bluuebunny/crossref_metadata_2025 huggingface dataset:
Endothelium-Dependent Relaxation in Perforating Branch of Human Internal Mammary Artery
Authors: Pešić S. , Jovanović A. , Grbović L. , Inić M. , Munjas N.
Published: September 2024

The purpose of the present study was to examine the effect of acetylcholine on perforating branch of the human internal mammary artery (HIMA). Acetylcholine (10−9–10−5 M) induced concentration- and endothelium-dependent relaxation (pEC50 = 7.54 ± 0.03, maximal response was 98 ± 1.3%) of the precontracted arterial segments. Indomethacin, 4-aminopyridine (10−5 M) and precontraction with K+-rich Krebs—Ringer–bicarbonate solution had no effect on acethylcholine-induced relaxation. NG-monomethyl-L-arginine (L-NMMA) (10−5 M) inhibited relaxation evoked by acetylcholine. Indomethacin applied together with L-NMMA lead to further inhibition of acethylcholine-induced relaxation. Even in the presence of both L-NMMA and indomethacin, 4-aminopyridine had no provoked further inhibition of acetylcholine-induced relaxation of perforating branch of HIMA. It was concluded that the acethylcholine-induced relaxation of isolated perforating branch of HIMA is probably mediated via endothelial production of nitric oxide. However, when NO-synthase is inhibited, acetylcholine-induced vasorelaxation may be, in part, mediated through activation of cyclooxygenase pathway and consequent production and release of prostacyclin or some other cyclooxygenase products.
An Alternative Application of Sodium Nitroprusside to Overcome Perioperative Spasm of the Internal Thoracic Artery
Authors: Yorgancioǧlu Cem , Tokmakoǧlu Hilmi , Günaydin Serdar , Çatav Zeki , Süzer Kaya
Published: September 2024

Objective:

The internal thoracic artery (ITA) is currently the preferred conduit for myocardial revascularization; however, perioperative vasospasm of the internal thoracic artery may cause morbidity. Pedicle preparation and pharmacological vasodilatory treatment vary greatly. This clinical study was performed in order to define the effectiveness of two different applications of sodium nitroprusside as vasodilating agent.

Methods:

Eighty-six (86) consecutive patients whose left internal thoracic artery was mobilized only by one surgeon for elective coronary artery bypass graft operations were randomly divided into two groups. The internal thoracic artery was allowed to bleed freely, and the flow was determined (flow 1). In group I ( n = 42) 3mg sodium nitroprusside in 10 ml of 5% dextrose solution was sprayed with pressure on the pedicle with a thin 25 gauge needle. In group II ( n = 44) half of the solution was sprayed in the same manner, and the other half of the solution was injected into the pedicle in the periarterial tissue along the length of the pedicle. Free flows of the internal thoracic artery were registered before cardiopulmonary bypass (flow 2) and also just prior to performing internal thoracic artery anastomosis to the left anterior descending artery (flow 3). With each measurement hemodynamic parameters and the time between measurements were recorded.

Results:

No statistically significant differences were found between the groups in respect to sex ratio, age, body surface area, heart rate 1 and 2, mean arterial pressure 1 and 3. There was no significant difference in the initial flow among groups. Significant differences were noted in the second flow measurement ( P < 0.05) and in the third flow measurement ( P < 0.01) between two groups. For each group there was a significant increase in flow from flow 1 to flow 2 and from flow 2 to flow 3 ( P < 0.02).

Conclusion:

Sodium nitroprusside injection to the pedicle provides a better flow than simple spraying of the same agent.
The Loss of Circadian Heart Rate Variations in Patients Undergoing Mitral Valve Replacement and Corridor Procedure — Comparison to Heart Transplant Patients
Authors: Velimirovic D.B. , Pavlovic S.U. , Petrovic P. , Neskovic A. , Zivkovic M. , Bojic M.
Published: September 2024

We have presently demonstrated that when added to mitral valve replacement (MVR) the corridor procedure is 75% efficient in restoring and maintaining sinus rhythm in patients with chronic atrial fibrillation (AF), caused by rheumatic mitral valve disease, (follow up 13.9 months). In the same patient population, we observed that the typical day-night cycle heart rate (HR) variations were lost and our present study concentrates on this subject. Heart rate variability analysis based on 24-h Holter ECG recording (StrataScan 563 DelMar Avionics) or hospital discharge (12th-14th postoperative days) was performed in 3 patient groups: Group I: Patients with a Corridor procedure added to MVR (12 pts, m/f 10/2, mean age 47.3 ± 7.5 yr); Group II (control): with patients MVR performed through the left atrial approach, without additional antiarrhythmic procedures (10 pts, m/f 3/7 mean age 51.5 ± 6.7 yr). and Group III: heart transplant recipients (5 pts, mean age 46.4 ± 11.22yr). We analyzed the hourly heart rate over 24-h period divided into three 8-h segments (07–14 h; 15–22 h and 23–06 h). Statistical comparison of mean hourly heart rate values was made between the three time periods of Holter monitoring. The Corridor procedure performed with mitral valve replacement resulted in conversion of sinus rhythm in 75% of patients (Group I), but postoperative heart rate variability analyses based on Holter monitoring disclosed that the mean heart rate was not statistically significantly difficult between the three 8-h segments of the day-night ( P > 0.05). The same results were found in the group of patients after heart transplant ( P > 0.05). The same results were found in the group of patients after heart transplant ( P > 0.05). In the second group (classical MVR), statistically significant differences in mean HR variation existed between the three 8-h intervals ( P < 0.05), and although atrial fibrillation occurred postoperatively physiologic circadian heart rate variations were preserved.

With the Corridor procedure, both atria were surgically and electrically isolated and chronotropic function of the ventricles was restored by creating a small strip of atrial tissue with isolated sinus node and atrio-ventricular node, connected to the ventricles. This technique produced heart denervation nervous system influence, producing the loss of circadian HR variations, similar to the transplanted heart.
Permanent Endocardial Pacing by Cephalic Vein Access in New-Borns and Infants — Surgical Techniques
Authors: Stojanov Petar , Velimirovic Dusan , Zivkovic Mirjana , Pavlovic Sinisa U. , Putnik Svetozar
Published: September 2024

Most centers worldwide use permanent endovenous cardiac electrostimulation in children requiring pacing whose body mass is over 10 kg. The normal implantation route is via a subclavian vein puncture. In our Center, we have implanted permanent endovenous pacing systems for complete AV block in nine children with a mean body mass 7.4 kg (range 2.45–10 kg). The endovenous lead was placed using cephalic vein cutdown procedure. To allow ‘sliding’ during the child's growth, the lead was secured by absorbable sutures.
An Alternative System for Cerebrovascular Reconstructions: Non-Penetrating Arcuate-Legged Clips
Authors: Kirsch W. M. , Cavallo C. , Anton T. , Zhu Y. H. , Rouse G. , Martin R. , Fukushima T. , Rose J.
Published: September 2024

Non-penetrating, arcuate-legged titanium clips (VCS®) have been utilized successfully over the past five years for a variety of cerebrovascular reconstructions. These applications, including both micro and macrovascular reconstructions, their clinical outcomes and technical considerations are described. Applications include patch angioplasty of cervical carotid endarterectomies, superficial temporal to middle cerebral artery ‘bypass’ procedures, Takayasu's arteritis and cavernous carotid reconstructions. The non-penetrating clip has proven to be a safe and reliable alternative to suture for these demanding reconstructions. Clips provide the advantages of improved anastomotic compliance, reduced operative time, and reduced incidence of post-operative anastomotic intimal hyperplasia and stenosis. Clip related pitfalls are discussed with recommendations regarding usage.
Carotid Artery Surgery in the Presence of an Occlusion of the Contralateral Carotid Artery: Perioperative Risk Analysis and Follow-up
Authors: Lacroix H. , Beets G. , Van Hemelrijck J. , Carton H. , Nevelsteen A. , Suy R.
Published: September 2024

A retrospective study of 129 carotid artery reconstructions with an occlusion of the contralateral Internal carotid artery (group CO) is presented. A control group comprised 489 patients with a stenosis of <50% at the contralateral side (group CN). Both groups had the same mean age. There were fewer women in group CO (14% versus 31%. P< 0.0001). and more patients had a history of coronary heart disease (57% versus 44%, P< 0.05). In addition more patients of group CO had suffered a stroke (36% versus 27%, P< 0.05). A temporary shunt was used selectively and more frequently in group CO (87% versus 31%, P< 0.001). Major postoperative complications occurred with equal frequency in both groups: all strokes plus non-cerebral mortality (total combined morbidity and mortality): 4.65% versus 5.5%. The late incidence of stroke was the same in both groups: 8% in CO and 7% in CN at 5 years. The authors conclude that, under the described circumstances and with the appropriate surgical technique, the presence of an occlusion of the contralateral internal carotid artery does not imply an increase in major postoperative complications nor a higher stroke rate during follow-up.
Surgical Treatment of Giant Hydatid Cyst of the Left Ventricle and Diagnostic Value of Magnetic Resonance Imaging
Authors: Paşaoǧlu I. , Doǧan R. , Paşaoǧlu E. , Tokgözoǧlu L.
Published: September 2024

Cardiac echinococcosis has not been reported frequently. Because of the risk of potentially lethal complications, early diagnosis and definitive treatment are very important The case of a 41-year-old physician, in whom diagnosis of giant left ventricular hydatid cyst was established with cross-sectional echocardiography and magnetic resonance imaging, is presented. The cyst was removed surgically and mitral valve replacement performed because of destruction of the valve.
EXtensive Radiation Injury of the Aortic Valve, Ascending Aorta, Left Main Coronary Artery and Right Ventricle
Authors: Beckman D. J. , Bandy M. , Evans M.
Published: September 2024

Numerous case reports have elucidated the extent of radiation-induced injuries of the intrathoracic structures. An extensive radiation injury resulting from treatment of Hodgkin's disease is reported. This patient was successfully treated with multicoronary artery bypass grafting, aortic valve conduit and perioperative right ventricular inotropic support.
The Birth of Open-Heart Surgery: Then the Golden Years
Authors: Lillehei C.W.
Published: September 2024

The development of open-heart surgery has been reviewed beginning with general body hypothermia and inflow stasis, then continuing with extracorporeal circulation by controlled cross-circulation. The successes with the latter technique stimulated rapid development of the simple disposable highly effective bubble oxygenator for extracorporeal circulation to permit correction of virtually all forms of congenital and acquired heart disease. For the few conditions not amenable to corrective procedures, heart replacement became a practical reality. The creation of chronic heart block in the early operations had a very deleterious effect upon survival until highly effective electrical pacing was developed.
The New Stentless Aortic Valve: Clinical Results of the First 100 Patients
Authors: Vrandecic M. P. , Gontijo B. F. , Fantini F. A. , Gutierrez C. , Paula e Silva J. A. , Oliveira O. C. , Barbosa J. T. , Oliveira R. M. , Avelar S. O. S. , Miotto H. C. , Barbosa M. R. , Vrandecic E. , Vrandecic E. C.
Published: September 2024

From May 1990 to August 1993, 100 patients underwent aortic valve replacement using the stentless porcine aortic valve. There were 69 males and 31 females. The mean age was 36 (range 11–76) years. Of 70 patients under 40 years of age, 20 were less than 20 years old. Indications included rheumatic heart sequelae in 55 patients (first valve replacement), prosthetic failure in 20, endocarditis in 13, congenital aortic bicuspid valve in four, degenerative disease in four and senile calcified aortic valves in four. Twenty patients had aortic annular related pathology. There were 15 associated surgical procedures. Forty-three patients required aortic root enlargement. There were approximately equal numbers of patients in New York Heart Association (NYHA) functional classes III and IV. The hospital mortality rate was 6%; 14 patients who experienced hospital morbidity had a full recovery. Two late reoperations were performed in patients with primary valve endocarditis; their recovery was uneventful. Four late deaths were not valve related. Comparative echo Doppler analysis before and after operation demonstrated good improvement of left ventricular function in nearly all patients. The valve was competent in 96% of patients and the remainder displayed minor jets without haemodynamic significance. The valve coaptation was stable in all patients. Use of the stentless porcine aortic valve in this first 100 patients has provided excellent clinical results with a follow-up of 41 months. Further follow-up and close observation will be required to analyse the outcome of this new valve and procedure with time.
Carotid Endarterectomy without a Temporary Indwelling Shunt: Results and Analysis of Back Pressure Measurements
Authors: Boontje A. H.
Published: September 2024

A consecutive series of 342 carotid endarterectomies for cerebrovascular insufficiency without a temporary indwelling shunt is presented. The series is clinically analysed regarding the incidence of postoperative neurological deficits and mortality and statistically analysed concerning factors that may be reliable in identifying patients at risk. A transient neurological deficit occurred in five patients (1.5%) and a permanent deficit in six (1.7%). The mortality rate was 1.5% (five patients). The combined postoperative stroke and mortality rate was 2.6%. There was no statistical difference in the incidence of neurological deficits relative to operative indication (symptom-free 2.7%; transient ischaemic attack 1.4%; prior stroke 2.4%), and to the condition of the contralateral internal carotid artery (normal 1.4%; stenosis 2.9%; total occlusion 0%); nor betweeen patients with internal carotid artery back pressure measurements > 50 mmHg (1.2%). 25–50 mmHg (2.0%) and < 25 mmHg (3.8%). In conclusion, carotid endarterectomy without a shunt is a safe procedure with a low combined perioperative stroke and mortality rate.
Carotid Artery Surgery and the Principle of Prophylaxis: Recurrence in Operated and Non-operated Patients
Authors: Poulias G. E. , Doundoulakis N. , Skoutas B. , Haddad H. , Karkanias Gr. , Papadakis Em.
Published: September 2024

A total of 700 carotid endarterectomies have been performed over a 24-year period at the authors' institute; of these patients 632 (90.3%) had unilateral and 68 (9.7%) had bilateral disease. Some 71 patients who declined operation were followed-up to obtain the natural history of carotid disease. The operative results were compared against this untreated group of patients. Surgical endarterectomy was recommended for a recovered stroke in 190 patients (27.1%), progressive ischaemia in 20 (2.9%) and transient ischaemic attacks in 410 (58.6%). A group of 100 patients with non-specific symptomatology, who were considered ‘symptom-free’, were also operated on; none of these died or developed permanent postoperative neurological defects. The mean age of patients was 56 (range 28-86) years. The overall operative mortality rate was 0.8%. Perioperative neurological deficits occurred in 0.5% and temporary cranial nerve injury in 1.8%. The follow-up covered a period of 10 years, but was in several instances extended to 14 years. The incidence of late neurological events in the patients having an endarterectomy was 3%. In the non-operated group, 12% of normotenslve and 18% of hypertensive patients developed symptoms. The 10-year postoperative survival rate was 80% in the symptom-free group of patients. 70% in those with transient ischaemic attacks and 60% in those who had a previous stroke.
Surgical Reconstruction of the Superior Vena Cava
Authors: Magnan P.-E. , Thomas P. , Giudicelli R. , Fuentes P. , Branchereau A.
Published: September 2024

Ten patients (eight men, two women) who underwent surgical reconstruction of the superior vena cava using an expanded polytretraftuoroethylene (ePTFE) prosthesis between 1981 and 1991 were reviewed to assess the therapeutic value of such surgery. The mean(s.d.) age was 55(12) years. Obstruction of the superior vena cava was caused by pulmonary or mediastinal cancer in nine patients and chronic mediastinitis in one. Eight patients had superior vena cava syndrome and two had symptoms of lung disease. The diagnosis of superior vena cava obstruction was made before surgery by computed tomography or superior venacavography in eight patients and during the surgical procedure in two. Tumour resection was performed in five patients. Venous reconstruction was achieved by interposition of an ePTFE graft between the proximal and distal end of the vena cava in three patients and between one (four cases) or two (three cases) tributaries of the superior vena cava and the right atrium in seven. No patient died during the perioperative period. Symptoms of superior vena cava obstruction disappeared promptly after operation in all patients. Postoperative patency was assessed by cavography or computed tomography; all the grafts were patent. During follow-up no patients presented with recurrent superior vena cava syndrome. Eight patients died. The cumulative survival rates were 70. 25 and 12. 5% at 1, 2 and 5 years, respectively. Surgical reconstruction of the superior vena cava with an ePTFE prosthesis provided immediate and long-term relief of symptoms of superior vena cava obstruction with a low surgical morbidity, even In patients with unresectable malignancy.
Intravenous Leiomyomatosis Extending into the Right Atrium
Authors: Nakayama Y. , Kitamura S. , Kawachi K. , Kawata T. , Fukutomi M. , Hasegawa J. , Morita R.
Published: September 2024

Intravenous leiomyomatosis, also called benign leiomyoma, is a rare tumour that originates from a uterine myoma and spreads intravenously. A 54-year-old woman who had experienced faintness after a hysterectomy for uterine myoma 10 years earlier presented with this lesion. Ultrasonographic, computed tomographic and angiographic examination revealed a long tumour that originated in the uterus and extended into the right atrium through the right internal iliac vein and inferior vena cava. On the basis of a diagnosis of intravenous leiomyomatosis the neoplasm was extirpated by a one-stage cardiotomy and laparotomy with the aid of cardiopulmonary bypass. Retrospective histological analysis of the excised uterus revealed tumorous thrombosis in the venous cavity of the tunica muscularis. Some 26 cases in which open-heart surgery has been undertaken for intracardiac tumour thrombosis have been reported. These and the case described here are reviewed and analysed, in the present case, a full view of the tumour was obtained before surgery, and the lesion removed by a one-stage procedure using median sternotomy (cardiotomy) and laparotomy. Reports of one-stage procedures are few; only eight (30%) of 27 cases.
Intraoperative Assessment of Internal Mammary Artery Bypass Graft Patency by Thermal Coronary Angiography
Authors: Mohr F. W. , Falk V. , Philippi A. , Autschbach R. , Krieger H. , Diegeler A. , Dalichau H.
Published: September 2024

Following early graft failure in some patients during routine use of the internal mammary artery In coronary bypass surgery, a thermal coronary angiography technique was used for direct intraoperative control of internal mammary artery graft patency. This non-invasive method allows the evaluation of graft patency, anastomotic integrity and initial flow patterns without compromising the conduct of the surgical procedure. Internal mammary artery graft patency was controlled by thermal coronary angiography in 348 patients undergoing coronary bypass surgery. Graft anatomy, perfusion and distal run-off in the recipient native coronary artery was delineated by thermal coronary angiography using the temperature gradient of the warm perfusing blood and the cold myocardium. Thermal coronary angiograms were evaluated for graft and anastomotic patency as well as for direction and magnitude of internal mammary artery flow in the native coronarles. Some 348 internal mammary artery grafts, including 13 sequential grafts, were evaluated. Thermal coronary angiography failed for technical or logistical reasons in seven of 348 cases (2.0%). Thermal coronary angiography documented optimal anterograde flow in 282 of 341 cases (82.7%). reduced anterograde flow in 38 of 341 (11.1%) and no anterograde flow in 21 of 341 (6.2%). Using this approach 21 internal mammary artery graft occlusions were discovered, 18 at the anastomotic site and three at the site of the previously placed bulldog clamp. In addition, six unexpected distal native coronary stenoses and three Internal mammary artery graft spasms were detected by thermal coronary angiography and found to be responsible for impaired anterograde flow. Based on these findings, 16 anastomotic revisions, nine additional vein grafts and two additional vein patches were performed. Following revision, the patency of internal mammary artery anastomoses and of additional vein grafts was well documented by thermal coronary angiography in all but two cases; in these an additional vein graft was performed when revision of the internal mammary artery graft anastomosis proved ineffective. Thermal coronary angiography revealed an early internal mammary artery graft failure rate of 6.2%, caused by technical error in most cases. Thermal coronary angiography findings led to immediate, low-risk revision and affected intraoperative decision making in 7.9% of patients. Analysis of internal mammary artery graft failures demonstrated a lower incidence of technical errors among experienced surgeons. In conclusion thermal coronary angiography is an easy-to-use. intraoperative, non-invasive method of assessing internal mammary artery graft patency.
Efficacy of Aprotinin in Different Doses and Autologous Blood Transfusions in Cardiac Surgery
Authors: Gschoßmann J. , Pracki P. , Struck E.
Published: September 2024

A study was undertaken to compare the two doses of aprotinin and the amount of autologous blood transfused in order to determine the optimal dose of this inhibitor for use in cardiac surgery. A total of 120 patients undergoing elective cardiac surgery from November 1990 to April 1992 took part in this randomized double-blind study. Two groups of 60 patients were treated. Patients in the high-dose group were given the dose of aprotinin recommended by the Hammersmith group (6 million kallikrein inactivator units), the other 60 (the low-dose group) received half the dose. Blood loss from thoracic drains in the postoperative period showed a statistically significant difference between the two groups between 6 and 12 h (a mean loss of 610.9 ml in the low dose). The blood and clotting markers did not differentiate between the high- and low-dose patients. In combination with autologous blood transfusions, a low dose of aprotinin appears as efficient in reducing postoperative blood loss as the high-dose Regimen.
Right Ventricular Rupture after Coronary Surgery
Authors: Barnard S. P. , Kitching P. A. , Kulatilake E. N. P.
Published: September 2024

A 70-year-old woman suffered a fatal right ventricular rupture 12 h after uneventful coronary surgery. Post-mortem examination revealed that the rupture had occurred through an area of fatty infiltration. Myocardium had been replaced by fat cells. The literature is reviewed and pathology of this condition discussed.
Advantages of the Lateral Approach for Re-exploration of the Sapheno-Femoral Junction for Recurrent Varicose Veins
Authors: Belardi P. , Lucertini G.
Published: September 2024

Re-exploration of the sapheno-femoral junction for recurrent varicose veins presents many problems. The lateral approach to the sapheno-femoral junction via a groin incision as previously described was performed in 109 lower limbs. The operative mortality rate was 0%. Functional outcome was good in 106 cases (97.2%) and only in three (2.8%) did recurrent varicose veins occur in the upper thigh. Complications were mainly lymphorrhoea (six cases, 5.5%). Cosmetic results were also satisfactory. This surgical procedure allows an easy and safe approach to the sapheno-femoral junction and avoids damage to femoral vessels. Recurrence was rare and caused by incompetent communicating veins in the upper thigh. These characteristics make the lateral approach the preferred technique for re-exploration of the sapheno-femoral junction.
Anomalous Carotid Vertebral Anastomoses and Carotid Endarterectomy
Authors: Cao P. , Verzini F. , Caputo N. , Signorini E. , Moggi L. A.
Published: September 2024

A case of rare anomalous persistence of a primitive hypoglossal artery in a patient operated on for a carotid stenosis, focusing on the embryology of this vessel and the radiology and surgical management, is described.
Flow Study of Surgical Coronary Artery Fistula as an Alternative to Sequential Bypass
Authors: Nishida H. , Endo M. , Koyanagi H. , Grooters R. K. , Merkley D. F.
Published: September 2024

Surgical coronary artery fistula, in which the last anastomosis is created to a low-pressure cardiac chamber, was recently introduced as an alternative method to improve graft flow and patency in a sequential graft when coronary arteries are small or diffusely diseased. To assess graft flow, effect on haemodynamics, flow distribution and to determine proper size of the distal anastomosis, a saphenous vein was sequentially anastomosed from the ascending aorta to the left anterior descending artery and then to the left atrium in eight mongrel dogs. Graft flow was measured before and after opening the fistula to the left atrium between the ascending aorta and left anterior descending artery (flow A) and between the left anterior descending artery and left atrium (flow B). Left atrium pressure and systolic left ventricular pressure (mmHg) were recorded. The diameter of the distal anastomosis was regulated with a bulldog clamp. When distal anastomosis was at 2.5–3 mm mean(s.d.) flow A increased from 64.5(19.5) to 134.7(28.5)ml/min ( P<0.01) without significant left atrial pressure or left ventricular pressure change. With a distal anastomosis of 4 mm or more, flow A increased from 69.8(19.9) to 396.1 (62.2) ml/min ( P< 0.001). Left atrial pressure increased from 5.6(1.0) to 6.1(0.9) mmHg ( P< 0.05) without a change in left ventricular pressure. In both sizes of distal anastomosis, flow to the left anterior descending artery did not change either before or after the shunt (flow B) was opened. Neither volume loading, rapid atrial pacing, neosynephrine or epinephrine infusions caused deleterious haemodynamic effects with the shunt open. In conclusion, a surgical coronary artery fistulation of 2.5–3 mm will effectively increase total graft flow without decreasing flow to the bypassed coronary artery and does not cause deleterious cardiac haemodynamics.
Long-term Results of Mitral Valve Repair for Non-Rheumatic Mitral Regurgitation
Authors: Aoyagi S. , Tanaka K. , Kawara T. , Oryoji A. , Kosuga K. , Oishi K.
Published: September 2024

The durability of mitral valve repaired with reconstructive techniques is variable. If the durability continues to be good, mitral valve repair may be the procedure of choice in many patients with mitral regurgitation. Between December 1970 and June 1993, 54 patients had mitral valve repair for non-rheumatic mitral regurgitation. There were 38 men and 16 women with a mean age of 46.8 (range 19–68) years. The pathology which required surgical treatment was torn chordae in 38 patients, elongation of the chordae in five, valve prolapse without elongation or rupture of the chordae in six, infective endocarditis in three, and annular dilatation in two. Forty-four patients had triangular or quadrangular resection of the mitral leaflet, and seven had annuloplasty alone. Choral reconstruction was performed on three patients. There were no operative deaths. Five patients (9%) died late after operation. The actuarial survival rate and the valve-related death-free rate at 10 years were 83.9% and 90.0%, respectively. Seven patients (13%) required reoperation. Freedom from reoperation at 10 years was 84.5%. Improper evaluation of residual regurgitation during operation and suture dehiscence were the principal causes of reoperation. It was concluded that mitral valve repair for non-rheumatic mitral regurgitation showed low operative mortality and stable long-term results. It is suggested that intraoperative transoesophageal colour Doppler echocardiography provides accurate assessment of mitral valve competence and may be helpful in reducing the need for reoperation.
Vascular Emergencies: What's in Season?
Authors: Varty K. , Reid A. , Jagger C. , Bell P. R. F.
Published: September 2024

Seasonality in ischaemic coronary artery disease is well documented with a winter/summer variation the commonest pattern. The influence of seasonal variation on events in other vascular territories is less well documented. The incidence of ruptured abdominal aortic aneurysm and emergency lower-limb ischaemia was analysed on a monthly basis over a 5-year period. A total of 372 ruptured abdominal aortic aneurysms occurred with a peak incidence in spring and autumn; however, no seasonal pattern was seen in the rate of emergency admissions with lower-limb ischaemia ( n = 606). The explanation for this seasonal pattern in ruptured aneurysms is unknown. The haemodynamic adjustments to changes in climate require further study.
Recurrent Aortic Infection: Treatment by Arterial Homograft Replacement
Authors: Nevelsteen A. , Goffin Y. , Lacroix H. , Vandeginste N. , Suy R.
Published: September 2024

Deep infection remains the most problematic complication following prosthetic aortoiliofemoral reconstruction. Prosthetic excision and extra-anatomic revascularization is associated with significant morbidity and mortality. The possibilities of autogenous reconstruction are frequently limited. The authors present a patient with recurrent aortic infection who was succesfully treated by prosthetic excision and revascularization in situ with a cryopreserved arterial homograft.
Intraoperative Detection of Unsuspected Distal Coronary Obstruction by Thermal Coronary Angiography
Authors: Merin G. , Elami A. , Zucker M.
Published: September 2024

Intraoperative assessment of graft patency and completeness of revascularization can increase the success of coronary artery bypass grafting. A 56-year-old man underwent a quadruple bypass operation. Flow in the graft to the anterior descending artery was verified after completion of the distal anastomosis using a Doppler flow detector. Visualization of the native artery by thermal coronary angiography demonstrated that the flow passed into the second diagonal branch and not into the distal anterior descending artery, which had an unsuspected obstruction just distal to the anastomosis. The obstruction was dilated. Patency was verified with cold solution, and flow of warm blood to the entire artery was accomplished. This case demonstrates how the early (intraoperative) recognition of an unsuspected coronary obstruction using an infrared imaging system can improve the results of myocardial revascularization and avoid potential postoperative complications.
Carotid Endarterectomy: Are We Under-Performing?
Authors: Davies A. H. , Wilson Y. G. , Lamont P. M. , Baird R. N.
Published: September 2024

An audit of the number of carotid endarterectomies performed over the last 4 years was performed in the south western region. For the years 1990, 1991, 1992 and 1993 the number of cases were 126, 165, 165 and 164 respectively. It is estimated for this region that about 600 operations should be carried out per annum. This under-performance may reflect a lack of knowledge about the potential benefits of surgery.
Double Clostridial Mycotic Aneurysms of the Aorta
Authors: Messa C. A. , Kulkarni M. , Arous E.
Published: September 2024

Mycotic aortic aneurysm continues to present challenging and difficult management issues with a significant morbidity and mortality. The offending organism in the etiology of this aneurysm can be variable and unusual. The first report of two mycotic aortic aneurysms caused by Clostridium septicum in the same patient is described here. Presentation and management as well as conditions commonly associated with Clostridium septicum infection and a review of all clostridial mycotic aortic aneurysms in the English literature are discussed.
Prosthetic Graft Infection in the Descending Thoracic Aorta Treated by Extra-Anatomic Rerouting
Authors: Barnard S. P. , Dark J. H. , Jones N. A. G.
Published: September 2024

Prosthetic aortic graft infection is a dreaded complication associated with high mortality. Some of the best results have been achieved with removal of the infected prosthesis, although this is not always possible in the case of the thoracic aorta. A patient with an infected coarctation graft managed by aortic rerouting is described here.
Valve Replacement in Rheumatic Mitral Incompetence: Total versus Posterior Chordal Preservation
Authors: Hassouna A. , Elmahalawy N.
Published: September 2024

Several studies have shown that mitral valve replacement with total chordal preservation (MVR-TCP) improves left ventricular function when compared with total chordal transection. Few clinical studies, however, have compared this technique to that involving only posterior chordal preservation (MVR-PCP). This study was intended to cover this aspect. A total of 36 consecutive patients with chronic rheumatic mitral incompetence were operated upon by one surgeon and benefited from MVR-TCP (group I). During the same period and along similar selection criteria, 60 patients underwent MVR-PCP (group II) in our department. With the exception of a statistically significant higher preoperative left ventricular ejection fraction (LVEF) percentage and lower fractional shortening (LVFS) percentage in group II patients; both groups were comparable as regarding age, sex distribution New York Heart Association (NYHA) functional class (FC). preoperative left atrial diameter (LAD), left ventricular end-diastolic dimension (LVEDD), left ventricular end-systolic dimension (LVESD) as well as aortic cross-clamp and cardiopulmonary bypass times. The means of the differences, between the pre- and postoperative values of NYHA FC and echocardiographic data were compared between both groups. As compared with group II, group I patients showed lower: hospital mortality rate (0 versus 8.3%; P > 0.05); need for positive inotropic support (11.1 versus 20.8%; P > 0.05) and total ICU stay (2.9 ± 0.17 versus 2.2 ± 0.13 days; P < 0.01). In addition, group 1 patients showed a better NYHA FC improvement (−2.08 ± 0.15 versus −1.93 ± 0.11; P > 0.05) as well as a statistically significant ( P < 0.00001) higher decrease in the LAD (−18.19 ± 0.97 versus −11.59 ± 0.58 mm). LVEDD (−14.44 ± 0.91 versus −6.17 ± 0.05 mm). LVESD (−6.17 ± 0.77 versus −3.23 ± 0.01 mm), LVFS percentage (−0.06 ± 0.01 versus −0.01 ± 0.001%) and a higher increase in the LVEF percentage (8.1 ± 0.9 versus 1.48 ± 0.02%). The smaller mean diameter of the implanted St Jude prosthesis, in group I patients (26.77 ± 0.22 versus 27.43 ± 0.21 mm; P = 0.046), was neither associated with the use of a smaller prosthesis than that predicted for the patient size nor a significantly higher mean transprosthetic pressure gradient. These data suggest that in rheumatic patients with chronic mitral incompetence, MVR-TCP is always feasible: it is associated with lower hospital mortality and morbidity rates and better preservation of the postoperative left ventricular systolic functions when compared with MVR-PCP.
Preoperative Identification of Viable Myocardium: Effectiveness of Nitroglycerine-Induced Changes in Myocardial Sestamibi Uptake
Authors: Greco C. , Ciavolella M. , Tanzilli G. , Sinatra R. , Macrina F. , Schillaci O. , Tavolaro R. , Scopinaro F. , Campa P.P. , Marino B.
Published: September 2024

In order to predict tissue viability in infarcted myocardial areas, changes induced by nitroglycerine infusion on Sestamibi myocardial uptake were evaluated in 37 patients with previously confirmed myocardial infarction undergoing coronary artery bypass grafting, and compared with echocardiographic and perfusional changes occurring after the operation. The improvement of Sestamibi uptake after nitroglycerine correctly classified 24/26 (92%) patients showing postoperative improvement of wall motion in the infarcted area, whereas 24/31 (77%) patients with nitroglycerine-induced increase in Sestamibi uptake had improved wall motion after operation. The presence of collateral flow to the infarcted area was associated with a significantly ( P < 0.01) higher increase in Sestamibi uptake both during nitroglycerine infusion and postoperatively. An increase in wall motion score after operation was associated with a significantly higher ( P < 0.05) increase in Sestamibi uptake score during nitroglycerine infusion. Thus, the results of this study suggest that Sestamibi perfusional myocardial scintigraphy during nitroglycerine infusion is capable of assessing viable but chronically hypoperfused myocardium and predicting postoperative wall motion and perfusional improvement, to yield the best results in patients with evidence of collateral circulation that supplies the infarcted area.
Treatment of May—Thurner Syndrome with Catheter-Directed Thrombolysis and Stent Placement, Complicated by Heparin-Induced Thrombocytopenia
Authors: Seidensticker D. , Wilcox J. , Gagne P.
Published: September 2024

May—Thurner syndrome is an uncommon process in which the right common iliac artery compresses the left common iliac vein, resulting in left iliofemoral deep vein thrombosis and severe leg edema. We report the case of a 41-year-old female who presented with severe left leg edema present for 1 day. One week earlier she had experienced acute shortness of breath and pleuritic chest pain. Duplex ultrasound revealed a left iliofemoral deep vein thrombosis. A computed tomography (CT) scan performed for abdominal pain revealed thrombosis of the entire left common and external iliac veins. A ventilation—perfusion scan diagnosed a pulmonary embolism. The patient was treated with systemic intravenous heparin and catheter-directed thrombolysis of the iliofemoral deep vein thrombosis. Complete thrombolysis and iliofemoral vein patency was achieved over 5 days. A persistent stenosis in the left common iliac vein consistent with May—Thurner syndrome was alleviated with percutaneous balloon angioplasty and placement of a Wallstent. Heparin therapy was terminated at the time of stenting because of suspected heparin-induced thrombocytopenia. The patient was started on a continuous infusion of 10% dextran 40, and warfarin therapy was initiated. Heparin-induced antibodies were confirmed by a C-14 serotonin release assay. The endovascular reconstruction remains patent 4 months later. Heparin-induced thrombocytopenia complicating endovascular reconstruction of the iliofemoral venous system in a patient with May—Thurner Syndrome is an uncommon occurrence. This case and a review of the literature are discussed.
A Case of a Primary Giant Adrenal Gland Hydatid Cyst—An Exceptional Location: A Case Report
Authors: Agarwal Prachi , Aiyer Hema Malini , Singh Tej Pratap , Sharma Gaurav
Published: September 2024

Background and clinical presentation:

The adrenal hydatidosis is an exceptional site location for the occurrence of hydatid cyst with an incidence of being 0.073%. We hereby report this rare case of adrenal hydatid cyst in a 38-year-old male who presented with a history of right flank pain and no other associated complaints. On non-contrast computed tomography/high-resolution computed tomography, the whole abdomen revealed the finding of an adrenal hydatid cyst. He underwent laparoscopic right adrenalectomy, which was further confirmed with the pathological examination. In an adjunct to this, he was put on anti-helminthic drug Albendazole. On one year of follow-up, there was no recurrence.

Conclusion:

The hydatid cyst rarely occurs in the adrenal glands and is an uncommon pathology. It should always be suspected in the case of any cystic tumour of the adrenal gland, especially in endemic countries. The clinical features are variable and non-specific in the majority of the cases. Ultrasonography and CT abdomen hold a significant sensitivity in the diagnosis of the hydatid cyst. Surgical excision is the main choice of treatment. Adjunctive medical treatment improves the outcome and decreases the recurrence rate.
A snapshot of Australian university responses to campus sexual violence
Authors: Henry Allison
Published: September 2024

In recent years Australian universities have come under increasing pressure over their management of sexual assault and sexual harassment. In February 2024, on the eve of an unprecedented regulatory intervention from Australian governments, the Australian Human Rights Institute analysed university websites to assess the degree to which Australian universities had adopted good practice guidance in their responses to sexual violence. The Institute’s subsequent report highlighted gaps and inconsistencies in institutional responses, serving to underline the need for the new national Action Plan Addressing Gender-based Violence in Higher Education.
Navigating Identity and Resilience: A Lesbian's Journey Through Family Substance Use
Authors: Vogelsang Alison , McGill Craig M. , Vinzant Ryan C. , Dorn-Medeiros Cort M. , Caraway S. Jean
Published: September 2024

This study explores the complex journey of a young lesbian navigating her sexual identity in the challenging environment of a residential treatment center due to her mother's substance use. Through qualitative methods, this research delves into the intertwining of family dynamics, societal pressures, and minority stress in shaping self-acceptance. The study highlights the critical role of supportive relationships and affirming interventions in fostering resilience and mental well-being among LGBTQ+ individuals. This study contributes to a deeper understanding of how personal and environmental factors coalesce to impact the identity development of LGBTQ+ youth in specialized care settings.
Multi-Stage Evaluation Using GONUKE
Authors: Boring Ronald L. , Ulrich Thomas A. , Lew Roger
Published: September 2024

Multi-stage validation (MSV) has become an important concept in nuclear power plant control room design and modernization. MSV consists of multiple stages of collecting evidence that establish reasonable confidence in the design. The Guideline for Operational Nuclear Usability and Knowledge Elicitation (GONUKE) was created as a framework to support different types of human factors evaluations across different stages of the design and development life cycle. The GONUKE framework did not originally address MSV, but it espoused safety case approaches that build different evidences toward design completion, which is a complementary approach to MSV. In this paper, we show how GONUKE specifically aligns to MSV. We then expand the discussion to include multi-stage evaluation. As defined in GONUKE, there are three types of evaluation. Validation is empirical evidence collected through human-in-the-loop studies, whereas verification is expert comparison of a design against formalized standards, and epistemiation is expert knowledge transfer to design.
Nearly complete hair re-pigmentation in an older patient treated with hydroxyurea for essential thrombocytosis
Authors: Salmasi Shiva , Hassan Ruba Alchaikh , Gafarzadeh Zahra , Dasanu Constantin A.
Published: September 2024

Introduction

Employed in the treatment of malignancies and non-neoplastic conditions, hydroxyurea is associated with integumentary adverse effects, including skin discoloration, xerosis, pruritus, cutaneous atrophy, chronic leg ulcers, oral ulcerations, alopecia, and some nail abnormalities.

Case Report

A 77-year-old woman was diagnosed with essential thrombocytosis and started on low dose hydroxyurea. After 20 weeks of treatment, she experienced an unexpected change in hair color from gray to dark brown, without using hair dye or supplements. She later developed bilateral dorsal hand melanoderma, melanonychia, and onychodystrophy.

Management and outcome

It was decided to monitor the patient with no action taken as she was happy with this side effect of hydroxyurea. The platelet count has remained in excellent control. The dark brown hair color persisted over time.

Discussion/Conclusion

Hair hyperpigmentation likely occurred through melanocyte activation via hydroxyurea. Severe side effects may require dosage adjustments, while milder effects can be monitored closely. The newly observed hair color restoration in this case highlights potential dual (therapeutic and aesthetic) applications of this class of agents.
“You Never Know Who’s Gonna Be Next”: The Role of Community Violence Intervention Workers in Responding to Homicides and Survivor Support
Authors: Bocanegra Kathryn , Aguilar Nathan
Published: September 2024

The racial and spatial concentration of homicides coupled with the low levels of protection, safety, and accountability afforded to surviving family, friends, and community members raises the question of who is capable of accompanying impacted individuals and negotiating safety in the aftermath of violent death. Community Violence Intervention (CVI) workers are a growing professional field of indigenous peacemakers who lead community-based efforts to both prevent and intervene violence. The current study presents original, novel research engaging CVI workers’ experiences responding to homicides to prevent retaliation and support survivors and how persistently responding to violent death in their community impacts their wellbeing. This exploratory study involved 35 in-depth, qualitative interviews with CVI workers and their supervisors in Chicago, IL. Thematic analysis indicates they are “first among first responders” and are critical information intermediaries to designate appropriate violence prevention and intervention strategies. CVI workers also experience traumatic grief, largely associated by their relationship and proximity to homicide victims. The implications highlight the distinctive contributions of CVI workers in formulating more comprehensive, community-based post-homicide strategies aimed at supporting marginalized survivors and communities disproportionately affected by violence.