bluuebunny/crossref_metadata_2025_split huggingface dataset:
Performance of the Tilt-Disc Valve in the Inferior Vena Cava: An Animal Study
Authors: Phifer Travis J. , Price David T. , Thomas Mary B. , Grafton Warren D. 
Published: August 2008

The authors' laboratory recently reported long-term patency of valvular xenografts in the canine inferior vena cava. Valve fibrosis, however, followed early nonocclusive perileaflet thrombosis. A potential design flaw in the tricus pid prototype with open leaflets juxtaposed to the vascular wall possibly caused flow stagnation in valve cusps and initiated thrombus formation. The authors evaluated this hypothesis by design modification to a tilt-disc mechanical proto type with no valve cusps and continuous washing of the open midlumenal disc. The study included 12 metal alloy, tilt-disc valves placed in the canine infe rior vena cava. Daily aspirin (80 mg) and dipyridamole (50 mg) were begun on the day before implantation, with a single bolus of intravenous heparin (100 units/kg) administered prior to vascular occlusion. Angiography followed by complete autopsy was performed at two weeks in 6 animals, and at four weeks in 4 animals. Two animals underwent valve explantation fifteen minutes after reflow with examination of the vena cava at the site of valve placement by scan ning electron microscopy. Five valves were patent at two weeks. Four valves were patent at four weeks. Thrombus formed on the surface of the disc and supporting structure in all 9 patent valves, however, and underwent progressive organization with eventual valve fibrosis. A small, asymptomatic pulmonary embolus was discovered upon autopsy at four weeks in 1 animal. Scanning electron microscopy showed leuko cyte adherence to the lumenal surface within fifteen minutes after reflow. This study, as well as previous work, shows feasibility for maintenance of prosthetic valve patency in the vena cava. Correction of a potential design flaw in the tricuspid tissue valve by elimination of the sinus with continuous leaflet washing in a tilt-disc mechanical prototype failed, however, to prevent peri leaflet thrombosis.
Dye-Enhanced Tissue Welding Using Fibrinogen and Continuous-Wave Argon Lasers
Authors: Libutti Steven K. , Oz Mehmet C. , Chuck Roy S. , Treat Michael R. , Nowygrod Roman 
Published: August 2008

Despite their theoretical advan tages, laser-welded anastomoses ini tially appear prone to rupture. Furthermore, the repair of defects seen in the weld following laser energy expo sure is often hindered by thermal in jury to the tissue edges. In this study, the immediate strength of these welds has been increased by the application of fibrinogen combined with a laser-en ergy-absorbing dye, fluorescein isothiocyanate (FITC, maximum absorbance 490 nm), to the anasto motic site prior to continuous-wave argon laser exposure (488-514 nm, 5.66 watts/cm2). A rabbit abdominal aorto tomy model was employed. Data ob tained immediately after welding demonstrated that the mean bursting pressure of welds created without fi brinogen (184 ± 65 mm Hg, n = 12) was significantly less than that of re pairs with fibrinogen (407 ± 72 mm Hg, n = 11) (p<.001). Defects seen in the weld immediately after laser expo sure could be easily repaired by addi tional application of fibrinogen and repeated laser treatment. Histologi cally, aortotomies repaired with fibrin ogen demonstrate less thermal injury to host tissues than nonsolder repairs do. Laser soldering with exogenous fi brinogen significantly improves the bursting strength of primary laser- welded anastomoses and mitigates technical difficulties with laser tissue welding.
Fatal Paradoxical Embolus Due to a Central Venous Pressure Catheter: Case Report
Authors: Raffa Hassan , Mosieri Jackmerry , Fageeh Nizar 
Published: August 2008

A case of paradoxical embolus that caused initial ischemic changes on the electrocardiogram monitor and later a massive myocardial infarction and cardiac arrest with death is presented. This occurred during a pulmonary wedge biopsy to determine the operability in a twenty-eight-year-old patient with ventricular septal defect and high pulmonary artery pressure diagnosed by catheterization. Autopsy revealed a long blood clot measuring 6 cm in length and 0.5 cm in width sitting and completely blocking the orifice of the left coronary artery. This caused the coronary insufficiency. A similar clot was found on the tip of the central venous pressure catheter when the right atrium was opened. The causes of and means of preventing this fatal complication in patients with left and right-heart communications are discussed in detail.
Changes in Femoral Artery Blood Flow and Supersensitivity of Arteries to Norepinephrine After Lumbar Sympathectomy in Dogs
Authors: Iwahashi Kanji , Hiratani Katsuhiko , Tsunekawa Kengo 
Published: August 2008

Blood flow of the femoral arteries of both sides was measured, and changes in sensitivity of the arteries to norepinephrine were studied in unilateral sym pathectomized canine hindlimbs, in order to demonstrate the presence of super sensitivity of arteries to norepinephrine after sympathectomy. Before injections of norepinephrine into the vein, the ratio of blood flow in the femoral artery on the sympathectomized side to that on the opposite side increased in L3-L5 and in L3-L7 sympathectomized hindlimbs. This ratio of blood flow decreased in inverse proportion to the increase of doses of norepinephrine admin istered into the vein in both groups, and finally the flow on the sympathectomised side became lower than that on the nonsympathectomized side. The dorsal pedal arteries on the L3-L5 sympathectomized side, which are subject to decentralization but not denervation, had a slight degree of supersen sitivity to norepinephrine. The saphenous arteries on the L3-L5 sym pathectomized side were incompletely denervated and showed a moderate degree of supersensitivity to norepinephrine. The saphenous and the dorsal pedal arteries on the L3-L7 sympathectomized side were denervated almost completely and showed a significant increase in sensitity to norepinephrine. These results provide evidence that supersensitivity to norepinephrine does occur in the arteries of sympathectomized canine hindlimbs.
Diabetes Mellitus and Coronary Artery Bypass Surgery
Authors: Berki Thran , Kocak Tuncer , Balkanay Mehmet , Isik Ömer , Yakut Cevat 
Published: August 2008

Two hundred diabetic coronary artery heart disease patients were operated during a fifty-four-month period. The total number of coronary artery bypass grafting (CABG) operations performed in this period was 1300. Emergency CABG operations were excluded from this study. The diabetic patient population was subclassified as having latent diabetes, diabetes regulated with diet or oral antidiabetic agents, and insulin-dependent diabetes mellitus (IDDM). Congestive heart failure and left ventricular hypertrophy seen in the diabetic population was a significant clinical feature as compared with the nondiabetic patients. An giographically the distribution of localized coronary artery lesions was similar, but a diffuse atherosclerotic vessel disease pattern was prominent in the diabetic group. Segmental wall motion in diabetic patients revealed severe ventricular dysfunction as compared with the nondiabetic group. Hospital mortality was 6.8% to 8.5 % in favor of the nondiabetic group. Low cardiac output, renal complications, mediastinitis, and wound infections were encountered more fre quently in the diabetic patients. The distal coronary artery anastomosis rates in nondiabetic and diabetic patients were 2.8 and 3.1 respectively. The high rate of vascular and metabolic complications seen in this systemic disease has led the authors to accept diabetes mellitus as a risk factor in CABG surgery.
A New Syndrome: The Popliteal Pseudo-Entrapment
Authors: Psathakis Dimitrios N. 
Published: August 2008

The pseudo-entrapment syndrome is caused by kinking of the popliteal artery and vein, and/or of the common tibial nerve, and occsionally of the common fibular nerve. The clinical symptoms are similar to the symptoms found in the entrapment syndrome. The kinking in pseudo-entrapment syndrome is caused by a transverse fibrous band, resulting in calf pain and distress. Pathogenesis, diagnosis, and operative treatment of this new and common syndrome are described. In 66 lower limbs of 49 patients a popliteal pseudo-entrapment syndrome was confirmed by Doppler ultrasound. It was caused by kinking of the popliteal vessels and nerves on one or more fibrous bands transversing the popliteal fossa from the lateral to the medial head of the gastrocnemius muscle. Of the 49 patients (66 limbs), 32 patients, mostly women, (41 limbs) were opperated on by dividing the fibrous bands. Results after operation were assessed by Doppler ultrasound. Pulsation in the pedal arteries was present in spite of maximal knee flexion and tiptoeing. Postoperatively the patients were without symptoms and complaints. The results achieved by operation were still maintained five years later.
Leiomyosarcoma of the Inferior Vena Cava—A Case Report
Authors: Wicky B.N. , Sege D.G. , Amgwerd R. 
Published: August 2008

The authors report a rare case of leiomyosarcoma of the inferior vena cava (IVC) with an unusually long survival time of more than five years without signs of local or systemic tumor recurrence up to today. The diagnostic and therapeutic problems are discussed and the relevant literature is considered. The diagnosis was assessed by computed tomographic scan. The surgical treatment consisted of resection of the tumor (located in the inferior and middle third of the IVC), together with the right kidney. After proximal ligature of the left kidney vein no reconstruction of the resected segment of the IVC was performed. Owing to an adequate collateral venous drainage the kidney function remained normal. The prognosis of this rare tumor is reported to be quite poor with a resectability rate of about 60% and a mean survival time of two to three years after surgery. Alternative treatment modalities such as irradiation or chemotherapy are considered to be of no additional benefit.
Results of 300 Bileaflet Mechanical Valve Implanatations
Authors: Işik Örner , Balkanay Mehmet , Kisacikoglu Bülent , Tanugur Hüseyin , Bayezid Omer , Yakut Cevat 
Published: August 2008

Three hundred bileaflet mitral or aortic mechanical prosthetic heart valves were implanted in 250 patients over a four-year period at Kosuyolu Heart and Research Center: 96 patients underwent mitral valve replacement (MVR), 81 aortic valve replacement (AVR), and 73 AVR + MVR. Seven of the mitral, 8 of the aortic, and 2 of the double valve replacements involved additional cardiac proce dures. Sex ratio was 63% females, 37% males. The youngest patient was nine, the oldest was seventy-six, and the average age was thirty-nine years; 59% of the patients had atrial fibrillation, 66% were in NYHA functional Class III-IV, and 61% were in congestive heart failure. Hospital mortality was 9.6% and late mortality was 4%. The predictors of survival were evaluated. Preoperatively and postoperatively 17 variables were studied by statistical analysis. Factors identified as influencing survival were: female sex, advanced age, NYHA Class more than III, increased cardiothoracic ratio, congestive heart failure, diabetes mellitus, giant left atrium, and prosthet ic valve endocarditis. Eleven patients developed endocarditis, and 21 had throm boembolic episodes. The authors conclude that the bileaflet mechanical prosthetic heart valve is a good candidate for mechanical valve replacement among the currently availa ble choices.
Inferior Vena Cava Interruption for the Prevention of Pulmonary Emboli: Advantages, Disadvantages, and Complications
Authors: Borrero Edgar , Rosenthal David 
Published: August 2008

Pulmonary embolism (PE) in high-risk patients is minimized by inferior vena caval interruption by ligation, plication/clipping, intraluminal filters, or intralu minal balloons. Vena caval filter implantation is the least traumatic of all surgi cal implantation is the least traumatic of all surgical methods of preventing PE. These nonocclusive methods are preferred to minimize the possible sequelae of venous insufficiency. The prevention of septic emboli requires complete liga tion of the inferior vena cava (IVC). The transvenous approach to IVC inter ruption by intraluminal filter is particularly useful in severely ill patients. The Kim-Ray Greenfield filters are at present the most frequently used mo dalities for prevention of fatal PE when intervention is required. In a large ser ies of patients who have had the Greenfield filer implanted, there has been an operative mortality of less than 1%, with an incidence of recurrent emboli of less than 2%, and an incidence of venous stasis sequelae of approximately 20%. In general, this device has greater ease and flexibility of placement with lower mortality and morbidity rates.
Arteriovenous Communications in Patients with Primary Varicose Veins: An Investigation Using Thermography, Blood Oxygen Tension, and Operative Microscopy
Authors: Kimura Tadahiro , Yoshizaki Satoshi , Matsumoto Sumio 
Published: August 2008

The presence of arteriovenous communications (AVCs) in the lower extremi ties of patients with primary varicose veins with or without ulcerations was inves tigated by use of thermography, analysis of the blood oxygen tension, and observation under operative microscopy. Fifty-six subjects, including 20 normal subjects and 26 patients with primary varicose veins, were studied. Subjects maintained a standing position in a quiet room while thermography was performed both before and after exercise. The exercise was performed tiptoeing at a rate of twenty times per minute. After exer cise, hot spots on the lower extremities of the patients with varicose veins were localized by thermography. In the normal subjects, blood samples were aspi rated percutaneously from the femoral artery and vein before and after lumbar anesthesia. In the patients with primary varicose veins, an incision was made in the inguinal region following lumbar anesthesia and samples of blood were aspirated from the femoral artery and vein, the saphenous vein, and the ther mographic hot spots. The venous and arterial blood oxygen tensions were deter mined immediately in the hospital laboratory by means of a blood gas analyzer. After lumbar anesthesia, there were significant differences between the oxy gen tensions of the hot spots and those of the femoral or saphenous veins in the patients with varicose veins (p < 0.01, p < 0.05). At operation, the hot spots were investigated by operative dissection and microscopy. Small, pulsating arteries were observed at the sites that corresponded to the hot spots. These results strongly suggest that AVCs open up in the dermal capillary bed as the result of a persis tently high venous pressure, and these shunts, by diverting oxygenated blood away from the overlying skin, produce skin ischemia and ulceration.
Laser Vascular Anastomosis—Preliminary Evaluation of a New Anastomotic Technique
Authors: Brooks Stephen G. , Ashley Simon , Gehani Abb A. , Davies G. Alban , Fisher John , Kester Ralph C. , Rees Michael R. 
Published: August 2008

Laser vascular anastomosis (laser welding) is a developing technique that em ploys the thermal effect of laser energy to achieve fusion of apposed vessel edges. The authors have attempted to establish a definitive technique by an investiga tion of the physical properties of laser welds. Porcine coronary arteriotomies were repaired in vitro by two different laser wavelengths (Argon [488/514 nm] and Nd:YAG [1064 nm]) and by use of chromophore dyes to enhance energy absorption at the anastomosis. Anastomatic bursting strength was measured directly by means of saline infusion and vessel constriction (caused by diffusion of heat from the weld) assessed by a constant-pressure flow rate model. Histo logic techniques were also employed to estimate the degree of thermal damage to the vessel. In all these respects optimal results were obtained by the Argon laser and use of the chromophore Basic Fuchsin. These repairs all burst at greater than 200 mmHg and were minimally constricted. Thermal tissue damage was accurately confined to the anastomotic site. This technique will, therefore, be employed in future studies.
Red Cell Deformability Changes as a Prognostic Indicator of Postoperative Morbidity in Cardiac Surgery Using Cariopulmonary Bypass
Authors: Belboul Ali , Al-Kahaja Najib , Bergman Per , Roberts Donald , William-Olsson Göran 
Published: August 2008

Preoperative and intraoperative red cell deformability assessed by a standard microfiltration technique was used to study the gross rheologic changes of red cells due to disease and mechanical trauma in relation to postoperative compli cations following the use of cardiopulmonary bypass (CPB) for elective heart surgery in 142 patients in NYHA (New York Heart Association) class III. The red cell filtration rate (RCFR) in μL/s was determined before surgery and grouped rheologically into four functional classes (GTCA = Gothenborg Cardio-Thoracic Association). Compared with their laboratory's normal reference for 200 healthy individuals (mainly blood donors) (61 ± 9 μL/s ± 2 SD), the RCFR was signifi cantly reduced by 21% (p < 0.05) to GCTA class I (1-25% reduction) in 18 pa tients, by 34% (p<0.01) to class II (26-50% reduction) in 99, and by 54% (p<0.001) to class III (51-75% reduction) in 25. Significant RCFR reductions during CPB were seen in all the groups, where the mean reduction was lowest in class I (15% p<0.001) and highest in class III (76% p<0.001) as compared with normal subjects. The analyses of complications showed that significantly higher frequencies of bleeding, blood transfusion, respirator usage, and arrhythmia were found in class III than in class I (1.5 vs 0.8 L, p<0.05; 3 vs 1.5 units, p < 0.05; 14 vs 6 hours, p<0.05 respectively). The authors conclude that preoperative red blood cell deformability testing and grading of the patients' microrheologic status of red blood cells can be a complement to the NYHA function classification and can also be useful for study ing the morbid effects of surgical trauma associated with CPB.
Rupture of an Iliac Artery Aneurysm into the Rectum: A Case Report
Authors: Ravi Rajagopalan 
Published: August 2008

Arterioenteric fistulas are uncommon, particularly when involving the colon and rectum, and death often ensues from multisystem failure. A seventy-eight-year-old man was admitted to the hospital within a few hours after the onset of profuse rectal bleeding. The preoperative diagnosis was perfo rated diverticulitis, but exploratory laparotomy uncovered a ruptured right iliac artery aneurysm that had eroded into the rectum. A diverting sigmoid colosto my and cross femoral grafting were performed, and the patient recovered. Ear ly, aggressive surgical intervention and medical management were essential to the successful outcome of this case.
Coronary Sinus Pressure: A Condition per Se of Return Volume via the Coronary Sinus in the Healthy Animal? Surgical Considerations in Atriopulmonary Anastomosis Procedures
Authors: Fentidis P. , Fernández Ruiz Ma , Madero Jarabo R. , Cordovilla Zurdo G. 
Published: August 2008

In order to test the hypothesis of the "vascular waterfall" mechanism in coronary venous circulation, the role of coronary sinus pressure in the regulation of coronary return volume (CRV) via the coronary sinus (CS) was studied in healthy animals. An experimental model of pressure regulation in the CS was prepared and aortic and left atrial pressures, EKG, and the cardiac output (measured by thermodilution) were recorded. The return volume via the CS was measured at CS pressures of 10 or less, 15, 20, and 25 mm Hg or more, for a total of 36 determinations. Overall, increased CS pressure did not produce significant changes in aortic and left atrial pressures, heart rate, cardiac index, or CRV via the CS. When CS pressure was 25 mm Hg or more, however, there was a significant decline in the average CRV via the CS. Nevertheless, stepwise variant regression showed that the CS per se does not condition the volume of coronary return via the CS. The authors' results suggest that in healthy animals, the hypothesis of the "vascular waterfall" mechanism in coronary venous circulation is not valid. Thus, in correcting congenital cardiac malformations by use of atriopulmonary anastomosis procedures, there is no justification for employing techniques that ensure CS drainage into the left atrium in order to avoid the hemodynamic repercussions attributable to the hypothesis of the "vascular waterfall."
Use of Non-Valved Extracardiac Conduits in Complex Congenital Anomalies
Authors: Sarioglu Tayyar , Paker Tufan , Sarioglu Ayse , Bayindir Osman , Köner Ali , Aytaç Aydin 
Published: August 2008

Between March, 1986 and September, 1989, nonvalved conduits were used in 9 patients, ages ranging between five and seventeen years. Cardiac pathologies were atrioventricular and ventriculoarterial discordance with ventricular septal defects (VSD) and pulmonary stenoses (PS) in 5, transposition of great arteries (TGA) + VSD + PS in 1, and double-outlet left ventricle (DOLV) + VSD + PS in 3. Pulmonary obstruction was valvular in 1, valvular and infundibular in 7. There was 1 patient with pulmonary atresia. Valveless conduits 16-22 mm in diameter were used between the pulmonic ventricle and the pulmonary artery. All patients recovered from operation and remained well, except 1 with DOLV who died with severe arrhythmias the third postoperative day. During the mean follow-up of 32 ± 11.8 months 1 patient died of acute cardiac failure in the ninth month and all other patients were asymptomatic without needing reoperations. These results have been encouraging for the use of nonvalved conduits in complex congenital cardiac anomalies.
Ten Years of Experience with Aortoiliac Polytetrafluoroethylene Grafts—Effects of Postoperative Anticoagulation on Graft Function and Patient Survival
Authors: Függer Reinhold , Prager Manfred , Sautner Thomas , Magometschnigg Heinz , Kretschmer Georg , Polterauer Peter 
Published: August 2008

Between 1980 and 1990, 354 aortoiliac repair procedures were performed with polytetrafluorethylene (PTFE), which had become available in 1980. This retrospective analysis was designed to show whether anticoagulation or antiaggregant treatment had beneficial effects on patient survival and graft function. In patients with unilateral aortoiliac grafts, antithrombotic therapy with phenprocoumone or acetylsalicylic acid (ASA) improved graft function (Breslow, p=0.038; Mantel, p=0.013) and long-term survival (Breslow, p=0.013; Mantel, p = 0.009). However, the results concerning survival are devaluated, because the members of the control group were older (65.9 years vs 61.1 years, Chi square test p=0.01). In patients with PTFE bifurcation grafts, in whom risk factors and age were well balanced, survival was also significantly prolonged by postoperative drug treatment in the early years of the follow-up (Breslow, p=0.038; Mantel, p=0.298), but graft function was unaffected. These results suggest that postoperative anticoagulant therapy with ASA or phenprocoumone may be of some benefit in patients undergoing iliac PTFE grafting procedures. Based on these retrospective data, a randomized prospective trial was initiated to study the effects of different drugs suppressing coagulation, ie, anticoagulants and antiaggregants, on allogenous grafts.