Asian Cardiovascular and Thoracic Annals current issue

Selection of Valve Substitutes in Young Adults in Asia: An Evolving Issue [EDITORIAL]

Loisance — Tue, 02 Feb 2010 01:27:45 PST

3f Prosthesis Aortic Cusp Replacement: Implantation Technique and Early Results [ORIGINAL ARTICLE]

Pillai, Ratnatunga, Soon, Kattach, Khalil, Jin — Tue, 02 Feb 2010 01:27:46 PST

Stentless aortic bioprostheses have been successfully used for over a decade. The 3f bioprosthesis is a new equine pericardial stentless valve, unique in its tubular design, preserving the native aortic sinuses post-implant. Forty-six consecutive aortic valve replacements with the 3f bioprosthesis were performed between June 2003 and January 2005. The patients were prospectively assessed and echocardiography was performed at 6 months, 12 months, and annually thereafter. The median follow-up was 2.1 ± 0.9 years. There was one early and 4 late deaths; none were valve-related. The 2-year mean transvalvular gradient was 8.8 ± 3.8 mm Hg, the mean echocardiographic aortic regurgitation grade was 0.4 ± 0.7 (grade 1 being trivial). Echocardiographic sizing of the aortic annulus before surgery accurately predicted prosthesis size. The 3f bioprosthesis is easy to implant. Early clinical results are favorable, with hemodynamic profiles consistent with those of other stentless prostheses. Longer follow-up is required to confirm its durability.

Hemodynamic Advantages of Right Heart Decompression during Off-Pump Surgery [ORIGINAL ARTICLE]

Velissaris, Jonas, Ohri — Tue, 02 Feb 2010 01:27:46 PST

Cardiac maneuvering during off-pump coronary artery bypass surgery can compress the right ventricle, causing temporary dysfunction and hemodynamic instability. The hemodynamic impact of a decompression technique comprising right pleurotomy and pericardial release was investigated during cardiac elevation. Intraoperative continuous real-time monitoring of cardiac index and stroke volume index was carried out using the PulseCO system in 12 consecutive patients with normal ventricular function who underwent off-pump coronary artery bypass by a single surgeon. A pulmonary artery catheter was used to monitor pulmonary artery pressure and systemic venous O₂ saturation. Hemodynamic changes during vertical displacement of the heart were measured before and after performing a right pleurotomy and pericardial release. Following right heart decompression, stroke volume index, cardiac index, mean arterial pressure, and systemic venous O₂ saturation were significantly better preserved during cardiac elevation. This demonstrates that right heart decompression via pleurotomy and pericardial release significantly improves hemodynamic stability during cardiac manipulation. We recommend the use of this procedure in off-pump coronary artery bypass when cardiac tilting is required.

Simultaneous Use of Argatroban and Heparin during Cardiopulmonary Bypass [ORIGINAL ARTICLE]

Okamura, Shin'oka, Ishibashi, Ishii, Kurosawa — Tue, 02 Feb 2010 01:27:46 PST

Heparin is the routine anticoagulant for cardiopulmonary bypass, but complications due to heparin are often reported. This study assessed argatroban as an alternative to heparin. Normothermic cardiopulmonary bypass with hemodilution was performed for 2 h in 15 dogs (mean weight, 9.8 kg) randomly assigned to 3 groups of 5 each. The controls were given heparin 200 IU·kg^–1 before cardiopulmonary bypass; group A had argatroban infused continuously at a rate of 20 µg·kg^–1·min^–1; group H/A had half doses of both heparin (100 IU·kg^–1) and argatroban (10 µg·kg^–1·min^–1). Blood samples were collected at 5 time points during the experiment. Activated clotting time, hemoglobin level, platelet counts, and serum concentrations of fibrinogen, antithrombin III, and thrombin-antithrombin III complex were measured. The platelet count was reduced significantly, and the production of thrombin-antithrombin III complex was inhibited in group H/A. Activated clotting time remained <300 sec at all time points in group A, but it was maintained at approximately 400 sec in group H/A. Fibrinogen and antithrombin III levels were reduced to half in all groups after initiation of cardiopulmonary bypass. The simultaneous use of heparin and argatroban infusion might be useful for cardiopulmonary bypass with hemodilution.

Comparison of Cryoprecipitate with Commercial Fibrinogen in Bullectomy [ORIGINAL ARTICLE]

Nakanishi — Tue, 02 Feb 2010 01:27:46 PST

Fibrin glues are widely used for various pulmonary operations, but commercially produced glues are made of heterogeneous fibrinogen that has infection risks. We used autologous cryoprecipitate and evaluated its clinical value as a fibrin sealant instead of the commercially available glue. One hundred patients who underwent thoracoscopic bullectomy for primary spontaneous pneumothorax were studied. The apical visceral pleura was covered with an absorbable mesh and a fibrin glue. Autologous cryoprecipitate glue was used in 30 patients (group A), and commercially produced fibrinogen was used in 70 (group B). The mean duration of postoperative chest drainage was 1.9 days in group A and 1.5 days in group B. The cumulative 2-year postoperative recurrence rate was 3.4% in group A and 6.5% in group B. There were no differences in clinical results after surgery for primary spontaneous pneumothorax, using either autologous cryoprecipitate or commercially produced fibrinogen. The production autologous cryoprecipitate was easy and low-cost. We propose that autologous cryoprecipitates be used in operations for primary spontaneous pneumothorax.

Positron-Emission Tomography for Lung Cancer in a Tuberculosis-Endemic Region [ORIGINAL ARTICLE]

Sit, Sihoe, Suen, Cheng — Tue, 02 Feb 2010 01:27:46 PST

A potential limitation of integrated positron-emission tomography and computed tomography in non-small-cell lung cancer may be false-positive results due to granulomatous disease. This retrospective study examined the accuracy of this imaging modality for mediastinal nodal staging of non-small-cell lung cancer in Hong Kong where tuberculosis remains endemic. There were 249 lymph node stations evaluated in 107 patients, of whom 38 (36%) had active tuberculosis or evidence of previous tuberculosis. Imaging results were compared with histological findings. The sensitivity, specificity, and accuracy of integrated imaging for mediastinal nodal staging were 52%, 86%, and 80%, respectively; the overall positive-predictive value for mediastinal nodal metastasis was 46%, and the overall negative-predictive value was 89%. The positive-predictive value for mediastinal nodal metastasis was 39% in patients with tuberculosis and 50% in controls; the negative-predictive value was high in both groups (92% and 87%). The likelihood ratio for true positives was 6.47 in patients with tuberculosis vs. 10.97 in controls. This suggests that the reliability of positron-emission/computed tomography may be substantially poorer in patients with tuberculosis. Histological confirmation should be considered mandatory in patients with suspected metastasis on integrated imaging.

Repair of Left Ventricular Pseudoaneurysms [ORIGINAL ARTICLE]

Fedakar, Bugra, Onk, Mataraci, Eren, Zeybek — Tue, 02 Feb 2010 01:27:46 PST

The outcomes of 3 different methods of repair of left ventricular pseudoaneurysm after myocardial infarction were analyzed retrospectively. The operations were carried out in 22 patients between 1985 and 2008. Repair procedures included primary closure with Teflon-pledgeted sutures, and Dacron or pericardial patches. Overall hospital mortality was 27.3% (2 patients had primary closure, 3 had a Dacron patch, and 1 had a pericardial patch). Mean postoperative bleeding was 885 mL (range, 200–4,800 mL). Mean preoperative and postoperative ejection fractions were 40% (30%–47%) and 48% (30%–65%), respectively. The overall incidence of arrhythmia was 36.4% (8 patients). The incidence of arrhythmia was lowest in the pericardial patch group, but this was not statistically significant. No significant differences in postoperative ejection fraction or hemorrhage were found among the study groups. Mean survival was 61.9 ±41.4 months in the 16 hospital survivors. Although the 3 techniques gave similar results, repair with an autologous pericardial patch may offer an advantage in terms of less postoperative arrhythmias.

Off-Pump Coronary Artery Bypass Surgery in Severe Left Ventricular Dysfunction [ORIGINAL ARTICLE]

Azarfarin, Pourafkari, Parvizi, Alizadehasl, Mahmoodian — Tue, 02 Feb 2010 01:27:46 PST

Our aim was to examine hospital outcomes of coronary artery bypass surgery in patients with and without left ventricular dysfunction, with regard to the surgical technique (off- or on-pump). Between March 2007 and March 2008, 689 consecutive patients underwent isolated first-time coronary artery bypass; 127 had ejection fractions ≤30% (group 1) and 562 had ejection fractions >30% (group 2). Data of preoperative risk profiles and hospital outcomes were collected prospectively. Off-pump operations were performed in 49 (38.6%) patients in group 1 and 196 (34.9%) in group 2. The incidences of infectious, neurologic, and cardiac complications postoperatively were significantly higher in group 1. In multivariate analysis, preoperative ejection fraction ≤30% was found to be an independent risk factor for postoperative complications and hospital mortality. The subgroup of patients undergoing off-pump surgery in both groups had a significantly lower rate of total complications than those undergoing conventional on-pump operations, but no significant difference in mortality was observed between those undergoing off-pump or conventional surgery in either group. Off-pump surgery helped to limit the increased morbidity rate after coronary bypass in patients with ventricular dysfunction.

Complications of Angioplasty and Stenting of Cervicocerebral Arteries in Iran [ORIGINAL ARTICLE]

Ghandehari, Edraki, Karimi, Ghorbani, Borhani Haghighi, Shabestari — Tue, 02 Feb 2010 01:27:46 PST

Angioplasty and stenting of the cervicocerebral arteries is a novel treatment for atherosclerotic stenosis, which has periprocedural complications. Data were collected prospectively from 2007 to 2009 in a multicenter cohort of patients undergoing interventions for cervicocerebral stenosis. Retrospective assessment of the 2003–2006 archives of the same interventionists and a review of their published work is the second part of this national survey. In 592 extracranial internal carotid artery angioplasty and stenting procedures in 581 patients (73% male; mean age, 63.4 ± 7 years), transient ischemic attack, stroke, intracerebral hemorrhage, and death occurred in 1.7%, 1.7%, 0.34%, and 1.52%, respectively. In 114 extracranial vertebral artery angioplasty and stenting procedures in 110 patients (68% male; mean age, 65.3 ± 6 years), transient ischemic attack and stroke each developed in 1 (0.92%) patient, but there was no intracerebral hemorrhage or death. In 70 intracranial angioplasty and stenting procedures in 67 patients (76% male; mean age, 68.5 ± 8 years), transient ischemic attack, stroke, intracerebral hemorrhage, and death were observed in 1.4%, 8.6%, 1.4%, and 2.9%, respectively. The frequency of periprocedural complications in angioplasty and stenting of cervicocerebral arteries by our neurointerventionists was similar to that in developed countries.

Midterm Evaluation of Hemodynamics of the Top Hat Supraannular Aortic Valve [ORIGINAL ARTICLE]

Aagaard, Nissen, Geha — Tue, 02 Feb 2010 01:27:46 PST

The CarboMedics Top Hat supraannular aortic valve provides an orifice-to-annulus ratio of 1:1 in most patients, and enhances patient outcomes. This study compared the midterm echocardiographic parameters of 52 patients undergoing aortic valve replacement with a Top Hat valve with those in other studies of Top Hat or CarboMedics intraannular valves. Echocardiography was performed 6–48 months after surgery with Top Hat sizes 21–27. Parameters evaluated included mean gradient, peak gradient, effective orifice area, and effective orifice area index. Preoperative and postoperative echocardiographic measurements were compared in 38 patients with aortic valve stenosis. Hemodynamic data were comparable to those of other studies, but the Top Hat prosthesis implanted was significantly larger (by a mean of 3.29 mm) than the valve size indicated using an intraannular valve sizer in 48 patients. Mean effective orifice area improved significantly from 0.73 cm² preoperatively to 2.04 cm² postoperatively. In patients with preoperative aortic valve stenosis, postoperative mean peak gradient was significantly reduced. The larger orifice-to-annulus ratio of the Top Hat valve improved hemodynamic parameters assessed by echocardiography up to 4 years postoperatively, with a lower transvalvular gradient, hence decreased left ventricular workload.

64-Slice Computed Tomography of Bovine Internal Mammary Artery Coronary Grafts [ORIGINAL ARTICLE]

Colli, Budillon, Cademartiri, Palumbo, Maffei, Gherli — Tue, 02 Feb 2010 01:27:46 PST

In cases where conventional aortocoronary grafts cannot be used, No-React bovine internal mammary artery is a possible alternative. The aim of this study was to assess the patency and clinical performance of bovine internal mammary artery as a coronary bypass conduit, using 64-slice computed tomography coronary angiography. Eleven patients (mean age, 68.2 ±5.9 years) received 11 bovine grafts between 2002 and 2006. Eight of these patients were alive after a mean follow-up of 29.4 ±16.3 months. Their mean additive EuroSCORE was 6.5 ±3.2. The mean number of distal anastomoses was 2.5 ±0.5. Six grafts were anastomosed to the right coronary artery, 2 to the left anterior descending artery, and 3 to the circumflex artery. All 11 bovine grafts were found to be occluded after 14.1 ±3.6 months. This demonstrates very poor results with the bovine coronary graft, thus we do not recommend its use, and we suggest considering an hybrid approach in selected cases.

Robot-Assisted Excision of Ectopic Mediastinal Parathyroid Adenoma [CASE STUDIES]

Chan, Wan, Wong, Hsin, Underwood — Tue, 02 Feb 2010 01:27:46 PST

Robot-assisted excision of an ectopic parathyroid adenoma in the superior mediastinum was performed in a 57-year-old man. The mass was located by methoxyisobutylisonitrile scan and computed tomography. Identification of the ectopic parathyroid adenoma was facilitated by the 3-dimensional images of the da Vinci robotic system, and resection was achieved using EndoWrist instruments. Robot-assisted excision of parathyroid adenoma located in the relatively inaccessible superior mediastinum proved to be feasible.

Emergency Computed Tomography for Aortic Valve Vegetation Mimicking Disruption [CASE STUDIES]

Weininger, Yildirim, Ritter, Leyh, Hahn, Beissert — Tue, 02 Feb 2010 01:27:46 PST

A 47-year-old man presented with symptoms typical of infective endocarditis and history of streptococcal meningitis 8 months previously. Echocardiography showed a large aortic valve vegetation that was interpreted as disruption of the noncoronary cusp. This was ruled out by 64-slice cardiac computed tomography. Valve replacement was performed successfully.

Blunt Coronary Injury Presenting as Massive Left-Sided Hemothorax [CASE STUDIES]

Tyson, Anderson, Rodriguez, Kypson — Tue, 02 Feb 2010 01:27:46 PST

Hemothorax after blunt trauma results from injury to intrathoracic structures or the chest wall. Tube thoracostomy is the most common mode of treatment; depending on the type of injury, it is frequently the only intervention required. Rarely, blunt cardiac injury can produce hemothorax if a communication exists between the pericardium and pleural space. We describe such a case that highlights the importance of a broad differential diagnosis when treating acutely injured patients.

Stomach Pierced by Apical Cuff late after Removal of Toyobo Assist Device [CASE STUDIES]

Nawata, Kyo, Ono, Motomura, Takamoto — Tue, 02 Feb 2010 01:27:46 PST

A 38-year-old woman suffering from dilated cardiomyopathy underwent successful removal of a Toyobo left ventricular assist device after 11 months of support. Four months later, discharge of pus from the skin resulted from the contaminated residual apical cuff. The purulence stopped spontaneously 16 months later, but halitosis then developed. Two weeks later, fever and hematemesis occurred. Emergency surgery revealed gastric perforation by the apical cuff, which was removed under cardiopulmonary bypass.

Fracture of Epicardial Resynchronization Lead Caused by Deceleration Injury [CASE STUDIES]

Tue, 02 Feb 2010 01:27:46 PST

A 50-year-old man with heart failure, systolic dysfunction, and abnormal septal motion underwent ventricular resynchronization. Postoperative clinical and echocardiographic improvement was observed. Several months later, he complained of worsening functional class after a traffic accident. Pacing lead fracture was diagnosed. After replacing the lead, improvement of clinical condition and ventricular parameters was achieved. The role of seat belts in causing dysfunction of pacemakers and resynchronization devices after deceleration injury is discussed.

Predifferentiated Adult Stem Cells and Matrices for Cardiac Cell Therapy [REVIEW PAPER]

Spadaccio, Chachques, Chello, Covino, Chachques, Genovese — Tue, 02 Feb 2010 01:27:46 PST

Stem cell therapy is a major field of research worldwide, with increasing clinical application, especially in cardiovascular pathology. However, the best stem cell source and type with optimal safety for functional engraftment remains unclear. An intermediate cardiac precommitted phenotype expressing some of the key proteins of a mature cardiomyocyte would permit better integration into the cardiac environment. The predifferentiated cells would receive signals from the environment, thus achieving gradual and complete differentiation. In cell transplantation, survival and engraftment within the environment of the ischemic myocardium represents a challenge for all types of cells, regardless of their state of differentiation. An alternative strategy is to embed cells in a 3-dimensional structure replicating the extracellular matrix, which is crucial for full tissue restoration and prevention of ventricular remodeling. The clinical translation of cell therapy requires avoidance of potentially harmful drugs and cytokines, and rapid off-the-shelf availability of cells. The combination of predifferentiated cells with a functionalized scaffold, locally releasing molecules tailored to promote in-situ completion of differentiation and improve homing, survival, and function, could be an exciting approach that might circumvent the potential undesired effects of growth factor administration and improve tissue restoration.

Multiple Intrathoracic Hydatids [IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY]

Singh, Rana, Singh, Sharma, Sharma — Tue, 02 Feb 2010 01:27:46 PST

Spasms of Coronary Artery Immediately After Off-Pump Bypass Grafting [IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY]

Nabuchi, Kurata, Okuyama, Muto, Endo — Tue, 02 Feb 2010 01:27:46 PST

Liver and Renal Failure due to Thrombus arising from Intraaortic Balloon Pump [IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY]

Khaladj, Rodt, Peterss, Hagl, Haverich, Shrestha — Tue, 02 Feb 2010 01:27:46 PST

Median Sternotomy with Left Anterolateral Thoracotomy: An Interesting Option [LETTERS TO THE EDITOR]

Borisov, Bletkin, Savichev — Tue, 02 Feb 2010 01:27:46 PST

Fibrillation without Cross-Clamping in the Pesence of Sclerotic Ascending Aorta [LETTERS TO THE EDITOR]

Ugurlucan, Basaran, Ogus, Isik — Tue, 02 Feb 2010 01:27:46 PST