for non-ischemic non-valvular dilated cardiomyopathy with associated mitral regurgitation were assessed in 8 consecutive patients who underwent 9 mitral valve operations between 2001 and 2004. Mitral valve replacement was performed when the coaptation depth exceeded 10 mm. Two patients initially underwent mitral valvuloplasty, and 6 underwent valve replacement. One patient had valve replacement soon after valvuloplasty. Transthoracic echocardiography was performed immediately before surgery, before discharge, and during follow-up. Transesophageal echocardiography was carried out intraoperatively to assess valvular and ventricular function. Postoperative mean functional class was significantly better than the preoperative value (2.4 ± 0.7 vs. 3.3 ± 0.7), and the improvement was sustained during follow-up (2.0 ± 0.7). The ejection fraction and left ventricular end-diastolic dimension did not improve. One patient died without leaving hospital and two died during follow-up. The 2- and 4-year survival rates were 75.0% and 37.5%. Mitral valve surgery improved functional class without obvious changes in ejection fraction or left ventricular end-diastolic dimension.
Analysis of Surgical Treatment for Pulmonary Aspergilloma
Authors: Demir Adalet , Gunluoglu Mehmet Z , Turna Akif , Kara Hasan V , Dincer Seyyit I
Published: May 2013

Surgery for pulmonary aspergilloma is reputed to be risky. The results of surgical treatment of pulmonary aspergilloma in 41 patients between 1988 and 2003 were evaluated retrospectively. Hemoptysis occurred in 31 patients (75.6%) and it was massive (> 300 mL in 24 hr) in 3. The underlying lung disease was tuberculosis in 35, bullous lung disease in 2, hydatid cyst in 2, and lung carcinoma in 2 patients. Lobectomy, bilobectomy, wedge resection, and pneumonectomy were performed in 27, 4, 6, and 4 patients respectively. The postoperative complication rate was 24.4%. One patient, who had a right pneumonectomy, died due to respiratory failure; the mortality rate was 2.4%. Recurrent hemoptysis was observed in only one patient. Early surgical treatment of patients with pulmonary aspergilloma resulted in a satisfactory outcome with acceptable morbidity, low mortality, and effective prevention of recurrent hemoptysis. Pneumonectomy has a high morbidity, thus it should be avoided if possible.
Multinodular Goiter Compressing the Trachea following Open Heart Surgery
Authors: Sajja Lokeswara R , Mannam Gopi C , Sompalli Sriramulu , Simhadri Chandra SR , Hasan Ashfaq
Published: May 2013

Acute hemorrhage into an adenomatous goiter following cardiac surgery is a rare cause of acute upper airway obstruction. We report an unusual presentation of respiratory distress in a patient with goiter recovering from open heart surgery, which was successfully treated by left hemithyroidectomy. A mandatory evaluation of the upper trachea in patients with long-standing benign goiter is recommended prior to cardiac surgery.
Thoracoscopic Findings of a Small Posterior Mediastinal Parathyroid Adenoma
Authors: Taguchi Masanobu , Endo Shunsuke , Hasegawa Tsuyoshi , Sato Yukio , Sohara Yasunori
Published: May 2013

We report herein the rare case of a posterior mediastinal parathyroid adenoma 8 mm in diameter, that was identified by both 99m-technetium-methoxyisobutylisonitrile scintigraphy (Tc-MIBI) and high-resolution chest computed tomography (HRCT). Thoracoscopy clearly showed a mediastinal parathyroid adenoma which was successfully removed.
Successful in Situ Treatment of Infected Aortic Arch Prosthesis by Omental Wrapping
Authors: Nishimura Yoshiharu , Okamura Yoshitaka , Hiramatsu Takeshi , Mori Hideaki , Hayashi Hiroki , Komori Shigeru
Published: May 2013

A 67-year-old man who underwent total aortic arch graft replacement with coronary artery bypass grafting developed postoperative Serratia mediastinitis. Re-operative debridement and irrigation were carried out. An infected aortic arch prosthesis was successfully treated by in situ disinfection followed by complete omental wrapping.
A Case of 24 Years Longevity of an Ionescu-Shiley Bioprosthesis in the Mitral Position
Authors: Watanabe Yutaka , Ohkawa Shuuichi , Yamabuki Keisuke , Tsuneoka Hidekazu , Sugiyama Noboru , Hiyama Teruo
Published: May 2013

Valve dysfunction, attributed to primary tissue failure several years after implantation of Ionescu-Shiley bioprostheses, has led to re-operation in most cases. We report a rare case of this bioprosthesis showing stenosis and regurgitation after implantation in the mitral position 24 years previously. No cusp tears, but severe calcification and well-grown neointima over the Dacron cloth of the inner surface were observed. This may explain how the valve functioned for such a long period of time. We replaced it with a Carpentier-Edwards pericardial bioprosthesis.
Long-Term Outcome of Intracardiac Repair under Simple Deep Hypothermia
Authors: Sakamoto Takahiko , Asou Toshihide , Takeda Yuko , Date Kouichiro , Nanaumi Miwa
Published: May 2013

Development of cardiopulmonary bypass has contributed to pediatric cardiac surgery, but at the dawn of cardiac surgery, simple deep hypothermia was used to avoid the deleterious effect of cardiopulmonary bypass. Between 1981 and 1990, 45 patients with simple cardiac anomalies underwent definitive surgery under deep hypothermia. Age at operation was 35 days to 20 months, and body weight was 2.3 to 8.0 kg. Under morphine and ether anesthesia, a median sternotomy was performed when the esophageal temperature reached 26.3°C ± 1.3°C by the application of surface cooling. At a minimum esophageal temperature of 19.6°C ± 2.3°C, inflow occlusion and cold cardioplegia were applied to induce circulatory arrest for 32.4 ± 10.2 min. Direct cardiac massage was used to restore cardiac activity during rewarming. All but one patient was in New York Heart Association functional class I postoperatively. The latest cardiothoracic ratio was 49.8% ± 4.7%. All but 2 patients are free from medication. Five of 30 patients showed developmental delay in the long-term; 2 of these had a long circulatory arrest period, and 3 had prolonged heart failure postoperatively. The other 25 patients had excellent physiologic and mental development. The long-term outcome of perfusionless hypothermic cardiac surgery is satisfactory when applied appropriately.
Mortality and Morbidity after Aortic Root Replacement: 10-Year Experience
Authors: Ghavidel Alireza A , Tabatabaei Mohammad B , Yousefnia Mohammad A , Omrani Gholam-Reza , Givtaj Nader , Raesi Kamal
Published: May 2013

Aortic root reconstruction remains a challenging surgical procedure. This retrospective study was carried out to evaluate the early and long-term outcomes of aortic root replacement over a 10-year period. There were 83 patients with a mean age of 43.2 ± 14 years (range, 10 to 78 years). Type A aortic dissection and Marfan syndrome were found in 28% and 24%, respectively. The most common technique used for repair of this condition was the Bentall operation. The mean duration of follow-up was 29.6 ± 28 months, ranging from 1 to 120 months. Hospital (30-day) mortality was 13.3% (11 patients). Two patients died during the late follow-up. The mortality was significantly higher in patients presenting with cardiogenic shock, those with long cardiopulmonary bypass and crossclamp times, and the group who had concomitant coronary artery bypass grafting. Emergency operation was not a significant risk factor for early death in our patients. The most common complications were bleeding and neurological sequelae. Aortic root replacement can be achieved with acceptable mortality and morbidity in a high-risk group of patients. Improvements in the outcome may be achieved by faster transport of patients in cardiogenic shock, and by reducing the cardiopulmonary bypass and crossclamp times.
Modification of Thoracoscopic Surgery for Spontaneous Pneumothorax
Authors: Cho Kyu-Do , Park Chan-Beom , Cho Min-Seob , Jin Ung , Cho Deog-Gon , Kim Chi-Kyeong
Published: May 2013

Morbidity, use of analgesics, postoperative drainage, and hospital stay are reduced after video-assisted thoracoscopic surgery for pneumothorax. However, some surgeons prefer a minithoracotomy because the rate of recurrence after thoracoscopic surgery is 5%–10%. A modified thoracoscopic bullectomy is described, which has the advantages of both conventional video-assisted thoracoscopic surgery and a minithoracotomy. Of 69 patients who underwent surgery for pneumothorax from January 2002 to February 2003, 13 were treated by conventional video-assisted thoracoscopic surgery and 21 by the modified thoracoscopic bullectomy. The mean ages were 20.6 years in the conventional group and 23.0 years in the modified group, with follow-up of 25.8 ± 1.8 months in the conventional group and 20.6 ± 1.3 months in the modified group. The duration of operation was similar in both groups (49.3 ± 16.0 vs. 44.2 ± 19.2 min). Significantly fewer staples were used in the modified group (1.62 ± 0.74 vs. 2.92 ± 1.19). The duration of chest tube drainage and postoperative hospital stay were significantly reduced in the modified group. The modified thoracoscopic bullectomy is an effective procedure for the treatment of primary spontaneous pneumothorax.
Coronary Artery Bypass Surgery in the Elderly: Experience of Tertiary Care Hospital
Authors: Siddiqui Fahad J , Sami Shahid A , Sarwar Ghulam , Shahabuddin Syed , Ahmed Bilal
Published: May 2013

In the subcontinent, improving life expectancy may increase the number of elderly patients requiring coronary artery bypass. The elderly have a higher risk of mortality, and cost vs benefit is presumed to be unrewarding, leading to a disinclination to operate on such patients. We reviewed the records of patients ≥ 70 years old undergoing coronary revascularization in a 10-year period. Between 1995 and 2004, 3,312 coronary bypass operations were performed, including 242 (7.3%) in patients ≥ 70 years. Of these, 207 (86%) were male, 73 (30%) had non-elective surgery, and 177 (73%) had a high-risk EuroSCORE. Early postoperative mortality was 8.7% (21/242), and 33 (13.6%) patients experienced morbidity. One-year follow-up of 106 (44%) patients was possible. There were 4 (1.7%) late deaths from noncardiac causes. Death, morbidity, and postoperative functional class were significantly associated with preoperative functional class. Meticulous selection of elderly patients for coronary artery bypass may help maximize the benefits of this surgery.
Postcardiotomy Extracorporeal Life Support
Authors: Kazaz Hakki , Hazan Eyup , Oto Öztekin , Sariosmanoğlu Nejat , Dereli Nuran A
Published: May 2013

The need for postcardiotomy mechanical support is uncommon and likely to decline. A mixture of options is necessary to meet the diverse indications for cardiac support in a comprehensive heart failure program. Between January 1997 and December 2000, 29 adult, neonate, and infant cardiac surgical patients were supported on an extracorporeal life support system. Indications for cardiac assist included post-cardiotomy low cardiac output syndrome, and hyperacute rejection after cardiac transplantation. Data for analysis were collected prospectively. Survival on the life support system was 20/29 (69%) and 12 patients (41%) survived to discharge. The mean time to starting extracorporeal life support was longer in survivors than non-survivors. The extracorporeal life support system provides effective cardiopulmonary and end-organ support.
Surgical Outcome of Heterotaxy Syndrome in a Single Institution
Authors: Takeuchi Koh , Murakami Arata , Hirata Yasutaka , Kitahori Kazuo , Doi Yoshiroh , Takamoto Shunichi
Published: May 2013

Heterotaxy syndrome encompasses a wide range of anatomical variants including poor pulmonary vascular development. Surgical outcome remains poor in this difficult subgroup. Between April 1996 and November 2004, 27 patients with visceral heterotaxy were enrolled in this study. The median age at presentation was 25 days. There were 11 patients with asplenia and 16 with polysplenia. There were 5 deaths (4 in patients with asplenia, 1 in a patient with polysplenia). All patients with asplenia were scheduled for single-ventricle repair, and 5 completed a modified Fontan procedure. Of the 16 patients with polysplenia, 8 completed 2-ventricle repair and 6 had a modified Fontan. In polysplenia, actuarial survival was 93.8% at 4 months, and remained constant thereafter. In asplenia, survival was 81.8% at 1 month, and 53.0% at 1 year. A significant correlation was found between nonconfluent pulmonary arteries and mortality. The medium-term result in polysplenia was satisfactory, but not in asplenia. Nonconfluent pulmonary arteries carry a high risk of mortality, and a strategy to create pulmonary vascular confluence and satisfactory pulmonary blood flow is mandatory.
Cardiac Transplantation and Aortic Coarctation Repair in Severe Heart Failure
Authors: Raffel O Christopher , Abraham Arun , Ruygrok Peter N , Finucane A Kirsten , McGeorge Alastair D , French Renelle L
Published: May 2013

A 37-year-old man presented with severe dilated cardiomyopathy secondary to occult aortic coarctation. He was successfully managed with combined orthotopic heart transplantation and aortic coarctation repair.
Effective Bleeding Control during Resection of Giant Carotid Body Tumor
Authors: Korkut A Kubilay , Lice Hasan , Aygutalp Nadir
Published: May 2013

Carotid body tumor is a rare neoplasm located at the carotid bifurcation. Ligation and excision of the external carotid artery together with the tumor is preferred in patients with transmural tumor invasion. In those without transmural tumor invasion, temporary occlusion of the external carotid artery at the bifurcation allows trouble-free tumor excision and keeps the external carotid artery intact.
Is Chlamydia Pneumoniae a Risk Factor for Peripheral Atherosclerosis?
Authors: Üstünsoy Haşim , Sivrikoz Cumhur , Sirmatel Fatma , Bakir Kemal , Burma Oktay , Kazaz Hakki
Published: May 2013

Seroepidemiological studies have shown a relationship between Chlamydia pneumoniae and coronary atherosclerosis. It is not clear whether Chlamydia pneumoniae is also a risk factor for peripheral atherosclerosis. Chlamydia pneumoniae antibodies were measured by a microimmunofluorescence method in 75 patients who underwent surgery for peripheral atherosclerosis, and the seroprevalence was compared with that in the normal population. Chlamydia pneumoniae immunoglobulin-G seroprevalence was 80% in the study group vs. 40% in controls. More foam cells were noted on light microscopy in atherosclerotic plaques from the infected patients. The 60 infected patients were divided into: group A ( n = 35) given both anti-chlamydial and antiplatelet agents for 1 year; and group B ( n = 25) given antiplatelet therapy only. The groups were compared on the basis of clinical findings, ankle-brachial index, and antibody titers. Decreasing Chlamydia pneumoniae immunoglobulin-G seroprevalence in group A correlated significantly with increasing ankle-brachial index and improvement in clinical findings. It was concluded that Chlamydia pneumoniae may be a risk factor for peripheral atherosclerosis.
Risk Evaluation and Midterm Outcome of Cardiac Surgery in Patients on Dialysis
Authors: Boku Noriko , Masuda Munetaka , Eto Masataka , Nishida Takahiro , Morita Shigeki , Tominaga Ryuji
Published: May 2013

The medical charts of 54 patients on maintenance dialysis who underwent cardiovascular surgery (37 elective and 17 urgent/emergency) from 1994 to 2004 were retrospectively analyzed. Thirty patients had coronary artery bypass grafting (17 elective and 13 urgent/emergency), 18 had valve replacement (16 elective and 2 urgent/emergency), and 6 underwent aortic surgery (4 elective and 2 urgent/emergency). The overall early mortality rate was 11.1%, comprising 2 patients (5.4%) who had elective operations and 4 (23.5%) who had urgent or emergency operations ( p = 0.049). The overall 5-year survival rate was 48.4%. The 5-year survival rate was 67.2% for elective surgery and 10.5% for urgent/emergency surgery ( p = 0.0001). The midterm clinical results after elective cardiovascular surgery were acceptable, whereas the results after urgent/emergency surgery were poor. For elective surgery, sufficient and detailed preoperative examinations might have contributed to the better operative outcome. Early diagnosis and consultation to avoid urgent/emergency operations in dialysis patients is recommended.
Bronchopleural Fistula after Lobectomy for Lung Cancer
Authors: Nagahiro Itaru , Aoe Motoi , Sano Yoshifumi , Date Hiroshi , Andou Akio , Shimizu Nobuyoshi
Published: May 2013

Bronchopleural fistula after lung resection is a fatal complication. The aim of this study was to determine the risk factors for bronchopleural fistula after lobectomy for lung cancer. Clinical records of 767 patients who underwent lobectomy or bilobectomy for lung cancer in our institution were reviewed. Twelve patients (1.6%) suffered a bronchopleural fistula, of whom 5 died because of this complication (mortality rate, 41.7%). Multivariate analysis revealed squamous cell carcinoma, preoperative chemotherapy, lower lobectomy, and middle and lower lobectomy were risk factors for bronchopleural fistula. In such cases, particular care must be exercised to maintain blood flow through the bronchial stump during surgery, and reinforcement, such as stump coverage, must be employed.
Sternal Bands for Closure of Midline Sternotomy Leads to Better Wound Healing
Authors: Bhattacharya Susmit , Sau Indrajit , Mohan Man , Hazari Kunal , Basu Rajarshi , Kaul Ajay
Published: May 2013

Midline sternotomy is the most common incision for cardiac surgery, but problems of wound healing and sternal instability are still matters of concern. The use of stainless steel wires only was compared with the use of wires plus sternal bands for closure of midline sternotomy wounds in a 2-year period. Of 370 patients in whom only stainless steel wires were used, 14 (3.78%) required re-operation for dehiscence. Only 3 (0.76%) of 395 patients in whom sternal bands were also used, required re-operation for dehiscence. The difference was highly significant. It was concluded that use of sternal bands leads to a more stable union.
Malplacement of a Pacemaker Lead — A Rare Cause for Aortic Valve Endocarditis
Authors: Matschke K , Tugtekin SM , Alexiou K , Knaut M , Park JW , Schulze M
Published: May 2013

Infective endocarditis of native valves following pacemaker implantation is rare but can be associated with serious complications, approaching a mortality of up to 25%. 1 Recent publications report a frequency of pacemaker related endocarditis between 0.5 and 7%. 2 Due to anatomical reasons the tricuspid valve is mostly affected in these patients, with involvement of the left heart valves usually secondary. We report an incidence of native aortic valve endocarditis due to a misplaced pacemaker lead into the left heart.
The Sock Method for a Distal Ascending Aneurysm
Authors: Matsuyama Katsuhiko , Yoshikawa Masaharu , Narita Yuji , Ueda Yuich
Published: May 2013

Although conservative operations such as reduction aortoplasty or wrapping for an ascending aortic aneurysm remain controversial procedures, the wrapping method has recently shown good long-term results. We report the sock method as an alternative wrapping procedure for an ascending aneurysm extending to the base of the innominate artery. This simple method can easily be performed in selected patients.
Primary Repair of d-Transposition with Complete Atrioventricular Canal Defect
Authors: Bisoi Akshaykumar , Abraham Smartin , Sai Krishna C , Chauhan Sandeep , Kothari Shyamsunder , Venugopal Panangipalli
Published: May 2013

A 4-month-old boy underwent successful single-stage anatomic repair of d-transposition of the great arteries with complete balanced atrioventricular canal defect, using the arterial switch procedure and two-patch repair of the atrioventricular canal defect. He had associated persistent left superior vena cava draining to the coronary sinus, and a patent ductus arteriosus.
Severe Sleep Apnea Syndrome Diagnosed with Acute Myocardial Infarction
Authors: Dursunoglu Nese , Dursunoglu Dursun , Özkurt Sibel , Tanriverdi Halil , Evrengül Harun , Kiter Göksel
Published: May 2013

A 55-year-old man with acute myocardial infarction and no heart failure, had episodes of severe oxygen desaturation and apnea, while his hemodynamic parameters were stable. Sleep recordings revealed severe sleep apnea, and pulmonary function tests showed bronchial obstruction. Apnea and desaturation resolved on bilevel positive airway pressure. Patients with acute myocardial infarction who have apnea and hypoxemia without evident heart failure should be evaluated for sleep disorders.
Primary Malignant Fibrous Histiocytoma of the Heart
Authors: Skarysz Janusz , Gołka Dariusz , Krejca Michał , Bochenek Andrzej
Published: May 2013

A 72-year-old male diagnosed with heart failure and dyspnea was found to have a lesion in his right atrium. Histological examination of the tumor revealed it to be a malignant fibrous histiocytoma. The patient's management and subsequent follow-up are presented.
Non-Clostridial Gas Gangrene of the Neck and Mediastinum
Authors: Fatimi Saulat , Sheikh Sadaf , Shafiq Majid , Shah Zaman
Published: May 2013

Herein we report a case of gas gangrene of the neck and mediastinum in a poorly managed Type II diabetic with concomitant chronic renal failure and a recent history of mucormycosis. Despite the burden of co-morbidities and the gravity of the illness, the patient was successfully treated and remained free of complications in the long term.
Shelhigh No-React Pulmonic Valve Conduit for Pulmonary Valve Endocarditis
Authors: Roberts Neil , Matuszewski Maciej J , Morgan-Hughes Nick J , Wilkinson Glen AL
Published: May 2013

Pulmonary valve endocarditis is uncommon, so experience of surgical treatment is limited. A case of pulmonary valve endocarditis in a 26-year-old man, with associated extension into the pulmonary valve annulus and vegetations in the main pulmonary artery, is described. This necessitated surgical excision of the main pulmonary artery and pulmonary valve including the root, annulus, and part of the right ventricular outflow tract. The defect was reconstructed with a Shelhigh No-React porcine pulmonic valve conduit.
Active Pulmonary Tuberculosis: Experience with Resection in 106 Cases
Authors: Naidoo Rishendran
Published: May 2013

The surgical management of pulmonary tuberculosis has evolved since collapse therapy was the mainstay of treatment. Despite this, resection for active tuberculosis is viewed with circumspection. Details of 106 patients with pathologically proven active pulmonary tuberculosis, who were operated on from January 1997 to January 2005, were reviewed retrospectively. Demographic data, radiographic profiles, indications for surgery, sputum status, and preoperative drug therapy were analyzed in relation to outcomes. The indications for surgery included multidrug-resistant tuberculosis in 27 patients, hemoptysis in 44, bronchiectasis in 27, and diagnostic dilemmas where a tumor could not be excluded in 8. All patients were operated on while receiving antituberculous therapy, and 17 were sputum positive at the time of surgery. Two (1.9%) patients died postoperatively. Morbidity was 16.9%, including 6 cases of postpneumonectomy empyema and one of bronchopleural fistula. Surgery for active tuberculosis may be undertaken with acceptable morbidity and mortality.
Surgical Embolectomy in Acute Massive Pulmonary Embolism
Authors: Amirghofran Ahmad A , Emami Nia Abbas , Javan Ramin
Published: May 2013

Acute pulmonary embolism is a serious condition and despite diagnostic and therapeutic advances, mortality is still high. Anticoagulation, thrombolytic therapy, catheter embolectomy, and open pulmonary embolectomy are therapeutic options. Surgical embolectomy was considered the management of last resort, but recent studies show the effectiveness of this therapeutic modality. We reviewed our 7-year experience of pulmonary embolectomy in patients with acute massive pulmonary embolism from 1997 to 2004. Eleven patients underwent open embolectomy, 7 (64%) were male, and the mean age was 45.6 years. Pulmonary embolism occurred after major surgery in 5 patients (46%), 2 were diagnosed with malignancy and spinal cord injury, and no risk factors were detected in 4. The diagnosis was made by spiral computed tomography alone in 4 patients, and by angiography in 7. Cardiac arrest occurred in 3 patients preoperatively; 2 of them survived. Open pulmonary embolectomy is the most effective treatment for acute massive pulmonary embolism. Cardiac arrest is the worst prognostic factor. Less aggressive clot evacuation in patients who are diagnosed late appears to be effective in minimizing postoperative hemoptysis.
Wandering Bullet Embolizing to the Pulmonary Artery: A Case Report
Authors: Agarwal Surendra K , Singh Amrendra , Kathuria Manoj , Ghosh Probal K
Published: May 2013

Whilst a missile embolizing to the right side of the heart is a common occurrence, embolization to the pulmonary arteries is rare. We report a case of a bullet entering through the right internal jugular vein to the right ventricle, and then migrating to the left pulmonary artery, and its management. To our knowledge, this is the first reported such case from the Indian subcontinent.
Simple and Secure Aortotomy Closure
Authors: Bhaskar Jayapadman , Sharma Ashok K
Published: May 2013

We describe a technique for closure of the transverse aortotomy incision after standard aortic valve replacement. This has proved to be an excellent technique that is expeditious and ensures a good seal of the aortotomy edges. It is easily reproducible, with consistently good results.
Pharmacological Neuroprotection During Cardiac Surgery
Authors: Kadoi Yuji
Published: May 2013

Despite more than 30 years of aggressive neuroprotective research by many investigators, neuropsychological deficit after cardiac surgery remains an important cause of postoperative morbidity. Although the neurological outcome is a result of a multifactorial etiology, many physicians world-wide have recognized the importance of this problem, and extensive efforts have been made in attempting to minimize the incidence of neurological and neurocognitive dysfunction. Pharmacological intervention is one of the important potential methods of neuroprotection during cardiac surgery. In vitro studies have identified drugs that are effective protectants against focal cerebral ischemia, hemorrhage, and global ischemia. However, at present there is no solid agreement on the need for prophylactic neuroprotectants in cardiac surgery. Researchers and clinicians must become more cognizant of the pitfalls and paradoxes that have arisen in attempting to translate the results of animal studies into clinical trial, with regard to neuroprotective therapy during cardiac surgery. There is an extensive need for new pharmacological approaches directed at reducing neurologic and neurocognitive injury during cardiac surgery. This article reviews past and present neuroprotective efforts and interventions during cardiac surgery.
Proteomics of Ascending Aortic Aneurysm with Bicuspid or Tricuspid Aortic Valve
Authors: Matt Peter , von Orelli Anne , Bernet Franziska , Grussenmeyer Thomas , Lefkovits Ivan , Zerkowski Hans-Reinhard
Published: May 2013

Bicuspid aortic valve is often associated with lesions of the ascending aorta, which differ histologically from those in tricuspid valve patients. We undertook proteomic analyses to assess differences at the proteome level. Aortic samples were collected from 20 patients undergoing aortic valve and/or ascending aortic replacement; 9 had a bicuspid valve: 5 with aortic aneurysm (diameter > 50 mm) and 4 without dilation; 11 had a tricuspid valve: 6 with aortic aneurysm and 5 without dilation. Patients with histologically proven connective tissue disorders were excluded. Samples were dissected, solubilized, and subjected to 2-dimensional gel electrophoresis. Gel patterns showed an average of 580 protein spots in samples from bicuspid valve patients, and 564 spots in those with tricuspid valves. Comparative analysis revealed a correlation coefficient of 0.93 for protein expression in the bicuspid valve group compared to the tricuspid group. Three protein spots were significantly over-expressed and 4 were significantly down-regulated in the bicuspid group compared to the tricuspid group. The lowest correlation in protein expression was between non-dilated aortic tissues. These differences between aortic tissues of bicuspid and tricuspid valve patients suggest that mechanisms of aortic dilation might differ, at least in part, between such patients.
Peratrial Closure of Atrial Septal Defects without Cardiopulmonary Bypass
Authors: Zeng Xiang-Jun , Chen Xu-Fa , Cheng Duan , Ma Xiao-Jing , Hu Xue-Song , Tao Liang
Published: May 2013

The objective of this study was to introduce a new technique for occlusion of an atrial septal defect without cardiopulmonary bypass, using a modified Amplatzer device. Between October 2004 and November 2005, 96 secundum atrial septal defects in 83 patients were occluded by this method. A 3-cm incision in the right 4th intercostal space and a minithoracotomy were performed. Via this incision, the right atrium was exposed and the septal closure device was deployed under transesophageal echocardiographic guidance. The sizes of the defects ranged from 10 to 39 mm. The mean device size was 34.1 ± 9 mm (12–46 mm). There was no operative mortality and no major morbidity on follow-up of 3–15 months. This new minimally invasive method of secundum atrial septal defect closure is safe and cosmetically superior to conventional surgery. Avoidance of cardiopulmonary bypass can reduce recovery time and complications. The indications are more extensive than percutaneous transcatheter closure, and the results are encouraging.
Nicorandil Attenuates Reperfusion Injury after Long Cardioplegic Arrest
Authors: Takarabe Kyoumi , Okazaki Yukio , Higuchi Shinya , Murayama Junichi , Natsuaki Masafumi , Itoh Tsuyoshi
Published: May 2013

The cardioprotective efficacy of nicorandil in cardiac surgery was determined using a surgically relevant 4-hr cardioplegic arrest model. Each isolated rabbit heart was parabiotically blood-perfused using a modified Langendorff column. The magnitude of left ventricular developed pressure and rate of change of developed pressure over time were measured before (baseline) and after ischemia. Nicorandil was administered either pre-ischemia, post-ischemia, pre/post-ischemia, or continuously (before, during, and after ischemia). The endothelium of the coronary artery was observed by scanning electron microscopy. Serum myeloperoxidase activities were also measured. Although pretreatment with nicorandil did not affect recovery of developed pressure, administration of nicorandil after ischemia, or before and after ischemia, enhanced the recovery of developed pressure. Serum myeloperoxidase activity was decreased in the pre/post-ischemia and continuous groups. Endothelial reperfusion injury decreased in all nicorandil-treated groups. Administration of nicorandil attenuated ischemia-reperfusion injury of the myocardium and coronary endothelium while ameliorating leukocyte activation. In the event of unexpected prolonged cardioplegic arrest, administration of nicorandil, even just after declamping, may improve cardiac function. However, pre-ischemia administration alone was not helpful in the heart subjected to prolonged cardioplegic arrest.
Pharmacological Prevention of the Deleterious Effects of Cardiopulmonary Bypass
Authors: Hassantash Seyed A , Omrani Gholam R , Givtaj Nozar , Afrakhteh Maryam
Published: May 2013

Indomethacin is a known immune modulator that inhibits cyclooxygenase. Studies indicate that ketoconazole, a selective lipoxygenase and thromboxane A2 synthetase inhibitor, can prevent activation of the inflammatory cascade by inhibition of proinflammatory mediators. This study was designed to determine if ketoconazole or indomethacin could reduce the adverse effects of extracorporeal circulation. As a double-blind prospective study, 76 patients were randomized into 3 groups according to preoperative medication: indomethacin, ketoconazole, and placebo groups, with 25, 26, and 25 patients, respectively. Four types of parameters were evaluated preoperatively and up to 24 hr after cardiac surgery in all patients: inflammatory (complement C3 and C4, C-reactive protein, immunoglobulins); hematologic; coagulation; and physiologic (blood loss, fluid and blood components received, weight gain, and duration of ventilation). Statistical analyses showed similar patient profiles in each group. Complement C4 decreased in all groups postoperatively, but significantly less in the indomethacin group ( p < 0.01). Ketoconazole reduced postoperative bleeding ( p < 0.0001) as well as the incidence of re-operation for bleeding ( p = 0.05). It was concluded that indomethacin decreases complement (specifically C4) consumption during cardiopulmonary bypass, and ketoconazole may reduce postoperative bleeding by limiting coagulation abnormalities in cardiac surgery patients.
Thromboendarterectomy for Severe Chronic Thromboembolic Pulmonary Hypertension
Authors: Ishida Keiichi , Masuda Masahisa
Published: May 2013

Pulmonary thromboendarterectomy is a curative surgical procedure for chronic thromboembolic pulmonary hypertension. The aim of this study was to clarify whether severe hemodynamic compromise affects surgical outcome. We studied 19 patients who underwent pulmonary thromboendarterectomy and compared 11 with pulmonary vascular resistance < 1,000 dyne·s·cm−5 (group 1) and 8 with pulmonary vascular resistance > 1,000 dyne·s·cm−5 (group 2). Mean pulmonary artery pressure and pulmonary vascular resistance decreased significantly after surgery in both groups. The incidence of postoperative complications did not differ between groups; however, one patient in group 2 died of multiorgan failure. The overall mortality rate was 5.3%, and the rate in group 2 was 13%. Our results indicate that preoperative hemodynamic compromise does not affect surgical outcome. Patients with high pulmonary vascular resistance can be treated effectively by thromboendarterectomy, with acceptable morbidity and mortality.
Endothoracic Papaverine Application for Internal Thoracic Artery Harvest
Authors: Bahcivan Muzaffer , Kolbakir Fersat , Karamustafa Hakan , Keceligil H Tahsin
Published: May 2013

This study compared the effects of different methods of papaverine application on free blood flow and harvesting time of the internal thoracic artery for coronary bypass grafting. Patients were randomly divided into 3 groups of 25 each: group 1 had papaverine injected into the endothoracic tissue around the internal thoracic artery before dissection, group 2 had papaverine injected into the periarterial tissues of the internal thoracic artery pedicle, and group 3 had intraluminal papaverine applied retrogradely into the internal thoracic artery. Mean blood flow was 56.3 ± 21.3, 21.1 ± 13.2, and 20.9 ± 9.1 mL · min−1 in groups 1, 2, and 3, respectively, immediately after harvesting. Flow in group 1 was significantly better than that in groups 2 and 3. Immediately before anastomosis, mean flow was 89.8 ± 19.1, 97.6 ± 35.4, and 95.9 ± 19.9 mL · min−1 in groups 1, 2, and 3, respectively, with no significant difference among groups. Internal thoracic artery harvesting times were shorter in group 1 than in groups 2 and 3. Administering papaverine into the endothoracic fascia of the internal thoracic artery bed prior to dissection is a reliable method that facilitates rapid harvesting of the graft without causing trauma and consequent spasm.
Repair of Anomalous Origin of Left Coronary Artery from the Pulmonary Artery
Authors: Guo Hong-Wei , Xu Jiang-Ping , Song Yun-Hu , Shen Xiang-Dong , Li Shou-Jun , Hu Sheng-Shou
Published: May 2013

Patients with anomalous origin of the left coronary artery from the pulmonary artery often have mitral valve regurgitation. Although establishing dual coronary circulation is the procedure of choice, there remains controversy as to how the mitral valve is handled. Between April 1999 and August 2005, 8 patients underwent surgical correction at our institution. There were 4 males and 4 females, aged from 9 months to 13 years (mean, 6.4 years). Six patients underwent direct aortic reimplantation and 2 had a Takeuchi procedure. Simultaneous mitral annuloplasty was performed in 7 patients with moderate or severe mitral regurgitation. There were no deaths or postoperative complications. Follow-up ranged from 4 to 80 months (mean, 34 ± 26 months). Left ventricular function improved significantly from a preoperative fractional shortening of 0.21 ± 0.09 to 0.35 ± 0.06. Mitral regurgitation decreased on follow-up in the 7 patients who had mitral annuloplasty. We recommend performing mitral annuloplasty at the time of operation in patients with moderate or severe mitral regurgitation and anomalous origin of the left coronary artery from the pulmonary artery.
Successful Mechanical Circulatory Support as a Bridge to Transplantation
Authors: Lee Sak , Park Young-Hwan , Lim Sang-Hyun , Kwak Young-Tae , Kim Hoon , Chang Byung-Chul
Published: May 2013

With the progression of congestive heart failure, therapeutic options become fewer, and cardiac transplantation is the final option. The use of a left ventricular assist device improves the survival rate and quality of life in patients on the waiting list for transplantation. A 64-year-old man was successfully maintained on mechanical circulatory support with a left ventricular assist device for 502 days, as a bridge to transplantation.
Coincidence of Spinal Canal Stenosis and Thoracoabdominal Aortic Aneurysm
Authors: James Justin , Kuduvalli Manoj , Lu John Y , Rashid Abbas
Published: May 2013

We report a case in which a thoracoabdominal aneurysm was present in association with previously unknown critical spinal canal stenosis. In spite of using left heart bypass, systemic hypothermia, and controlled cerebrospinal fluid drainage for spinal cord protection, the patient developed paraplegia following aortic aneurysm repair. Computed tomography scan revealed critical stenosis of the spinal canal that was thought to be sufficient to produce spinal cord compression syndromes including paraplegia.
Myocardial Revascularization: Surgery or Stenting?
Authors: Wong Sunny H , Wan Song , Underwood Malcolm J
Published: May 2013

There is current debate regarding the relative merits and roles of surgical revascularization and percutaneous revascularization for patients with obstructive coronary artery disease. This article reviews the current literature relating to this subject.
Differential Ventilation with Spontaneous Respiration for Bilateral Emphysema
Authors: Chakravarthy Murali , Jawali Vivek
Published: May 2013

In patients with bilateral bullous disease and empyema in one lung, controlled ventilation may be hazardous and result in severe hypoxia. A 50-year-old man with bullous disease and thoracic empyema on the left side was operated on under general anesthesia with spontaneous respiration using differential lung ventilation.
Strategy for Isolated Iliac Artery Aneurysms
Authors: Hiromatsu Shinichi , Hosokawa Yukio , Egawa Noriko , Yokokura Hiroko , Akaiwa Keiichi , Aoyagi Shigeaki
Published: May 2013

We retrospectively reviewed 41 patients with isolated iliac artery aneurysms presenting over a 21-year period. The mean age was 72 years. Mean aneurysmal diameter was 6.0 cm (range, 3.2–13 cm). The aneurysms were located in the common iliac artery in 31 patients, internal iliac artery in 7, and both arteries in 3. Rupture occurred in 20 patients (49%). The frequency of rupture of isolated iliac artery aneurysms was significantly higher than that of abdominal aortic aneurysms (8%) during the same period. The 30-day mortality was 9.8%; death in all 4 patients was due to rupture of the aneurysm. The surgical procedure was aneurysmectomy and replacement with a bifurcated prosthetic graft in 24 patients (59%), closure of the common iliac artery with a femorofemoral crossover in 7, minilaparotomy in 3, thromboexclusion in 6, and endoluminal stent-graft repair in one. In contrast to abdominal aortic aneurysms, isolated iliac artery aneurysms can be treated by various methods other than replacement with a bifurcated prosthetic graft. When selecting a strategy for such aneurysms, it is important to choose an approach appropriate to the location and risk, because of the frequency of rupture.
Surgical Results in Bronchiectasis: Analysis of 149 Patients
Authors: Stephen Thomas , Thankachen Roy , Madhu Andrew P , Neelakantan Nithya , Shukla Vinayak , Korula Roy J
Published: May 2013

Bronchiectasis remains a serious problem in developing countries. We reviewed the morbidity, mortality, and functional outcome of surgical treatment for bronchiectasis in our institution. Between 1992 and 2003, 149 patients (105 males, 44 females) underwent pulmonary resection for bronchiectasis. Their mean age was 33.7 years (range, 5–66 years). The indications for surgery were failure of conservative treatment in 59 (40%) patients, recurrent hemoptysis in 53 (36%), bronchial obstruction by a tumor in 9 (6%), and destroyed lung in 28 (19%). Bilateral disease was seen in 24 (16%) patients. Surgical treatment included pneumonectomy in 55 (37%) patients, lobectomy in 55 (37%), bilobectomy in 37 (25%), and lobectomy and/or segmentectomy in 2 (1%). There was one operative death (mortality, 0.67%) and morbidity occurred in 22 (14.8%) patients. Follow-up was complete in 94 patients, for a mean of 4.8 years (range, 3 months to 12 years). After surgery, 51 (34%) patients were asymptomatic. Surgical treatment for bronchiectasis can achieve good results with acceptable morbidity and mortality, not only in localized disease but also in extensive disease, if complete resection can be achieved.
Telecardiology: Effective Means of Delivering Cardiac Care to Rural Children
Authors: Sekar Prem , Vilvanathan Vairan
Published: May 2013

Telemedicine allows face-to-face interaction between the medical specialist and the patient. We present our experience of 102 pediatric telecardiology consultations between a tertiary care cardiac center and a remote rural hospital located 120 miles away, between July 2000 and December 2003. The connection was through a Very Small Aperture Terminal satellite bandwidth provided by the Indian Space Research Organization. An S-video link between the echocardiographic and videoconferencing equipment at the remote center allowed the specialist to view images in real time. Pathology was ruled out in 50 (49%) children by tele-echocardiography. Cardiac problems were diagnosed in 52 children (51%), of whom 30 (29%) required surgery. Successful cardiac surgery following telediagnosis was carried out in 18 patients, 8 are awaiting elective operations, and 4 died before surgical correction. The Very Small Aperture Terminal enabled a higher bandwidth that allowed clear images with no significant diagnostic errors. This study demonstrates that pediatric telecardiology effectively delivers cardiac care in rural centers in developing countries with stretched medical resources, where the specialists are urban centered and the majority of patients are rural based.
Single-Stage versus Two-Stage Modified Fontan Procedure
Authors: Attanavanich Sukasom , Limsuwan Alisa , Vanichkul Suthep , Lertsithichai Panuwat , Ngodngamthaweesuk Montein
Published: May 2013

We compared surgical outcomes of the single-stage and two-stage modified Fontan procedures to clarify clinical superiority. Of 28 children undergoing a modified Fontan procedure from October 1995 to October 2005, 15 had a 1-stage and 13 had a 2-stage operation. In the 2-stage group, pulmonary artery growth was evaluated before and after the first stage. Operative mortality was 26.6% in the 1-stage group and 0% in the 2-stage group. The benefits of a previous bidirectional Glenn shunt were decreased cyanosis and volume overload, but there was no significant difference in pulmonary artery growth reflected in pulmonary artery indices before and after the bidirectional Glenn procedure. Older children underwent a 2-stage modified Fontan procedure and had better outcomes in terms of lower mortality, improved oxygen saturation, decreased volume load, and less deterioration of atrioventricular valve regurgitation.
Internal Thoracic Artery Side Branch Ligation for Post Coronary Surgery Ischemia
Authors: Tsakiridis Kosmas , Mikroulis Dimitrios , Didilis Vassilios , Bougioukas Georgios
Published: May 2013

Two cases of internal thoracic artery side-branch ligation in patients with recurrent angina after coronary bypass are reported with long-term follow-up. Ligation was performed with clips via a left thoracotomy. Treadmill stress testing after 3 and 4 years did not provoke any myocardial ischemia. These findings suggest that an unligated side-branch can produce a steal phenomenon.
Innominate Artery Cannulation for Aortic Surgery
Authors: Chiu Kuan-Ming , Li Shao-Jung , Lin Tzu-Yu , Chan Chih-Yang , Chu Shu-Hsun
Published: May 2013

When disease involving the ascending aorta or aortic arch precludes ascending aortic cannulation, axillary artery cannulation is used for cardiopulmonary bypass. An additional incision and the relatively small caliber of the axillary artery are the drawbacks of this approach. Innominate artery cannulation using the same sternotomy wound is a simple and effective alternative.
Left Atrial Malignant Mesenchymoma — Emergency Resection and Mitral Replacement
Authors: Shanmugam Ganesh , Colquhoun Ian
Published: May 2013

Cardiac mesenchymoma is a rare malignancy with a dismal prognosis. We present a case of left atrial mesenchymoma, obstructing the mitral orifice. An emergent tumor resection with mitral valve replacement was performed. Few reports deal with emergency resection of cardiac malignancies with mitral valve replacement. Surgery is the only effective treatment modality.