Asian Cardiovascular and Thoracic Annals current issue

Video-assisted thoracoscopic patent ductus arteriosus closure in 2,000 patients [ORIGINAL ARTICLE]

Nezafati, Soltani, Mottaghi, Horri, Nezafati — 2011-12-07T00:33:16-08:00

Video-assisted thoracoscopic surgery has proved to be a safe and effective method with low complication and high success rates. From 1997 to 2008, 2,000 consecutive patients with patent ductus arteriosus underwent closure of the ductus with 2 titanium clips via a video-assisted thoracoscopic technique. Complete closure was confirmed using our handmade intraesophageal stethoscope. The mean age was 5.2 years, and mean weight was 9.8 kg. One death was reported 1 month after surgery, due to sepsis during hospitalization for chylothorax treatment. The procedure was converted to an emergency thoracotomy in one case, due to ductal wall rupture. There were 4 late residual shunts treated via thoracotomy. We observed transient laryngeal nerve dysfunction in 14 patients. All patients were reassessed by postoperative echocardiography. The mean procedure (skin-to-skin) time was 10 ± 2 min, and hospitalization was 21 h. This study indicates that video-assisted thoracoscopic closure of patent ductus arteriosus is a safe, simple, and cost-effective method with low complication and high success rates. Furthermore, the cosmetic benefits make it appropriate as an out-patient procedure.

NT-pro-brain natriuretic peptide levels after valve replacement [ORIGINAL ARTICLE]

Elasfar — 2011-12-07T00:33:16-08:00

Elevated plasma N-terminal pro-brain natriuretic peptide levels have been demonstrated in patients with chronic valvular disease. To assess whether changes in N-terminal pro-brain natriuretic peptide levels after mitral, aortic, and double-valve replacement reflect changes in heart failure symptoms, a prospective observational nonrandomized study was undertaken in 24 consecutive patients (mean age, 55.3 ± 16.2 years; 58% male) undergoing mitral and/or aortic valve replacement. Mitral valve replacement was carried out in 12 patients, aortic valve replacement in 8, and combined mitral and aortic valve replacement in 4. N-terminal pro-brain natriuretic peptide measurements, echocardiography, and functional class assessment were performed before and 6 months after surgery. A decrease in N-terminal pro-brain natri-uretic peptide at 6 months postoperatively was significantly associated with decreased left atrial dimension, left ventricular end-diastolic and end-systolic dimensions, increased ejection fraction, and improvement in functional class. Thus we can hypothesize that measurement of N-terminal pro-brain natriuretic peptide might allow early detection of any clinical deterioration as well as assessment of the long-term outcome in valve replacement patients.

Totally endoscopic atrial septal repair using no robotic techniques [ORIGINAL ARTICLE]

Xiangjun, Xufa, Liang — 2011-12-07T00:33:16-08:00

Standard surgical closure of an atrial septal defect via sternotomy is safe and effective. To avoid sternotomy and improve the cosmetic result, minimally invasive cardiac surgery has emerged as an alternative. Robot-assisted totally endoscopic atrial septal defect repair is convincingly superior, but the robotic system is expensive and complicated. We describe a technique of totally endoscopic closed-chest atrial septal defect closure without the aid of a robotic device. Twenty patients underwent totally endoscopic atrial septal defect repair using no robotic techniques between May 2009 and December 2009. No major intraoperative or postoperative complications were observed. One operation was converted to a conventional sternotomy because bleeding from the aortic root could not be controlled. Closure of an atrial septal defect can be performed safely and effectively via an endoscopic approach using no robotic techniques.

Coronary pseudoaneurysm in a non-polymer drug-eluting stent: a rare entity [CASE STUDIES]

Kapoor, Batra, Kumar, Pandey, Agarwal, Sinha — 2011-12-07T00:33:16-08:00

Coronary pseudoaneurysms following implantation of drug-eluting stents, although rare, are not unknown. Nearly all such cases have been reported in patients with sirolimus or paclitaxel polymer-based stents. We describe a case of coronary pseudoaneurysm developing with a non-polymer-based drug-eluting stent in a 50-year-old man who was successfully managed by coronary artery bypass grafting.

An interrupted technique for difficult distal anastomosis during arch surgery [CASE STUDIES]

Follis, Filippone, Montalbano, Centineo, Finazzo, Follis — 2011-12-07T00:33:16-08:00

During aortic arch replacement, construction of the distal anastomosis represents the crucial step because of the time limit of circulatory arrest. If the aneurysmal neck is located at the level of the 5^th thoracic vertebra, it becomes difficult to carry out through a sternotomy approach. We describe a case in which an interrupted suture technique, similar to that used for valve replacement, was employed to maximize the limited exposure and achieve a water-tight anastomosis.

Coagulase-negative staphylococcus endocarditis: staphylococcus lugdunensis [CASE STUDIES]

Sibal, Lin, Jogia — 2011-12-07T00:33:16-08:00

Staphylococcus lugdunensis is an infrequent cause of native valve endocarditis. A case of triple-valve involvement of Staphylococcus lugdunensis with intracardiac fistula formation in a 47-year-old woman was managed successfully with surgery. The importance of early diagnosis and prompt referral for surgical treatment is highlighted.

Ruptured saphenous vein graft aneurysm after aortocoronary bypass grafting [CASE STUDIES]

Satsu, Onoe, Miyashita — 2011-12-07T00:33:16-08:00

Computed tomography demonstrated a giant saphenous vein graft aneurysm that compressed the right atrium of a 72-year-old woman 20 years after undergoing coronary artery bypass grafting. Angiography revealed contrast medium leakage in the mid-portion of the graft aneurysm. Aneurysmectomy was performed without repeat grafting. Postoperative myocardial scintigraphy demonstrated no significant myocardial ischemia. The ischemic effect of non-revascularization should be considered preoperatively because of the difficulties with repeat grafting.

A case of aortoesophageal fistula [CASE STUDIES]

Bakhshandeh, Salehi, Radmehr, Riahi — 2011-12-07T00:33:16-08:00

Aneurysms of the thoracic aorta can have various manifestations, some of which may simulate esophageal diseases, clinically and radiographically. Aortoesophageal fistula is rare and usually fatal. We report a case of aortoesophageal fistula presenting with progressive dysphagia and intermittent episodes of upper gastrointestinal bleeding.

Aneurysm of sinus of Valsalva: uncommon presentation [CASE STUDIES]

Elumalai, Vaidyanathan, Nainar, Balasubramaniam, George — 2011-12-07T00:33:16-08:00

A 28-year-old man presented with acute onset of chest pain. Transthoracic echocardiography confirmed an aneurysm of the sinus of Valsalva dissecting into the interventricular septum. During the next 12 h, the aneurysm enlarged to involve the entire interventricular septum, and the patient developed features of cardiac tamponade. He underwent successful surgical repair.

Thoracoscopic management of spontaneous pneumothorax due to azygos lobe bullae [CASE STUDIES]

Azoury, Sayad — 2011-12-07T00:33:16-08:00

A 22-year-old man presented with recurrent right-sided spontaneous pneumothorax caused by rupture of azygos lobe bullae. Surgical management was successfully completed using a video-assisted thoracoscopic approach. Resection of the bullae harboring azygos lobe and subsequent pleurodesis were performed, sparing the meso-azygos and azygos vein.

Fenestration closure in a calcified ventricular septal defect patch [CASE STUDIES]

Raja, Atamanyuk, Pandey, Kostolny — 2011-12-07T00:33:16-08:00

Ventricular septal defect closure with a fenestrated patch is a recognized rescue maneuver to decrease the risk of right ventricular failure after complete repair in patients with pulmonary atresia. If the fenestration needs surgical closure, severe calcification of the patch may make it extremely difficult. We describe the closure of such a defect in a 6-year-old boy, using a double Dacron patch sandwich.

Adenocarcinoma in pulmonary sequestration [CASE STUDIES]

Lawal, Mikroulis, Eleftheriadis, Karros, Bougioukas, Bougioukas — 2011-12-07T00:33:17-08:00

A 67-year-old male smoker presented with hemoptysis and recurrent pneumonia. Chest computed tomography showed an emphysematous cyst and air-fluid level cavities in the left lower lobe. A left lower lobectomy was performed. The intraoperative finding was intralobar sequestration. Histopathology revealed adenocarcinoma within the sequestrated lobe. Only 8 cases of lung cancer and sequestration have been reported since 1963.

Ruptured pulmonary artery aneurysm: a surgical emergency [CASE STUDIES]

Puri, Kaur, Brar, Singh, Sahoo, Mahant — 2011-12-07T00:33:17-08:00

Idiopathic pulmonary artery aneurysm rupture was diagnosed in a 79-year-old man who presented with a dry cough. He was considered unlikely to tolerate extensive pulmonary artery reconstruction or lung resection; hence, he was salvaged by timely ligation of the distal pulmonary artery at the origin of the aneurysm.

Simple home-made suction device to aid excision of friable atrial myxoma [HOW TO DO IT]

Wong, Wan, Ng, Underwood — 2011-12-07T00:33:17-08:00

Atrial myxoma, especially the papillary subtype, is known to be friable and gelatinous. Manipulation of an atrial myxoma during surgery can be very difficult, and not uncommonly results in fragmention and embolization of part of the tumor. The conventional method using a metallic spoon to manipulate the tumor is widely practiced because alternatives are sparse. We describe a novel home-made suction device to aid the excision of friable atrial myxomas.

Angina in an adolescent [IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY]

Maddali, Al-Maskari, Al-delamie — 2011-12-07T00:33:17-08:00

Stridor with recurrent chest infection [IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY]

Ahmed, Kureel, Chandra — 2011-12-07T00:33:17-08:00

Pneumopericardium from esophageal-pericardial fistula due to cancer recurrence [IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY]

Kasama, Rino, Murakami, Suzuki, Isomatsu, Masuda — 2011-12-07T00:33:17-08:00

Missing floating thrombus in the aorta [IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY]

Nakamura, Nakano, Tagusari — 2011-12-07T00:33:17-08:00