bluuebunny/crossref_metadata_2025 huggingface dataset:
Harmonic Scalpel: Initial Experience
Authors: Bhan Anil , Choudhary Shiv Kumar , Saikia Manuj , Sharma Rajesh , Venugopal Panangipalli
Published: May 2013

A Harmonic Scalpel was used to harvest arterial conduits in 80 patients undergoing coronary bypass grafting (group 1). Another 80 patients had electrocautery (group 2). Off-pump beating heart coronary grafting was performed in 24 patients in group 1 and 18 in group 2; these patients underwent coronary angiography. Moderately hypothermic cardiopulmonary bypass was used in all others. There were 134 arterial conduits (78 left internal mammary arteries, 14 right internal mammary arteries, and 42 radial arteries) in group 1, and 141 arterial conduits (80 left internal mammary arteries, 11 right internal mammary arteries, and 50 radial arteries) in group 2. The number of hemoclips used, postoperative blood loss, and homologous blood product requirements were significantly less in group 1. One patient in group 1 and 3 in group 2 required reoperation for excessive bleeding. Postoperative angiograms in 24 patients in group 1 (37 arterial conduits) revealed 100% graft patency. In group 2, 1 of 18 patients who had angiography showed marked narrowing of the left internal mammary artery in the distal third, attributable to electrocautery injury. The Harmonic Scalpel was a useful, safe, and probably superior alternative to electrocautery for arterial harvesting.
Thoracoscopic Internal Thoracic Artery Harvest: Angiographic Assessment
Authors: Hirata Nobuaki , Ohtake Shigeaki , Sawa Yoshiki , Yoshitatsu Masao , Kato Hiroshi , Ohkubo Nobukazu , Matsuda Hikaru
Published: May 2013

Minimally invasive direct coronary artery bypass grafting was carried out in 10 patients. The left internal thoracic artery was mobilized under direct vision in the first 5 and by thoracoscopy in the next 5. Postoperative arteriography confirmed the advantage of thoracoscopic arterial harvest. The length of the thoracoscopically harvested artery was 10 ± 2 cm compared to 6 ± 1 cm for grafts harvested under direct vision (p < 0.05). The anastomotic angle between the internal thoracic artery and the left anterior descending coronary artery was 43° ± 4° for thoracoscopically harvested grafts versus 62° ± 5° for the direct vision method (p < 0.05). One anastomotic complication (occlusion) was found in a patient who had arterial harvest under direct vision. Internal thoracic artery harvested by thoracoscopy diverges from the chest wall and runs directly to the anastomotic site. Such a conduit harvested by direct vision runs along the chest wall until near the anastomotic site, which might increase the risk of anastomotic complications.
Development of In-Vitro Evaluation System for Annuloplasty Rings
Authors: Arita Makoto , Kasegawa Hitoshi , Umezu Mitsuo
Published: May 2013

An in-vitro system was devised to study the performance of newly developed annuloplasty rings as well as various conventional rings. The Duran Flexible Annuloplasty Ring was tested to define its characteristics and to validate the system for comparative testing. It was possible to obtain quantitative data using a microscope and a load cell to respectively measure valve orifice area and tensile load on the valve annulus. The results suggest that this apparatus could be employed to characterize the features and functional performance of other types of annuloplasty ring.
Calcification of Experimental Valve Bioprostheses
Authors: Chung Sung Woon , Kim Jong Won , Lee Hyung Ryul , Kim Yeong Dae , Chung Hwang Kiw
Published: May 2013

Bovine pericardial strips, porcine valve strips, and canine valve strips were treated with 0.625% glutaraldehyde and implanted subdermally in rats. Weight and calcium content were examined 9 weeks later. Bovine pericardial strips underwent calcification after implantation; electron microscopy showed concentric electron-dense calcified deposits in the collagen fibers. Implanted porcine valve strips also underwent calcification; electron microscopy showed concentric electron-dense calcified deposits in the interstitium. Calcification was also detected in canine valve strips after implantation, but the proportion of calcium was lower than in the other tissues; electron microscopy showed collagen bundles with speckled calcified granules. The process of calcification started on the surface of the collagen fibrils and in the interfibrillar space. It was concluded that preservation of collagen fibers would be helpful in preventing calcification. The use of canine cardiac valves might improve the durability of bioprostheses.
Limit of Indication for Plication of Giant Left Atrium
Authors: Tonguç Ece , Kestelli Mert , Özsöyler İbrahim , Yilik Levent , Yilmaz Arif , Özbek Cengiz , Akçay Ayhan , Yeşil Murat
Published: May 2013

Patients with giant left atrium were divided into 2 groups retrospectively. Group 1 comprised 10 patients with compression symptoms who received left atrial plication after mitral valve replacement. Group 2 comprised 31 patients without symptoms of compression who did not mreceive plication. Age, sex, ejection fraction, and left ventricular end-diastolic pressure were similar in the 2 groups preoperatively. Left atrial diameter reduction was not significantly different between the 2 groups. Mean left atrial diameter was 80.41 ± 15.08 mm preoperatively and 66.64 ± 13 mm postoperatively in group 1. In group 2, the mean values were 80 ± 8.95 and 66.1 ± 8.14 mm, respectively. Postoperatively, no differences were observed in ejection fraction or left ventricular end-diastolic pressure between the 2 groups. Left atrial diameter was over 80 mm in 12 patients in group 2 and it did not reduce postoperatively to below 65 mm in 11 of these patients. On the other hand, only 7 of 19 patients with a left atrial diameter below 80 mm preoperatively did not reduce to values below 65 mm (p = 0.04). Therefore, in cases of giant left atrium with a left atrial diameter below 80 mm, plication might not be necessary.
Abciximab during Rescue Angioplasty after Failed Thrombolysis
Authors: Kaul Upendra , Sapra Rakesh , Singh Balbir , Sudan Dinesh , Ghose Tapan , Dixit Narayan Shyamsunder , Wasir Harbans Singh
Published: May 2013

Abciximab (a glycoprotein IIb/IIIa inhibitor) was assessed in 16 of 36 patients with acute myocardial infarction who were referred for rescue angioplasty after failed thrombolysis. Baseline clinical and angiographic characteristics were comparable in the abciximab and non-abciximab groups. Coronary stenting was carried out in all patients in the non-abciximab group and in 13 in the abciximab group. Angiographic success was achieved in all patients. Persistence of slow flow was encountered more frequently in the non-abciximab group (30% versus 6.25%, p < 0.05). Stent thrombosis occurred in 2 patients (10%) who were successfully redilated and there was one case of bleeding requiring transfusion in the non-abciximab group; neither of these complications occurred in the abciximab group. Predischarge left ventricular ejection fraction was better in the abciximab group (44% ± 3% versus 36% ± 3%, p < 0.01). All patients were discharged alive and were asymptomatic at the one-month follow-up. Use of abciximab during angioplasty after failed thrombolysis improved angiographic and clinical results without increasing the risk of bleeding, and reduced the incidence of in-hospital complications. Larger studies are warranted to confirm this important observation.
Complicated Cardiac Surgery in Renal Transplant Patient
Authors: Hirose Hitoshi , Amano Atsushi , Takahashi Akihito , Nagano Naoko
Published: May 2013

Concomitant mitral valve repair, maze procedure, and coronary artery bypass grafting were carried out in a renal transplant recipient. The operation was complicated by intraoperative iatrogenic ascending aortic dissection that was successfully repaired.
Management of Graft Injury during Repeat Coronary Bypass Surgery
Authors: Bhattacharya Sudhansu S , Kole Shrikant D , Oswal Dilip H
Published: May 2013

A vein graft to the left anterior descending coronary artery was damaged during reoperation for further coronary bypass on an 82-year-old man. A temporary shunt was established to deliver retrograde cardioplegia before instituting cardiopulmonary bypass for further vein grafting.
Aortic Injury from Thoracic Vertebral Stabilization Instrument
Authors: Burma Oktay , Rahman Ali , Çekirdekçi Ahmet , Uyar Ihsan Sami , Topsakal Cahide
Published: May 2013

A case of delayed postoperative thoracic aortic rupture from erosion by a spinal fixation device is described to call attention to this potential catastrophe. Appropriate management and prevention of this complication is discussed.
Intrapulmonary Heterotopic Pancreas Presenting as Lung Abscess
Authors: Lone Ghulam Nabi , Sofi Ghulam Nabi , Bhat Mohammed Akbar , Dar Abdul Majid , Ahanger Abdul Gani , Ali Noor
Published: May 2013

Ectopic pancreas in the lung is an extremely rare entity. A 17-year-old girl presented with a cystic lesion in the lower lobe of the right lung with features of sepsis. Exploration revealed a huge infected cyst bearing a nodule on its wall, in the right lower lobe, extending to the middle lobe, which proved to be pancreatic in origin (exocrine tissue only) on histopathology.
Extrathoracic Heart (Ectopia Cordis)
Authors: Airan Balram , Wasir Harpreet , Choudhary Shiv Kumar , Kothari Shyam Sunder , Saxena Anita , Venugopal Panangipalli
Published: May 2013

Two cases of ectopia cordis are described. One patient underwent an initial procedure to cover the heart using homologous pericardium and a homograft pulmonary artery patch but did not survive. The other baby died before any surgical intervention could be performed.
Necrotizing Fasciitis of Thoracic Wall Complicating Chest Tube Drainage
Authors: Freixinet Jorge , Rodríguez Pedro , Santana Norberto , Hussein Mohamed , Cruz Francisco , de Castro Felipe Rodríguez
Published: May 2013

A 24-year-old man with Werdnig-Hoffman disease developed necrotizing fasciitis caused by Streptococcus milleri complicating treatment of empyema with a chest tube. Extensive debridement was performed repeatedly, but he died 18 days after admission.
Chordal Replacement with Polytetrafluoroethylene Suture: Midterm Results
Authors: Chotivatanapong Taweesak , Chaiseri Pradistchai , Kasemsarn Choosak , Yosthasurodom Chaiwuth , Sungkahapong Vibhan
Published: May 2013

From March 1994 to December 1999, polytetrafluoroethylene suture was used for chordal replacement during mitral valve repair in 30 patients. Follow-up ranged from 4 to 70 months with a mean of 36.6 months and was complete in 29 patients: 14 males and 15 females with a mean age of 40.6 years. Most (17) had rheumatic heart disease, 5 had degenerative disease, 6 had infective endocarditis, and 1 had ischemic heart disease. Preoperatively, 26 patients were in functional class III and IV. Operations comprised isolated mitral valve repair (15), combined mitral and tricuspid valve repair (4), mitral valve repair and aortic valve replacement (3), and others (7). The most frequent additional procedures were commissurotomy, papillotomy, resection of primary or secondary chordae, and chordal splitting. The mean cardiopulmonary bypass and aortic crossclamp times were 155.3 and 120.5 minutes, respectively. There was no hospital mortality. One patient died 20 months postoperatively from chronic obstructive lung disease. All survivors were in functional class I and II. Mitral regurgitation was reduced from a preoperative mean of +3.1 degrees to +0.43 degrees. No thromboembolic event or valve failure occurred during follow-up. It was concluded that polytetrafluoroethylene suture was safe and effective for mitral valve repair.
Descending Thoracic Aortobifemoral Bypass for Aortoiliac Occlusive Disease
Authors: Ihaya Akio , Chiba Yukio , Kimura Tetsuya , Morioka Koichi , Uesaka Takahiko
Published: May 2013

Descending thoracic aortobifemoral bypass was evaluated in 3 patients with Leriche's syndrome and 1 with severe arteriosclerosis obliterans. Indications for this approach were lack of a suitable site for aortic clamping in 3 and history of laparotomy in 1. Duration of surgery was 4.5 to 5.25 hours, and blood loss was 450 to 1,900 g. There was no surgical mortality. Major morbidity comprised visceral arterial ischemia postoperatively in 1 patient. During a mean follow-up of 60 months (range, 36 to 84 months), 2 limbs of the grafts became occluded. No patient developed proximal propagation of an aortic thrombus. This approach is recommended in selected patients without impaired pulmonary function, when conventional approaches to the abdominal aorta are considered hazardous.
Cor Triatriatum: Clinical Presentation of 18 Cases
Authors: Lupinski Ryszard W , Shankar Sriram , Wong Keng Yean , Chan Yoke Hwee , Vosloo Susan M , Moll Jacek J
Published: May 2013

From 1985 to 1999, 18 patients with cor triatriatum underwent surgical correction. Their ages ranged from 3 months to 9 years (mean, 32.5 months). Eight patients were cyanosed; the other 10 presented with congestive heart failure. Recurrent chest infection was observed in 10 cases, and failure to thrive in 7. One patient had isolated cor triatriatum, and 17 had an associated atrial septal defect. Other associated anomalies included patent ductus arteriosus, ventricular septal defect, and partial and total anomalous pulmonary venous connection. Two deaths occurred perioperatively in patients with associated severe heart defects. Follow-up ranged from 1 month to 10 years. No late events occurred among the survivors, and all were in New York Heart Association functional class I. Their most recent echocardiograms showed no residual obstruction or shunt and good development of the left cardiac chambers. Echocardiography is recommended as the diagnostic modality of choice. Cor triatriatum can be corrected surgically with low mortality and good long-term results.
Power versus Temperature-Controlled Ablation of Supraventricular Tachycardia
Authors: Tan Ru San , Ruth Kam Ming Li , Teo Wee Siong
Published: May 2013

Temperature-controlled radiofrequency catheter ablation was prospectively compared with the power-controlled technique in 53 patients with atrioventricular reciprocating tachycardia or atrioventricular nodal reentrant tachycardia. Patients were randomly assigned to either power-controlled (n = 26) or temperature-controlled (n = 27) ablation after electrophysiologic studies. The groups were comparable in terms of mean age (40 ± 16 versus 44 ± 15 years, p = 0.60), sex (54% versus 52% males, p = 0.88), and type of tachycardia (38% versus 52% atrioventricular reciprocating tachycardia, p = 0.91). Successful ablation was achieved in all patients, and the number of radiofrequency applications required were similar. There were no significant differences between groups in mean fluoroscopy time for initial success (2.1 ± 2.3 minutes versus 1.5 ± 1.2 minutes, p = 0.21), for ablative plus booster doses (6.9 ± 4.7 minutes versus 6.0 ± 3.5 minutes, p = 0.42), or for the entire procedure (13.1 ± 6.9 minutes versus 11.6 ± 4.5 minutes, p = 0.35). It was concluded that power-controlled and temperature-controlled methods of radiofrequency ablation were equally efficacious.
Rupture of Left Atrial Appendage and Pericardium Due to Blunt Trauma
Authors: Jha Neerod Kumar , Craddock David R , Thomson Bruce M , Jayaprasanna Kallukudige , Russell Walter J
Published: May 2013

A 37-year-old woman sustained a ruptured pericardium and two lacerations of the left atrial appendage in an automobile accident. Simple suture repair of the atrial appendage was achieved after clamping the base of the left atrium to control the bleeding.
Right Coronary Artery Origin in Stenosed Left Anterior Descending Artery
Authors: Göl M Kamil , Vefali Veli , Yilmazkaya Bayram , Göksel Sabahattin , Nisanoğlu Vedat , Yildiz Ülkü , Yener Ali , Taşdemir Oğuz
Published: May 2013

A very rare coronary artery anomaly of right coronary artery originating from the middle portion of the left anterior descending artery was discovered in a 58-year-old woman with unstable angina pectoris. Double coronary artery bypass grafting was performed successfully.
Venous Cannula Obstruction by Embolus during Cardiopulmonary Bypass
Authors: Hardikar Ashutosh A , Stubberfield John , Craddock David R
Published: May 2013

During a routine mitral valve repair with coronary revascularization in a 65-year-old man, venous return was suddenly interrupted. The venous cannula was rapidly removed, revealing a large thrombus obstructing its lumen. Prompt recognition of the problem and replacement of the venous cannula resulted in uneventful recovery of the patient.
Posttraumatic Left Ventricular Pseudoaneurysm in a Child
Authors: Özdoğan M Emin , Oktar G Levent , Tunaoğlu Sedef , Büyükateş Mustafa , Kula Serdar , Olguntürk Rana
Published: May 2013

A 7-year-old boy developed a left ventricular pseudoaneurysm after being struck by a tractor. The pseudoaneurysm was diagnosed and successfully resected 5 years after the accident.
Palliative Bilateral Unidirectional Glenn Shunts
Authors: Malik Kalpesh Satishkumar , Neema Praveen Kumar , Sivasankaran Sivasubramaniam , Manohar Soman Rema Krishna
Published: May 2013

A Fontan operation was planned for a 5-year-old girl with complex cyanotic heart disease and bilateral superior venae cavae. The unexpected finding of total anomalous pulmonary venous connection to the left superior vena cava led to a change of strategy. During a bilateral bidirectional Glenn procedure, the pulmonary confluence had to be disconnected to avoid pulmonary venous obstruction. This resulted in bilateral unidirectional cavopulmonary flow.
Familial Atrial Septal Defect with Atrioventricular Conduction Abnormalities
Authors: Emir Mustafa , Oguş Temuçin , Işik Ömer , Çiçek M Sertaç
Published: May 2013

The occurrence of several cases of atrial septal defect in the same family is rare. A family in which the father and his two daughters presented with atrial septal defect associated with atrioventricular conduction abnormalities is described.
Chest Trauma Due to Impalement in a Fall
Authors: Kok Va Kei , Chiang Tai Chow
Published: May 2013

A 17-year-old girl sustained impalement of the chest by a bamboo fence pole in a fall. She was rapidly transported to hospital while still impaled. The bamboo pole was successfully removed through a thoracotomy. Correct management at the scene and rapid transport were important factors in survival.
Combined Lung Resection and Aortic Valve Replacement via Ministernotomy
Authors: Mestres Carlos-A , Belda José , Greco Ernesto , Cartañá Ramón , Gimferrer José M
Published: May 2013

A technique for simultaneous cardiac operation and pulmonary resection via a small upper midline sternotomy is described. It was employed in a 62-year-old man undergoing aortic valve replacement and right lower lobectomy for a carcinoid tumor.
Myocardial Revascularization in Chronic Renal Failure: 10-Year Experience
Authors: Prifti Edvin , Bonacchi Massimo , Leacche Marzia , Frati Giacomo , Giunti Gabriele , Proietti Piero , Cricco Antonio Massimo , Brancaccio Gianluca , Furci Barbara , Baboci Arben , Toscano Michele
Published: May 2013

From January 1989 to June 1999, 244 patients with chronic renal failure underwent myocardial revascularization, of whom 56 were undergoing hemodialysis (group 1) and 188 (group 2) did not require hemodialysis. Mean age was 63.4 ± 6.5 years in group 1 and 65.4 ± 7 years in group 2. Hospital mortality was 7% overall; 6 (10.7%) patients died in group 1 versus 11 (5.9%) in group 2 (p > 0.05). Post-operative complications were significantly higher in group 1 versus group 2. Multivariate analysis revealed cerebrovascular disease, myocardial infarction, left ventricular ejection fraction < 35%, and duration of renal failure as strong predictors of poor survival in non-dialysis patients. Left ventricular ejection fraction < 35% and duration of hemodialysis were predictors of late mortality in group 1. The 1-, 3-, and 5-year survival rates were 90%, 76%, and 68% in group 1, and 95.5%, 86%, and 80.7% in group 2 (p < 0.004), respectively. Myocardial revascularization can be carried out in patients with chronic renal failure with acceptable early and late mortality and morbidity, but those undergoing hemodialysis are at substantial risk of major morbid events and poor long-term survival.
Bidirectional Glenn Shunt: 170 Cases
Authors: Xie Bin , Zhang Jin Fang , Shetty Devi Prasad
Published: May 2013

Between June 1997 and July 2000, 170 patients aged 0.5 to 20 years received a bidirectional Glenn shunt without the use of a temporary shunt or cardiopulmonary bypass. Arterial oxygen saturation rose from 78% ± 8.5% preoperatively to 90% ± 4.3% postoperatively. Hemodynamic studies showed a mean postoperative superior vena cava pressure of 13 ± 2 mm H2O. One patient had desaturation and the shunt was taken down, 5 required reexploration for bleeding, and 8 needed prolonged drainage of 9 to 19 days, 2 of whom had chylothorax. Hospital stay was 9.3 ± 3.5 days. There were 3 late operative deaths (1.8%) from low output syndrome. In 20 patients, bilateral bidirectional Glenn shunts were instituted. Three patients under-went a subsequent Fontan procedure without cardiopulmonary bypass. The bidirectional Glenn shunt remains an excellent palliative procedure as a preliminary step to a Fontan operation, or as an integral part of a Fontan or modified Fontan operation when the procedure is deferred because of age, weight, or cardiac malformations characterized by a hypoplastic right or left ventricle.
Management of Life-Threatening Hemoptysis
Authors: Lim Yeong Phang , Wong Daniel , Agasthian Thirugnanam
Published: May 2013

From June 1993 to June 1998, 50 patients were admitted with life-threatening hemoptysis (> 150 mL blood in 24 hours) due to pulmonary tuberculosis in 40, malignancy in 5, nontuberculous bronchiectasis in 4, and lung sequestration in 1. All patients had bronchial angiography with one session of embolization in 35 and more than one session in 11; no embolization was required in 4 cases. Surgery was necessary for recurrent hemoptysis in 6 patients. There were significant recurrences in 19 patients, of whom 5 died. Predictors of recurrence were the presence of mycetoma and presentation in a state of collapse. The fatal recurrences all took place within 1 week of the initial embolization and were probably due to incomplete embolization. In patients restudied after significant recurrences within 1 week of embolization, new vessels needed to be embolized in addition to previously treated vessels. It is postulated that some bleeding vessels may be missed at initial angiography, possibly due to vasospasm or low flow, and these may resume bleeding when the patient's hemodynamic status improves. An angiogram within 24 hours of embolization could identify such patients and they should be offered surgery if they are fit.
Carotid Body Tumors (Paragangliomas)
Authors: Ünlü Yahya , Ateş Azman , Özyazicioğlu Ahmet , Becit Necip , Erol Kemal , Ceviz Münacettin , Yekeler İbrahim , Vural Ünsal , Koçak Hikmet
Published: May 2013

Carotid body tumors were diagnosed in 19 patients (13 females and 6 males) between 1977 and 2000. All but one were operated upon. The ages of the 18 surgically treated patients ranged from 17 to 65 years. Carotid body tumor was confirmed in 16 cases; the diagnosis was neurofibroma in 1 and tuberculosis lymphadenitis in 1. The carotid body tumors were resected without a shunt procedure. Eight patients underwent total resection, 6 had resection and saphenous vein interposition, 1 had partial resection, and 1 had carotid artery ligation with no resultant neurological deficit. One case of hypoglossal paralysis and one benign ipsilateral recurrence were detected. Contralateral recurrence was detected in 1 patient 4 years postoperatively. No mortality or malignant course was observed.
Surgical Treatment of Giant Coronary Artery Aneurysm
Authors: Wu Qing Yu , Li Dian Yuan , Hu Sheng Shou , Pan Shi Wei , Qi Shi Tao
Published: May 2013

A 39-year-old man and a 38-year-old woman were diagnosed to have giant coronary artery aneurysm with a fistula to the left ventricle. Coincidental aortic valve incompetence was also present in the man. The manifestations and successful surgical management of this rare pathology are described.
Gastric Cancer Found Incidentally during Gastroepiploic Artery Harvest
Authors: Hirose Hitoshi , Amano Atsushi , Takahashi Akihito , Nagano Naoko
Published: May 2013

Gastric carcinoma was found incidentally while harvesting the gastroepiploic artery in 2 patients undergoing coronary artery bypass grafting. Careful examination of the stomach before harvesting the gastroepiploic artery is mandated, and if any masses are detected, an alternative conduit should be used.
Repair of Intercostal Arteries in Thoracoabdominal Aneurysm
Authors: Yokoyama Yukifusa , Tamaki Shuji , Ito Masao , Kato Noriyuki , Yokote June , Mutsuga Masato , Okada Masaho
Published: May 2013

A parallel aortic graft composed of a 20-mm graft with two 10-mm accessory grafts was used in the repair of a large thoracoabdominal aneurysm in a 50-year-old man. The graft was attached to 6 intercostal arteries and used immediately for spinal cord perfusion before repairing the aneurysm. The patient recovered quickly without paraplegia.
Repair of Double Coaraction or Aorta with Associated Anomalies
Authors: Bedi Harinder Singh , Kalkat Maninder Singh , Sharma Ved Prakash , Mahajan Vijay
Published: May 2013

An 8-year-old boy who had coarctation of the aorta with two stenotic ridges, a stenotic left subclavian artery, and absence of collaterals, underwent successful surgical repair. Both ridges showed histopathological features of true coarctation.
Right Atrial Hydatid Cyst with Multiple Organ Involvement
Authors: Kardelen Firat , Akçurin Gayaz , Ertuğ Halil , Beyazit Ömer
Published: May 2013

Cardiac hydatid disease is uncommon, especially in children. A 13-year-old girl had pulmonary and renal hydatidosis diagnosed by chest radiography, computed tomography, and magnetic resonance imaging. Serologic tests for hydatidosis were positive. A right atrial hydatid cyst was diagnosed on two-dimensional echo-cardiography. Medical treatment with albendazole was started and the cyst was successfully removed.
Management of Post-Fontan Chylothorax with Non-Valved Silastic Conduit
Authors: Jitendra Vikram , Reddy D Bhaktavatsala , Kumar M P Naresh
Published: May 2013

A non-valved silastic pleuroperitoneal shunt and omentoplasty were used to treat persistent chylothorax and chylopericardium in a 2-year-old boy who had undergone a Fontan operation.
Minimally Invasive Saphenous Vein Harvesting Using Conventional Instruments
Authors: Agarwal Vijay , Agarwal Surendra K , Gupta Nirmal K , Srivastava Ashok K
Published: May 2013

A technique to harvest saphenous vein using conventional surgical instruments is described. The method carries the advantage of dissection under direct vision without trauma to the vein.
Even a Root Canal Has its Advantages: Dental Syringe as a Mist Blower
Authors: Bedi Harinder Singh , Kalkat Maninder Singh
Published: May 2013

In coronary artery surgery, especially during off-pump procedures and when continuous retrograde warm blood cardioplegia is used, a gentle but effective system is required to improve visualization without desiccating tissues. A simple, efficient, reusable, and very cost-effective device is described.
Coronary Artery Assessment by Epicardial Pulsed Doppler Ultrasound
Authors: Tedoriya Takeo , Siniawski Henrik , Tambeur Luc , Huebler Michael , Hetzer Roland
Published: May 2013

An intraoperative method was developed for direct investigation of the coronary arteries using an epicardial high-frequency two-dimensional Doppler ultrasound transducer. This fingertip 7.5-MHz transducer was used in 30 patients undergoing coronary artery bypass surgery to measure blood flow in the coronary arteries and bypass grafts. In all the patients, clear images of the coronary arteries and the bypass grafts were obtained in the beating heart, and coronary blood flow could be measured to evaluate the degree of stenosis. There were no significant differences between the measurements obtained with the Doppler transducer and a transit-time ultrasonic flowmeter of blood flow in the left internal thoracic artery graft to the left anterior descending coronary artery, indicating that the Doppler method produces accurate and reproducible measurements. This method can provide useful intraoperative information about the coronary artery system in emergency operations such as acute aortic dissection.
Another Autograft for Coronary Artery Bypass Grafting
Authors: Wang Wen Lin , Zeng Wei Sheng , Jiang Ren Chao
Published: May 2013

To assess the possibility of using the descending branch of the lateral circumflex femoral artery as a free arterial autograft for coronary artery bypass grafting, the anatomy of this artery and its surrounding structures were studied in 19 cadavers. The artery was found to be situated in the groove between the rectus femoris and the vastus intermedius muscles. The mean length of the arterial trunk was 12 ± 2.36 cm (range, 9.2 to 15.1 cm). The diameter was 2.7 ± 0.35 mm at the origin and 2.2 ± 0.28 mm at the terminal end. The reflection of this artery on the body surface was easy to locate. It was concluded that the descending branch of the lateral circumflex femoral artery could be considered as a potential conduit for coronary revascularization.
Radical Pericardiectomy for Chronic Constrictive Pericarditis
Authors: Omoto Tadashi , Minami Kazutomo , Varvaras Dimitrios , Böthig Dietmer , Körfer Reiner
Published: May 2013

A retrospective analysis was undertaken in 79 patients who underwent pericardiectomy for chronic constrictive pericarditis from January 1985 to February 1999. Most operations (77) were carried out with cardiopulmonary bypass, with subtotal pericardiectomy in 75 patients, and concomitant operations in 25. Postoperative complications occurred in 8 patients: cerebrovascular accident in 2, renal insufficiency in 5, bleeding in 2, low output syndrome in 4, and respiratory insufficiency in 2. The operative mortality was 5%; causes of death were cardiac-related in all cases. Actuarial survival at 1, 5, and 10 years was 89.9% ± 3.4%, 74.9% ± 5.7%, and 55.4% ± 13.5%, respectively. Regression analysis was performed using 53 clinical variables. Female gender, renal insufficiency, concomitant coronary artery bypass grafting, and preoperative right ventricular end-diastolic pressure > 20 mm Hg were found to be predictors of poor survival. At follow-up, improved functional status was noted in 88% of patients. Subtotal pericardiectomy can be performed on cardiopulmonary bypass with low mortality and good long-term survival.
Surgical Management of Sternoclavicular Joint Infection
Authors: Lim Chong Hee , Lim Jeremy , Naik Madhava Janardhan , Agasthian Thirugnanam
Published: May 2013

Sternoclavicular joint infection is rare and tends to present insidiously in debilitated and immunocompromised patients. Between August 1996 and July 1998, we managed 7 patients with 8 sternoclavicular joint infections. Three were women. Their age ranged from 42 to 63 years. Five of the patients had significant associated medical conditions. Six patients, including 1 with bilateral involvement, underwent surgical resection, which consisted of radical excision of the involved joint, medial third of the clavicle, first and second ribs and adjacent muscular wall, and part of the manubrium. All of them underwent delayed reconstruction with either pectoralis major or latissimus dorsi flaps. There was 1 operative mortality from continuing sepsis from another source. All the surviving patients showed no sign of local recurrent infection and no functional deficits at follow-up. We conclude that infection of the sternoclavicular joint often presents late in debilitated patients. Medical therapy often fails in these cases. Radical excision is effective in eradicating the septic focus, and functional results after reconstruction are excellent.
Losartan in the Therapy of Heart Failure Patients
Authors: Berezin Alexander E
Published: May 2013

The effects of losartan on myocardial remodeling and neurohumoral status were studied in 240 patients with congestive heart failure. The patients were randomized into 3 groups of 80 subjects. Each group continued to receive conventional therapy including the angiotensin-converting enzyme inhibitor enalapril. Group 1 was also given a placebo, groups 2 and 3 had losartan in doses of 25 mg and 50 mg daily, respectively. The course of treatment was 48 weeks. Cardiac function was assessed by B-mode and Doppler echocardiography. Plasma neurohormone levels were determined by radioimmunoassay. Losartan in a dose of 50 mg daily gave the best improvement in cardiac function and the most marked reduction in plasma levels of renin, angiotensin II, aldosterone, atrial natriuretic peptide, endothelin-1, and norepinephrine levels than the lower dose of losartan or placebo. The fall in cortisol and serotonin levels was similar in each group. These data demonstrate the dose-dependent effects of losartan and clarify its role in the treatment of congestive heart failure.
Routine Transradial Coronary Angiography in the Malaysian Population
Authors: Pillay Devan , Lam Kai Huat , Joshi Sanjiv , Muda Mohd Nasir , Hamid Zainal Abidin Abdul
Published: May 2013

The feasibility and safety of routine transradial coronary angiography was assessed prospectively in 394 patients between March 1998 and July 1999. All patients had a normal Allen's test. The right radial approach was used in 84% of cases and the left in 16%. Radial artery catheterization was successful in 91% of patients; the left coronary artery was selectively catheterized in 92%, and the right coronary artery in 91%. Procedure time was 28 ± 20 minutes, screening time was 8 ± 5 minutes, and 62% of patients were discharged on the same day. The optimal catheter selection was a single Castillo catheter for both coronary arteries. Left ventriculography was performed with the same catheter in 25% of patients. One patient had a left Judkins catheter that kinked and became entrapped in the right subclavian artery, requiring vascular surgery. No coronary or neurological complications were observed. Asymptomatic radial occlusion occurred in 3.5% of patients. The transradial approach was considered to give a high degree of success and an acceptable complication rate in this patient population.
Complete Myocardial Revascularization in Severe Arteriopathy
Authors: Tang Augustine TM , Devbhandari Mohan , Ohri Sunil K
Published: May 2013

Multivessel coronary revascularization was successfully performed in a 75-year-old man with severe atherosclerosis of the ascending aorta and aortic arch, significant stenoses in the right subclavian, innominate, and aortoiliac arteries, renal impairment, and conduit shortage, by combining the beating-heart approach with aorta-sparing pedicled arterial and venous grafts. No postoperative complications were encountered.
Infected Myocardial Hydatid Cyst Imitating Pericardial Cyst
Authors: Özergin Ufuk , Durgut Kadir , Görmüş Niyazi , Sunam Güven Sadi , Yüksek Tahir
Published: May 2013

Pericardial hydatid cyst was diagnosed by 2-dimensional echocardiography and magnetic resonance imaging in a 25-year-old female. At operation, an infected myocardial hydatid cyst was found on the lateral wall of the left ventricle.
Accessory Mitral Valve Tissue Obstructing Left Ventricular Outflow Tract
Authors: Sajja Lokeswara Rao , Mannam Gopi Chand , Sriramulu Sompalli , Missula Satish Kumar
Published: May 2013

A 6-year-old girl underwent surgical excision of accessory mitral valve tissue causing significant subaortic stenosis. Preoperative 2-dimensional echocardio-graphy gave the necessary information on this isolated anomaly. The approach through an aortotomy provided adequate exposure. Postoperatively, there was no residual gradient across the left ventricular outflow tract, or mitral regurgitation.
Surgical Retrieval of Malpositioned Ductal Coil
Authors: Chowdhury Sowrangshu Kumar , Ranjit Madathil Sahadevan , Saldanha Richard , Balakrishnan Komarakshi Rajagopalan
Published: May 2013

A 3.5-year-old girl underwent transcatheter closure of a patent ductus arteriosus, which resulted in severe hemolysis. The malpositioned coil was surgically retrieved under cardiopulmonary bypass.
Epigastric Pain after Tube Thoracostomy: A Case of Vagal Irritation
Authors: Kaya Seyda Ors , Yuncu Gokhan , Cakan Alpaslan
Published: May 2013

A 58-year-old man with spontaneous pneumothorax experienced severe burning pain in the epigastric region after insertion of a chest tube. Chest radiography showed malposition of the tube, abutting the mediastinum. On suspecting that the vagus nerve had been stimulated by the tip of the tube, the tube was withdrawn 3 cm, and the pain disappeared completely.
Pseudolymphoma of the Lung: Benign or Malignant?
Authors: Rana Sandip Singh , Dhaliwal Rajinder Singh , Bambery Pradeep , Kakkar Nandita
Published: May 2013

Pseudolymphoma of the lung has been considered benign, premalignant, or frankly malignant. A case that responded to simple surgical resection is described. The patient remained well during a follow-up of more than 10 years.
Mini-Incision Midline Approach for Infrarenal Abdominal Aortic Aneurysms
Authors: Ogino Hitoshi , Matsumoto Masahiko , Sugita Takaaki , Nishizawa Junichiro , Matsuyama Katsuhiko , Yoshioka Tatsuya , Tokuda Yoshiyuki
Published: May 2013

A small (13.1 ± 1.3 cm) anterior midline incision is described for graft replacement of infrarenal abdominal aortic aneurysms. Stoney vasculature retractors were employed to achieve sufficient exposure. The operative outcome was satisfactory in 33 elective cases.
Cardiac Surgery under Perfusionless Hypothermia: Siberian Experience
Authors: Karaskov Alexander M , Kitchlu C Saifuddin , Lomivorotov Vladimir N
Published: May 2013

Between January 1995 and December 1999, 942 patients (452 males and 490 females) aged 1 to 51 years underwent definitive surgery under perfusionless hypothermia for correction of congenital heart defects, predominantly uncomplicated ventricular or atrial septal defects (80%). Hypothermia of 24°C to 28°C was achieved in 15 to 45 minutes (mean, 25.7 ± 1.2 minutes) by application of crushed ice over the body and head. Aortic crossclamp time ranged from 10 to 76 minutes (mean, 26.1 ± 0.25 minutes). Cardiac restoration time ranged from 1 to 10 minutes (mean, 2.1 ± 0.08 minutes). Eight patients (0.85%) died postoperatively: 4 from acute cardiac insufficiency, 2 as a consequence of technical faults, 1 from persistent pulmonary hypertension, and 1 had sudden cardiac arrest. None of the surviving patients showed any gross neurological deficit. Perfusionless hypothermic cardiac surgery, when applied appropriately, is safe and simple, and might still have a place in treating a selected group of patients with uncomplicated congenital heart defects.
Early and Long-Term Results of Surgical Repair of Pectus Excavatum
Authors: Erdoğan Abdullah , Ayten Arife , Öz Necdet , Demircan Abid
Published: May 2013

From 1990 to 1998, 30 patients underwent surgery for correction of pectus excavatum. There were 19 (63%) males and 11 (37%) females, aged 4 to 32 years (mean, 12.57 years). Bilateral excision of 4 to 6 costal cartilages and sternal wedge osteotomy were performed on 27 (90%) patients, and Kirschner wires were used for substernal support in 25 (83%). A median sternotomy was carried out in males and a submammary transverse incision was preferred in females. All patients were followed up at yearly intervals. Early results were excellent in all except 2 cases: a 14-year-old boy developed contralateral sternal depression after costochondral excision without sternal elevation for correction of one-sided costochondral hyperplasia; and an 8-year-old girl in whom no Kirschner wires had been inserted developed recurrent minimal sternal depression. Long-term follow-up showed recurrent sternal depression 6 years postoperatively in a boy who had undergone surgery at 4 years old, with early removal of the Kirschner wires. It is recommended that correction of pectus excavatum should be carried out in prepubertal children, and Kirschner wires should be used for substernal support.
Common Causes of Pleural Effusion in Referral Hospital in Isfahan, Iran 1997–1998
Authors: Golshan Mohammad , Faghihi Mehri , Ghanbarian Khadijeh , Ghanei Mustafa
Published: May 2013

During a one-year period to September 1998, data were collected from all 213 patients referred with pleural effusion. There were 132 males and 81 females; their ages ranged from 18 to 85 years. The most common etiologies of effusion were congestive heart failure (39.4%), malignancy (27.2%), pneumonia (8%), empyema (5.2%), and tuberculosis (5.2%). Pleural effusions are frequent in Iran, and the causes are fairly similar to those reported by European authors, but with slightly more tuberculosis cases, mostly among Afghan refugees.
Superior Mesenteric Artery Aneurysm
Authors: Yüksel Münevver , Islamoğlu Fatih , Egeli Ünal , Posacioğlu Hakan , Yilmaz Rasih , Büket Suat
Published: May 2013

A 38-year old woman with mid-epigastric pain, diarrhea, and weight loss, underwent resection of a superior mesenteric artery aneurysm and primary repair of the artery. Pathological examination showed degenerative atherosclerotic changes, marked medial and intimal thickening, and vegetations. Microbiological studies demon-strated Streptococcus viridans as the infecting organism of this mycotic aneurysm. The patient made a good recovery and remained well after 3 years.
Surgical Treatment of Echinococcal Cysts of the Heart: Report of 3 Cases
Authors: Özyazicioğlu Ahmet , Koçak Hikmet , Ceviz Münacettin , Balci Ahmet Yavuz
Published: May 2013

Three patients diagnosed with hydatid cysts of the heart underwent surgical treatment. The cysts were enucleated and the cavities were closed in 2 cases by plication and obliteration. In one case, the cystic cavity was closed with biologic glue. The outcome was satisfactory in all 3 patients. Postoperative treatment with albendazole is recommended.
Iatrogenic Coarctation after Coil Occlusion of Arterial Duct
Authors: Aydoğan Ümrah , Batmaz Gülhis , Tansel Türkan
Published: May 2013

Coil occlusion of a patent ductus arteriosus was performed in an 8.5-month-old girl with a large left-to-right shunt through a wide arterial duct. Post-occlusion echocardiography revealed iatrogenic obstruction of the aorta caused by protrusion of the loops of the Jackson coil into the descending aorta. The problem resolved spontaneously during follow-up.
Right Pulmonary Artery-to-Left Atrial Fistula
Authors: Faizal Ali , Sankar Nainar Madhu , Murthy Kona Samba , Cherian Kotturathu Mammen
Published: May 2013

Right pulmonary artery-to-left atrial fistula is a rare congenital anomaly. Contrast echocardiography and cardiac catheterization diagnosed a right pulmonary artery-to-left atrial fistula in a 24-year-old female with a history of cyanosis since childhood, and recurrent thromboembolism. She underwent successful surgical closure of the fistula.
Cardiopulmonary Bypass before General Anesthesia in Prosthetic Valve Thrombosis
Authors: Erdil Nevzat , Çetin Levent , Nisanoglu Vedat , Sener Erol , Demirkiliç Ufuk
Published: May 2013

Valve obstruction is a lifethreatening complication of mechanical valve prostheses. Emergency operation is mandatory for patients who subsequently develop cardiogenic shock and severe pulmonary edema. In this severely compromised hemodynamic condition, cardiac arrest develops in most of the patients before surgery and just after general anesthesia induction. In one such case, we performed femorofemoral cardiopulmonary bypass with local anesthesia before general anesthesia induction and successfully replaced the thrombosed prosthetic valve, thus avoiding a catastrophic outcome.
Spinal Cord Ischemia Associated with Cardiac Arrest
Authors: Bozkurt A Kürsat
Published: May 2013

Ischemic spinal cord damage from cardiac arrest is rare. A 48-year-old man underwent a straightforward retroperitoneal aortofemoral bypass operation. The following day, he developed cardiac arrest and was resuscitated successfully, but permanent paraplegia was observed soon afterwards.
Power Doppler Imaging for Detection of Harvest Injury of Internal Mammary Artery
Authors: Suematsu Yoshihiro , Takamoto Shinichi , Ohtsuka Toshiya , Motomura Noboru , Miyairi Takeshi
Published: May 2013

Harvest injury of the internal mammary artery can lead to early thrombosis, which may be difficult to differentiate from atherosclerosis or harvest spasm in some cases. We describe the efficacy of intraoperative evaluation of the internal mammary artery by power Doppler imaging during off-pump or minimally invasive direct coronary artery bypass grafting.
Totally Robotic Technique in Multivessel Coronary Disease — Is it Possible?
Authors: Susilo Andi W , Schulz Arndt P
Published: May 2013

Robotic techniques in coronary surgery have been established for a few years. The preparation of the internal mammary arteries is now a well-described procedure, as is anastomosis to the anterior wall vessels under cardiopulmonary bypass. To achieve totally robotic complete revascularization of the heart, there are still some problems to be solved. Potential solutions are discussed. Current techniques using telemanipulation systems in cardiac surgery are described and explained. Totally endoscopic off-pump complete revascularization of the heart might be achieved by a combination of techniques already developed by different teams around the world.
Clinical Features and Surgical Treatment of Cardiac Myxoma: Report of 18 Cases
Authors: Durgut Kadir , Görmüs Niyazi , Ozulku Mehmet , Özergin Ufuk , Özpinar Cevat
Published: May 2013

Myxomas are the most common benign primary cardiac tumors. As many patients with cardiac myxoma suffer from cerebral or systemic embolism, which are serious complications, diagnosis of the tumor is vital. Between 1990 and 2000, 18 patients (6 males, 12 females), aged 24 to 73 years (mean, 55.3 years), were operated on for cardiac myxoma. The most common location of the myxoma was the left atrium (78%), and the transseptal surgical approach was preferred (78%) as it allows total resection of the left atrial myxoma along with its pedicle. Carney complex, a familial autosomal dominant form of atrial myxoma, was not found in any of the patients. There had been no operative or postoperative mortality and morbidity. The mean postoperative follow-up period was 5 years (mean, 1 to 10 years). No recurrence had been seen. We believe that the transseptal approach, in allowing total resection of the myxoma, prevents recurrence.
Arterial Duct Closure with Detachable Coils: Application in the Small Child
Authors: Aydoğan Ümrah
Published: May 2013

Transcatheter closure of patent ductus arteriosus using controlled-release coils was performed in 16 patients weighing < 10 kg. No embolization occurred. Procedure-related complications occurred in 3 patients (18.8%): massive femoral hemorrhage in 1 and femoral artery thrombosis in 2. The ductus recanalized in 1 of them because of mechanical hemolysis caused by streptokinase treatment. This was the only patient who underwent another occlusion procedure. Complete occlusion was achieved in 7 patients (43.8%) immediately, in 13 (81.2%) the following day, and in all 15 patients who had completed the 6-month follow-up. During follow-up, flow velocities between the left and the main pulmonary arteries and between the descending and the ascending aortae did not differ significantly. Flow velocity was > 2 m·sec−1 in 3 patients in the left pulmonary artery and in 1 in the descending aorta. Protrusion of the coil was seen in 3 of these patients. Flow velocity was also high in the main pulmonary artery in the 4th patient. In conclusion, coil occlusion of ductus arteriosus is feasible in the small child, but no more than half a loop of the coil should be left at the pulmonary site. High flow velocity does not always mean obstruction.