Asian Cardiovascular and Thoracic Annals recent issues

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

Endovascular Management of Stanford Type A (Ascending) Aortic Dissection [EDITORIAL]

Chan, Cheng — Mon, 21 Dec 2009 04:36:18 PST

Identifying Paraplegia Risk Associated with Thoracic Endografting [ORIGINAL ARTICLE]

Preventza, Wheatley, Williams, Ramaiah, Rodriguez-Lopez, Diethrich — Mon, 21 Dec 2009 04:36:19 PST

Endografting, like open surgical repair of the thoracic aorta, can be complicated by paraplegia. We reviewed our thoracic endografting experience regarding the incidence and treatment of spinal cord neurologic events. Between February 2000 and July 2008, 346 patients underwent endoluminal grafting of the descending thoracic aorta. Indications for intervention included atherosclerotic aneurysms (45.9%), acute and chronic dissections (31.5%), miscellaneous lesions (13.6%), and penetrating aortic ulcers (8.9%). Ten women and 4 men (4.0%), with a mean age of 71.3 years, developed either paraparesis (1.7%) or paraplegia (2.3%). Nine (64.3%) of these patients had an aneurysm, 4 (28.6%) had acute or chronic type B aortic dissection, and 1 (7.1%) had a penetrating aortic ulcer; 3 (21.4%) of them had previously undergone open abdominal aortic aneurysm repair, and 13 (92.9%) required coverage of more than 20 cm of the aorta. Cerebrospinal fluid drainage was instituted in 7/8 paraplegic patients. Eight (57.1%) of the 14 patients recovered fully, 2 (14.3%) experienced partial recovery, and 4 (28.6%) had significant neurological deficits. Paraplegia following thoracic endografting appears to be associated with female sex, long-segment coverage of the thoracic aorta, and aneurysmal disease.

Cardiac Bioassist: Results of the French Multicenter Cardiomyoplasty Study [ORIGINAL ARTICLE]

Chachques, Jegaden, Mesana, Glock, Grandjean, Carpentier — Mon, 21 Dec 2009 04:36:19 PST

The French multicenter experience (6 centers) of dynamic cardiomyoplasty was analyzed for long-term survival and functional outcome, the most important endpoints in congestive heart failure therapy. Cardiomyoplasty was performed in 212 patients with symptoms of chronic heart failure despite maximal pharmacological therapy. The etiology was ischemic (48%), idiopathic (45%) or other (7%). Cardiomyoplasty was performed using the latissimus dorsi muscle which was electrostimulated after surgery. During follow-up, 88% of patients improved clinically. Hospital death occurred in 29 (14%) patients and was related to the severity of preoperative heart failure symptoms. Late mortality occurred in 99 patients due to heart failure (44%), sudden death (37%), or noncardiac causes (18%). Combined dynamic cardiomyoplasty and implantation of a cardiac rhythm management system was safely achieved in 22 patients, and 26 underwent heart transplantation for recurrent heart failure. Long-term functional improvements were observed in most patients, and the best outcome was achieved in those with isolated right ventricular failure. Dynamic cardiomyoplasty can be considered as a destination therapy or a mid- to long-term biological bridge to heart transplantation.

Stem Cell Experiments and Initial Clinical Trial of Cellular Cardiomyoplasty [ORIGINAL ARTICLE]

Guhathakurta, Subramanyan, Balasundari, Das, Madhusankar, Cherian — Mon, 21 Dec 2009 04:36:19 PST

Growing myocardial cells from human stem cells and stem cell transplantation to repair injured myocardium are new frontiers in cardiovascular research. The 1^st stage of this study was conducted to determine whether transplantation of autologous bone marrow stem cells into infarcted myocardium of sheep could differentiate into beating cardiomyocytes. The 2^nd stage was to demonstrate transdifferentiation of human bone marrow mesenchymal stem cells to precursor cardiomyocytes in vitro, using a novel conditioning medium. In the 3^rd stage, a clinical trial of stem cell implantation in patients with severe myocardial dysfunction involved injection of peripheral blood-derived endothelial precursor cells in 11 patients and autologous bone marrow mononuclear cells in 29. A marginal improvement in myocardial function was noted at 3 months (mean increase in ejection fraction, 6% ± 1%), although it plateaued at 6 months. The trial proved to be safe because there was no procedure-related mortality. There is growing optimism that stem cell therapy may delay heart transplantation.

Figure-of-Eight vs. Interrupted Sternal Wire Closure of Median Sternotomy [ORIGINAL ARTICLE]

Ramzisham, Raflis, Khairulasri, Ooi Su Min, Fikri, Zamrin — Mon, 21 Dec 2009 04:36:19 PST

Sternal dehiscence is a rare but devastating complication following median sternotomy for cardiac surgery. The optimal technique for sternal closure is unclear. We conducted this prospective randomized trial to compare the incidence of sternal dehiscence after figure-of-8 and simple interrupted suturing in patients undergoing coronary artery bypass grafting. Between January 2007 and June 2008, 98 patients had figure-of-8 suturing and 97 had interrupted sutures. The mean age of the patients was 60.9 ± 7.6 years. The overall sternal dehiscence rate was 8%; 7 cases in the in figure-of-8 group and 9 in the interrupted group. Thirteen patients had no wound infection and healed with conservative treatment. Only 3 patients had sternal dehiscence with infection: 2 with simple interrupted closure and 1 with figure-of-8 sternal closure. There was no significant difference in rates of sternal dehiscence between the 2 groups. It was concluded that figure-of-8 sternal suturing is equally effective as simple interrupted suturing in preventing sternal dehiscence.

Impact of Valves in a Biomechanical Heart Model Assisting Failing Hearts [ORIGINAL ARTICLE]

Guldner, Klapproth, Margaritoff, Noel, Sievers, Grossherr — Mon, 21 Dec 2009 04:36:19 PST

Experimental valveless muscular blood pumps (biomechanical hearts) in goats can pump more than 1 L·min^–1, but due to a high pendulum volume, no significant flow contribution to the circulation is gained. Thus valved and valveless biomechanical hearts were compared for efficacy. Heart failure was induced in 5 adult Bore goats by repeated intracoronary embolization. A valved and balloon-equipped pumping chamber was integrated into the descending aorta, simulating standard biomechanical circulatory support. The valveless biomechanical heart supported a failing heart with a baseline cardiac output of 2,670 ± 710 mL·min^–1 by contributing additional flow of 113 ± 37 mL·min^–1. The biomechanical heart model incorporating an outlet valve offered an additional 304 ± 126 mL·min^–1, and the use of 2 valves significantly enhanced pulmonary blood flow by 1,235 ± 526 mL·min^–1. The use of 2 valves in biomechanical hearts seems to be essential to achieve adequate circulatory support. Double-valved biomechanical hearts driven by an appropriate skeletal muscle ventricle may contribute to the therapy of heart failure.

Blunt Traumatic Bronchial Rupture in Patients Younger than 18 Years [ORIGINAL ARTICLE]

Gwely — Mon, 21 Dec 2009 04:36:19 PST

The aim of this study was to evaluate our results of management of bronchial rupture after blunt chest trauma in young patients. Between January 2000 and December 2007, 34 patients aged 6–18-years old were treated for bronchial rupture; 25 presented early and 9 presented late. The 21 (62%) boys and 13 (38%) girls had a mean age of 11.58 ± 2.51 years. Radiography, computed tomography, and rigid bronchoscopy were performed in stable acute cases and late-presenting cases, with rapid bronchoscopy followed by thoracotomy in urgent cases. In the patients who presented early, repair was undertaken through a right thoracotomy in 21 (84%) and via a left thoracotomy in 4 (16%). Direct suturing was carried out in all except 3 patients who needed lobectomy. Reimplantation of the main bronchus after debridement of the edges was possible in 4 (44%) of the chronic cases, and pulmonary resection was required in 5 (56%). Four (11.8%) patients died due to perioperative cardiac arrest and cerebral hypoxia with failure of resuscitation. Meticulous collaboration between the surgeon and anesthetist is important to ensure survival.

Prolonged QT Interval and Coronary Artery Bypass Mortality due to Heart Failure [ORIGINAL ARTICLE]

Mon, 21 Dec 2009 04:36:19 PST

QT-interval prolongation has been shown to predict mortality in coronary artery disease and heart failure. To assess the prognostic value of QT interval for death due to low cardiac output after coronary artery bypass grafting, the QT interval was measured in 3 consecutive beats on the preoperative electrocardiogram (leads II and V₄) in 30 patients who died perioperatively due to heart failure and a control group of 168 randomly matched hospital survivors during the same 3-year period. Mean corrected QT interval was significantly longer in the patients who died compared to the control group (480.7 ± 96.2 vs. 425.4 ± 21 ms). Among the variables evaluated, QT prolongation was the only independent predictor of perioperative death. In patients admitted for coronary artery bypass grafting, QT interval measurement is a simple clinical tool that may identify patients with a greater probability of a troublesome operative course.

Etiopathology and Management Challenges of Blunt Chest Trauma in Nigeria [ORIGINAL ARTICLE]

Thomas, Ogunleye — Mon, 21 Dec 2009 04:36:19 PST

Blunt chest trauma had not been roundly studied in Nigeria. This study was conducted to determine the etiopathological and management challenges of chest trauma in a developing country. In a prospective multicenter hospital-based study of 10-years duration in the city of Lagos, the data of 896 patients were recorded. The male-to-female ratio was 8 : 1, and the mean age was 27.1 years. The majority of patients (76.9%) were aged 20–39 years. Road traffic accidents caused 98.1% of the injuries. Lung parenchymal injuries occurred in 66% of patients, and cardiac trauma in 0.1%. Isolated chest trauma was found in 85% of patients, and 134 had associated injuries. The incidence of blunt chest trauma could be reduced if the number of road traffic accidents in Nigeria is reduced.

Risk Factors for Mediastinitis and Endocarditis after Cardiac Surgery [ORIGINAL ARTICLE]

Gualis, Florez, Tamayo, Alvarez, Castrodeza, Castano — Mon, 21 Dec 2009 04:36:19 PST

A prospective open-cohort study was performed in 838 adults undergoing coronary revascularization or valve surgery to define the risk factors for development of surgical site infections. Patients diagnosed with mediastinitis or endocarditis during follow-up were compared with patients with no such infection. After 1 year of follow-up, 22 (2.6%) patients had developed mediastinitis or endocarditis. No preoperative or intraoperative variables were identified as risk factors. By multivariate analysis of postoperative variables, respiratory insufficiency, microorganisms in blood cultures, and intensive care unit stay were independent risk factors for the development of these complications. The type of antibiotic prophylaxis had no influence on the incidence of organ or space infections after cardiac surgery.

Incidence and Impact of Cardiac Cachexia in Valvular Surgery [ORIGINAL ARTICLE]

Tepsuwan, Schuarattanapong, Woragidpoonpol, Kulthawong, Chaiyasri, Nawarawong — Mon, 21 Dec 2009 04:36:19 PST

Cardiac cachexia is a wasting feature of advanced heart failure, which is due to several etiologies and associated with a poor prognosis. This study assessed the incidence and impact of cardiac cachexia retrospectively in 353 patients who underwent valve surgery from June 2005 to June 2006. Using 80% of ideal body weight as a cut-off point, 46 (13%) of these patients were considered to have cardiac cachexia. Patients with cachexia were predominantly male with more underlying diseases and a lower body mass index than those without cachexia. The New York Heart Association functional class was significantly worse in patients with cachexia (class III/IV: 54.4% vs. 21.2%) and they had greater incidences of active infective endocarditis (21.7% vs. 5.2%) and tricuspid regurgitation (41.3% vs. 21.8%) compared to those with normal body weight. The cachexia group had significantly longer postoperative hospitalization and more complications (37% vs. 21.5%); perioperative mortality tended to be higher (6.5% vs. 2.3%) although not statistically significant. Cardiac cachexia remains an important problem in patients undergoing valve surgery, which indicates end-staged disease, and contributes to poor perioperative outcomes. Special care and attention are needed in this particular group of patients.

Integrated Positron-Emission Tomography for Nodal Staging in Lung Cancer [ORIGINAL ARTICLE]

Lee, Kim, Kang, Lee, Kang, Kim — Mon, 21 Dec 2009 04:36:19 PST

As lymph node metastasis is the most important factor determining the surgical outcome of lung cancer, we evaluated the accuracy and clinical usefulness of functional imaging with integrated positron-emission tomography and computed tomography in nodal staging of non-small-cell lung cancer. Between October 2003 and August 2004, 43 newly diagnosed patients underwent curative surgical resection or mediastinoscopic nodal biopsy after chest computed tomography as well as whole-body functional imaging for clinical staging. Based on histopathologic findings in the lymph nodes, we compared the diagnostic usefulness of computed tomography and functional imaging. Twenty-two patients were N0 stage, 6 were N1, 11 were N2, and 4 were N3. Although functional imaging seemed to be superior for evaluation of N2 nodes, there were no significant differences in the sensitivity, specificity, positive-predictive value, negative-predictive value, or accuracy. The situation was similar for N1 nodes, and there were no significant differences except for the false-negative rate. High false-positive and negative-rates for N2 lymph nodes suggest that functional imaging should not replace mediastinoscopy.

Long-Term Results up to 19 Years of Mitral Balloon Valvuloplasty [ORIGINAL ARTICLE]

Fawzy — Mon, 21 Dec 2009 04:36:19 PST

Clinical and echocardiographic data of 547 consecutive patients (mean age, 31.5 years) undergoing mitral balloon valvuloplasty with follow-up of 1.5–19 years, were analyzed. Immediately after valvuloplasty, mitral valve area increased significantly from 0.92 ± 0.17 to 1.95 ± 0.29 cm². Restenosis occurred in 169 (31%) patients; it was less common (20%) in those with a mitral echocardiographic score ≤8. Actuarial freedom from restenosis at 10, 15, and 19 years was 78% ± 2%, 52% ± 3%, and 26 ± 4%, respectively, and significantly higher in patients with echocardiographic scores ≤8: 88% ± 2%, 67% ± 4%, and 40% ± 6%, respectively. Event-free survival at 10, 15, and 19 years was 88% ± 2%, 60% ± 4%, and 28% ± 7%, respectively, and significantly higher in patients with echocardiographic scores ≤8: 92% ± 1%, 70% ± 4%, and 42% ± 7%, respectively. Multivariate analysis identified echocardiographic score ≤8 and post-procedure valve area ≤1.8 as predictors of restenosis, and echocardiographic score>8 and preexisting atrial fibrillation as predictors of combined events. Valvuloplasty provides excellent results in selected patients with mitral stenosis. The long-term outcome can be predicted from the baseline characteristics of the mitral valve.

Malignancy of Congenital Cystic Adenomatoid Malformation of Lung in Aged [CASE STUDIES]

Benouaich, Marcheix, Begueret, Brouchet, Velly, Jougon — Mon, 21 Dec 2009 04:36:19 PST

Congenital cystic adenomatoid malformation is rare in adults, and often asymptomatic. We describe a case of malignant degeneration of a congenital cystic adenomatoid malformation in a 77-year-old man. Congenital cystic adenomatoid malformation must be considered a premalignant lesion, even in older patients. Rigorous preoperative staging must be undertaken. Anatomic resection with extensive lymphadenectomy remains the treatment of choice.

Aneurysm of All 3 Sinuses of Valsalva Causing Coronary Insufficiency [CASE STUDIES]

Bhat, Babu, Gehlot, Peer — Mon, 21 Dec 2009 04:36:19 PST

A 35-year-old woman presented with chest pain and easy fatigability. Transthoracic echocardiography demonstrated an unruptured aneurysm involving all 3 sinuses of Valsalva. Successful surgical repair was undertaken, without the need for aortic valve replacement or coronary artery bypass.

Type A Aortic Dissection, Right-Sided Aortic Arch, and Thoracic Aortic Aneurysm [CASE STUDIES]

Hori, Tanaka, Yamaguchi, Adachi — Mon, 21 Dec 2009 04:36:19 PST

A previously healthy 78-year-old woman presented with severe chest pain. Computed tomography revealed a right-sided aortic arch with an aberrant left subclavian artery originating from Kommerell’s diverticulum, a thoracic aortic aneurysm, and Stanford type A acute aortic dissection. Successful emergency repair of the ascending aorta, total arch, and descending aorta were performed through a median sternotomy only.

Repairing of Infarcted Myocardium Using a Novel Cell Patch Therapy [CASE STUDIES]

Yokomuro, Ichikawa, Shiono, Kajiwara — Mon, 21 Dec 2009 04:36:19 PST

A 54-year-old man underwent left anterior descending artery bypass grafting with cell patch therapy for myocardial infarction. We applied a novel approach to replicating the infarcted myocardium by anchoring polyglycolic acid felt seeded with autologous peripheral blood mononuclear cells in front of the infarcted area. The cell patch remained fixed to the myocardium for 1 month, and the infarcted myocardium was reperfused.

Late Presentation of Aortic Root Abscess in Endocarditis with Coronary Ischemia [CASE STUDIES]

Namboodiri, Bohora, Misra, Bijulal, Jayakumar, Tharakan — Mon, 21 Dec 2009 04:36:19 PST

Formation of a large aortic root abscess is an infrequent complication of aortic valve endocarditis in adults. Extrinsic compression of the coronary arteries by this abscess is still rarer. Here, we report a case of a 22-year-old male with aortic root abscess, who presented 2 months after the completion of treatment of endocarditis with exertional angina. Coronary angiogram revealed compression of proximal left anterior descending and left circumflex arteries by the abscess. The patient was successfully treated with pericardial patch exclusion of the abscess cavity and coronary artery bypass graft. The presentation of aortic root abscess with myocardial ischemia as a late complication of treated endocarditis has not been reported earlier.

Beating-heart Valve Surgery: A Systematic Review [REVIEW PAPER]

Salhiyyah, Taggart — Mon, 21 Dec 2009 04:36:19 PST

Beating-heart continuous coronary perfusion (BHCCP) has been promoted as an alternative to the technique of cardioplegic arrest in valve surgery. Its potential advantage is the elimination of cardioplegia and the corollary risk of ischemic reperfusion injury. The use of CCP has been recommended especially when performing more complex operations, such as mitral valve repair, and particularly as surgeons become more familiar with beating-heart coronary surgery. We conducted a systematic review to assess the strength of the evidence supporting the efficacy of BHCCP compared to cardioplegia in valve surgery. Thirty nine reports were identified. Of these, only two were randomized control trials. Overall the studies were generally of poor quality and had a low evidence level. In those studies, mortality and major morbidity from BHCCP were within acceptable levels, nevertheless, there was no advantage over cardioplegic arrest. On the other hand there is weak evidence that it may reduce functional and biochemical markers of myocardial injury. In conclusion, BHCCP is an operative strategy in valve surgery with some potential benefits. There is, however a need for a high quality, prospective, randomized control trial to establish the exact role for BHCCP in complex valve surgery.

Giant Cystic Lymphangioma in the Thoracic Wall in a Newborn [IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY]

Eren, Avci — Mon, 21 Dec 2009 04:36:19 PST

Heart and Great Vessels after Mediastinal Irradiation [IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY]

Okamoto, Matsumoto, Inoue, Katsu — Mon, 21 Dec 2009 04:36:19 PST

Contrast-Enhanced Computed Tomography of Adult Scimitar Syndrome (Variant Form) [IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY]

Siu, Cheung, Chan, Jim, Tse — Mon, 21 Dec 2009 04:36:19 PST

Chronic Pulmonary Hypertension due to In-Situ Pulmonary Thrombus [IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY]

Krishnamoorthy, Deshmukh, Mullasari — Mon, 21 Dec 2009 04:36:19 PST

Endovascular Management of Traumatic Thoracic Aortic Transection [ORIGINAL ARTICLE]

Asmat, Tan, Caleb, Lee, Robless — Thu, 12 Nov 2009 07:32:36 PST

The conventional treatment of traumatic thoracic aortic transection is open surgical repair but it is associated with high rates of morbidity and mortality, particularly in patients with multiple injuries. We reviewed our experience of endovascular repair of traumatic thoracic aortic transection. Between March 2002 and December 2007, 7 patients (male 6, female 1; mean age 40 years) with multiple injuries secondary to blunt trauma underwent endovascular stenting. One patient required adjunctive surgery to facilitate endovascular stenting. Mean intensive care unit stay was 8.6 days (range, 3–16 days). Arterial access in all patients was obtained by femoral cut-down. The mean operating time was 122 min. Technical success was achieved in all cases. There was no mortality. One patient suffered a right parietal stroke, but none developed procedure-related paralysis. The mean follow-up period was 18.6 months (range, 6–48 months). There was no evidence of endoleak, stent migration, or late pseudoaneurysm formation on follow-up computed tomography. Endovascular stents can be used to treat traumatic thoracic aortic transection, with low rates of morbidity and mortality. Although early and midterm results are promising, the long-term durability of endovascular stenting for traumatic thoracic aortic transection remains unknown.

Intraoperative Continuous Venovenous Hemofiltration during Coronary Surgery [ORIGINAL ARTICLE]

Roscitano, Benedetto, Goracci, Capuano, Lucani, Sinatra — Thu, 12 Nov 2009 07:32:36 PST

Postoperative continuous venovenous hemofiltration decreases acute renal failure in patients with moderate renal dysfunction undergoing coronary artery bypass grafting, but it prolongs intensive care unit stay. We developed a simple method to connect a hemofiltration machine to the cardiopulmonary bypass system. To evaluate the benefit of intraoperative hemofiltration, 124 consecutive patients (mean age, 67 ± 6 years) with moderate renal dysfunction were studied. Surgery was preformed between January 2005 and May 2007. On-pump coronary artery bypass with hemofiltration was carried out in 40 patients (group A), 44 had on-pump coronary artery bypass without hemofiltration (group B), and 40 had off-pump coronary artery bypass (group C). Postoperative acute renal failure was defined as either renal failure requiring dialysis or ≥50% decline from the baseline glomerular filtration rate but not requiring dialysis. The 3 groups had similar demographic data and preoperative renal function. After adjusting for covariates and propensity scores, multivariate analysis showed that intraoperative hemofiltration and off-pump surgery protected postoperative renal function. Independent risk factors for postoperative renal dysfunction were age >70 years, left ventricular ejection fraction <35%, and the preoperative glomerular filtration rate.

Surgery for Bronchogenic Cysts: Always Easy? [ORIGINAL ARTICLE]

Granato, Voltolini, Ghiribelli, Luzzi, Tenconi, Gotti — Thu, 12 Nov 2009 07:32:36 PST

A few cases of major complications after surgery for bronchogenic cyst have been reported. The purpose of this study was to analyze the complicated and unusual cases among 30 consecutive patients with bronchogenic cysts treated surgically at our institution between 1975 and 2007. There were 3 cases of mediastinal bronchogenic cyst characterized by significant surgical complications or very unusual pathological findings. The operations were performed through a thoracotomy in 25 patients, and by video-assisted thoracoscopic surgery in 5. Two patients suffered iatrogenic injury of the contralateral main bronchus during excision of a mediastinal cyst; in one of them, late development of foreign body granuloma was related to migration towards the bronchial wall of cyanoacrylate used to reinforce suturing of the bronchial tear. Histological examination of one resected specimen showed a large-cell anaplastic carcinoma arising from the wall of a mediastinal bronchogenic cyst. Bronchogenic cysts should be excised before they become symptomatic or infected, which leads to more difficult surgery and complications. The small risk of developing malignancy within a bronchogenic cyst also justifies early intervention.

Surgery for Chronic Total Occlusion of the Left Main Stem: A 10-Year Experience [ORIGINAL ARTICLE]

Akhtar, Naqshband, Abid, Tufail, Waheed, Khan — Thu, 12 Nov 2009 07:32:36 PST

Chronic total occlusion of the left main stem coronary artery is rare. This retrospective study was conducted to evaluate outcomes of coronary artery bypass grafting between June 1998 and June 2008 in patients with chronic left main stem total occlusion. There were 17 (0.025%) cases detected in 67,082 coronary angiograms. The 14 men and 3 women had a mean age of 55.32 ± 9.2 years. Risk factors included diabetes in 8, hypertension in 6, and smoking in 6. Of 54 grafts applied, 15 were arterial and 39 were venous; 14 patients had 3-vessel disease, and 3 had 4-vessel disease. Three patients required intraaortic balloon counterpulsation perioperatively. The mean intensive care unit stay was 2.1 ± 1.2 days, and hospital stay was 7.1 ± 1.5 days. Postoperatively, one patient suffered myocardial infarction, another had a transient ischemic attack with spontaneous recovery, and 2 developed atrial fibrillation. There was no operative or hospital death. Surgical revascularization is considered appropriate treatment for chronic total occlusion of the left main stem.

Postoperative Pericardial Effusion and Posterior Pericardiotomy: Related? [ORIGINAL ARTICLE]

Bakhshandeh, Salehi, Radmehr, Sattarzadeh, Nasr, Sadeghpour — Thu, 12 Nov 2009 07:32:36 PST

Large pericardial effusions develop in 30% of patients after cardiac surgery, and reach their maximum size after 10 days, with tamponade in 1%. The aim of this prospective randomized case-controlled study was to assess the effectiveness of a posterior pericardiotomy in preventing early and late (>30 days) development of pericardial effusion. Between April 2005 and May 2006, 410 patients with a mean age of 68.4 ± 9.2 years undergoing coronary artery bypass grafting alone or combined with valve surgery were divided into 2 groups of 205 each. In the pericardiotomy group, a 4-cm longitudinal incision was made parallel and posterior to the phrenic nerve. Echocardiography was performed at discharge and 15 and 30 days after the operation. At 15 and 30 days postoperatively, 90.2% and 97% of patients in the pericardiotomy group were free of effusion; while none in the control group were free of effusion. A posterior pericardiotomy is easy to perform and seems to be a safe and effective means of preventing postoperative effusion and its adverse consequences.

Video-Assisted Pericardial Fenestration for Effusions after Cardiac Surgery [ORIGINAL ARTICLE]

Georghiou, Porat, Fuks, Vidne, Saute — Thu, 12 Nov 2009 07:32:36 PST

Delayed-onset pericardial effusion following cardiac surgery can give rise to significant morbidity due to its presentation as well as management by traditional surgical techniques. An institutional experience of a video-assisted thoracoscopic technique to create a pericardial window, with the advantages of a minimally invasive approach combined with excellent visualization in such patients, was reviewed. A retrospective analysis was conducted on all patients undergoing video-assisted thoracoscopic for delayed pericardial effusion after cardiac surgery from January 2001 to January 2006 at our center. Seven patients with echocardiographically diagnosed delayed tamponade underwent video-assisted thoracoscopy; 5 were receiving anticoagulants after valve replacement, and 2 had undergone heart transplantation. Pericardial windows were created under general anesthesia and single-lung ventilation using 2 to 3 trocars. Mean operative time was 45 min. There were no complications of the thoracoscopic technique. Video-assisted thoracoscopic creation of a pericardial window is safe and effective treatment for loculated pericardial effusions secondary to cardiac surgery.

Hyperhomocysteinemia-Induced Myocardial Injury after Coronary Artery Bypass [ORIGINAL ARTICLE]

Thiengburanatham — Thu, 12 Nov 2009 07:32:36 PST

Hyperhomocysteinemia and other major cardiovascular risk factors are associated with increased vascular oxidative stress. To access the effects preoperative plasma homocysteine levels and other atherosclerotic risk factors on myocardial ischemia-reperfusion injury after conventional coronary artery bypass, 213 patients with normal renal function were enrolled prospectively. Cardiac troponin T was measured postoperatively to determine myocardial injury. There was a significant relationship between hyperhomocysteinemia and postoperative peak troponin T. This was more marked in patients without major atherosclerotic risk factors than in those who had at least one risk factor. Moreover, among current cigarette smokers, those with the highest preoperative plasma homocysteine levels had the lowest postoperative troponin T levels. From multivariate linear regression analysis, the predictors of high postoperative troponin T were hyperhomocysteinemia, hypertension, and aortic crossclamp time, but the presence of major atherosclerotic risk factors paradoxically modified the effects of hyperhomocysteinemia on postoperative myocardial ischemia-reperfusion injury.

Surgical Treatment of Left Ventricular Aneurysm [ORIGINAL ARTICLE]

Coskun, Popov, Coskun, Hinz, Schmitto, Korfer — Thu, 12 Nov 2009 07:32:36 PST

When a left ventricular aneurysm leads to pulmonary congestive symptoms, aneurysmectomy may provide relief. This retrospective study included 269 patients who underwent aneurysmectomy between 1993 and 2002, by the classic Cooley operation in 164 and by Dor ventriculoplasty in 105. There were no significant differences in early and late survival between groups, although the frequency of extended anteroseptal infarction was higher in patients undergoing the Dor procedure. Postoperative echocardiographic findings showed significant improvements in left ventricular function in both groups, in terms of end-diastolic and end-systolic dimensions and ejection fraction. Left ventricular aneurysmectomy significantly improved the clinical status and hemodynamic parameters of symptomatic patients. The choice of surgical technique depends on the extent of the scar segment, especially the presence of an anteroseptal scarred area. The Dor procedure is more suitable for restoring normal left ventricular geometry in patients with extensive septal infarction.

Off-Pump Coronary Surgery causes Immediate Release of Myocardial Damage Markers [ORIGINAL ARTICLE]

Karu, Tahepold, Sulling, Alver, Zilmer, Starkopf — Thu, 12 Nov 2009 07:32:36 PST

Off-pump coronary surgery does not eliminate the risks of ischemia-reperfusion injury. The main objective of this study was to describe the extent and time course of changes in myocardial metabolism and development of myocardial injury associated with revascularization. Coronary sinus and arterial blood samples for measurement of troponin I, creatine kinase MB, lactate, glutathione, and interleukin-6 were taken from 23 patients prior to grafting, after completion of each anastomosis, and up to the 1st postoperative morning. The results were evaluated together with parameters of cardiac function. Release of lactate, creatinine kinase MB, and troponin I into the coronary sinus was evident after completion of the 1st graft, and increased over time. During the procedure, only trace amounts of oxidized and reduced glutathione were detected in coronary sinus and arterial blood. Significant increases in interleukin-6 were found in coronary sinus samples after 5 and 20 min of reperfusion. Surgical trauma during off-pump coronary surgery is sufficient to activate an inflammatory response in the myocardium, together with unfavorable metabolic conditions to cause myocardial necrosis.

Safety of Mild Hypothermic Circulatory Arrest with Selective Cerebral Perfusion [ORIGINAL ARTICLE]

Toyama, Matsumura, Tamenishi, Okamoto — Thu, 12 Nov 2009 07:32:36 PST

Although hypothermic circulatory arrest with antegrade selective cerebral perfusion is used for cerebral protection, optimal perfusion characteristics are still unclear. Between May 2006 and March 2008, 26 patients (mean age, 68.9 years; 14 males) underwent thoracic aortic repair with mild hypothermic circulatory arrest (34.3°C ± 1.9°C) and antegrade selective cerebral perfusion (30°C) for various indications including 16 acute type A aortic dissections. Mean cerebral perfusion rate was 21.1 ± 4.3mL kg^–1 min^–1. Non-elective operations were carried out in 16 (61.5%) cases. Operative procedures were ascending aortic replacement in 16 patients, hemiarch replacement in 4, and total arch replacement in 6. Cardiopulmonary bypass time was 209 ± 61 min, cardiac ischemic time was 141 ± 45 min, cerebral perfusion time was 81 ± 67 min, and lower body circulatory arrest time was 65 ± 22 min. Mean rectal temperature drifted to 30.6°C ± 1.3°C. There was 1 (3.8%) hospital death due to rupture of a residual descending thoracic aneurysm. One patient needed reexploration for bleeding, and 2 (7.7%) suffered permanent neurologic dysfunction. No postoperative spinal cord dysfunction was observed. Mild hypothermic circulatory arrest with antegrade selective cerebral perfusion could be performed safely in our patient population.

Prevention of Venous Thromboembolism in Thoracic and Cardiovascular Surgery [ORIGINAL ARTICLE]

Egawa, Hiromatsu, Shintani, Kanaya, Fukunaga, Aoyagi — Thu, 12 Nov 2009 07:32:36 PST

Venous thromboembolism is the most preventable illness among patients in hospital. We prepared guidelines for the prophylaxis of venous thromboembolism, based on previous experience of perioperative risk factors. The aim of this study was to evaluate the effectiveness of these guidelines. All 1,467 patients who underwent surgery for thoracic or cardiovascular disease between April 2002 and July 2004, before the prophylactic guidelines were implemented, were assigned to group A. Another 1,389 patients who had surgery between August 2004 and December 2006, after the guidelines had been implemented, formed group B. The incidences of venous thromboembolism perioperatively in the 2 groups were compared. Six (0.4%) patients in group A developed deep vein thrombosis or pulmonary embolism, whereas no patient in group B experienced thromboembolism. The difference between groups was significant, so we consider our guidelines for venous thromboembolism prevention in the perioperative period to be clinically useful.

Transannular Pulmonary Enlargement and Bioprostheses for Carcinoid Disease [CASE STUDIES]

Choong, Arrowsmith, Klein, Wells — Thu, 12 Nov 2009 07:32:36 PST

A diminutive pulmonary artery and right ventricular outflow tract in a 46-year-old woman with a 10-year history of carcinoid syndrome required transannular pulmonary patch enlargement to allow replacement of the pulmonary and tricuspid valves with bioprostheses. The avoidance of anticoagulation permitted further hepatic arterial embolization without an increased risk of bleeding.

Pulmonary Artery Leiomyosarcoma Successfully Treated by Right Pneumonectomy [CASE STUDIES]

Stella, Davoli, Brandolini, Dolci, Sellitri, Bini — Thu, 12 Nov 2009 07:32:36 PST

A 79-year-old woman had a primary tumor of the pulmonary artery, which was initially diagnosed as chronic pulmonary thromboembolism. Multislice angio-computed tomography showed a solid mass in the right pulmonary artery. Radical resection of the tumor was achieved by right pneumonectomy via a transsternal transpericardial approach. The patient was alive and free of disease 36 months after surgery.

Repair of Aortic Coarctation in an Adult by Direct Aortoplasty [CASE STUDIES]

Charokopos, Artemiou, Antonitsis, Rouska, Stinios — Thu, 12 Nov 2009 07:32:36 PST

Various techniques have been proposed for surgical correction of aortic coarctation in adults. We describe direct aortoplasty repair in a 28-year-old woman with native coarctation. Four-year follow-up with magnetic resonance angiography confirmed a good result. This is a safe and effective technique that provides enlargement of the aortic lumen by avoiding extensive anastomotic suture lines or interposition of prosthetic graft material.

Post-Sternotomy Hemorrhage due to Left Internal Thoracic Artery Pseudoaneurysm [CASE STUDIES]

Yamashiro, Kuniyoshi, Arakaki, Inafuku, Morishima, Kise — Thu, 12 Nov 2009 07:32:36 PST

We describe a case of pseudoaneurysm of the internal thoracic artery, which was probably caused by infection. Four weeks after aortic valve replacement and coronary artery bypass surgery, an 84-year-old woman suddenly developed painful sternal instability and hypotension, with active hemorrhage from a left parasternal swelling. Selective arteriography revealed a pseudoaneurysm of the left internal thoracic artery. It was surgically excised, and the patient recovered uneventfully.

Video-Assisted Thoracic Surgery Excision of Mediastinal Hemangioma [CASE STUDIES]

Chan, Wong, Wan, Hsin, Underwood, Yim — Thu, 12 Nov 2009 07:32:36 PST

A 62-year-old woman with a middle mediastinal hemangioma was successfully treated using a video-assisted thoracic surgery approach facilitated by segmental rib resection, despite an initial radiological study that showed encasement by the surrounding great vessels. Pathological examination confirmed a cavernous hemangioma. This approach offers potential resection in difficult cases of mediastinal tumor.

The Forgotten Driving Forces in Right Heart Failure: New Concept and Device* [REVIEW PAPER]

Nour, Wu, Zhensheng, Chachques, Carpentier, Payen — Thu, 12 Nov 2009 07:32:36 PST

Background: Right heart failure is a frequent hemodynamic disturbance in pediatric cardiac patients. Besides inotropic and chronotropic drugs, fluid administration and inhaled nitric oxide, right ventricular mechanical assistance remains difficult to perform. A circulatory assist device adapted for the right heart biophysics and physiology might be more efficient. Materials and Methods: We are developing a prototype of a non-invasive cardiac assist device (CAD) for neonates and pediatrics. It is based on a pulsatile suit device covering and affecting all territories of the right heart circuit. It will be tested in a neonatal animal model of right ventricular (RV) failure. Experimental models will be matched and compared with control and sham groups. Expected results would be immediate hemodynamic improvement due to synchronized diastolic reduction of stagnant venous capacitance, increasing preload and contractility. On long term, increased shear stress with changing intrathoracic pressure in a phasic way would improve and remodel the pulmonary circulation. Future studies will be focused on: hemodynamic, biochemistry, endothelium function test, and angiogenesis. Comments: A non-invasive CAD guarantees better hemodynamics and endothelial function preservation with low morbidity and mortality. This is a physiological approach, cost-effective method, and particularly interesting in neonates and pediatrics with RV failure.

Asymptomatic Vascular Rings of Aorta in Adult Cardiac Surgery Patients [IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY]

Minakata, Yunoki, Sakai, Kataoka, Ujino — Thu, 12 Nov 2009 07:32:36 PST

Aneurysm of the Sinus of Valsalva [IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY]

Hamada, Kawata — Thu, 12 Nov 2009 07:32:36 PST

Large Pulmonary Hernia following Thoracotomy [IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY]

Ritter, Weininger, Hahn, Beissert — Thu, 12 Nov 2009 07:32:36 PST

Huge Intrathoracal Cystic Mass Restricted by Dense Calcification [IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY]

Turut, Koksal, Dagli — Thu, 12 Nov 2009 07:32:36 PST

Virtual Histology of Aneurysmal Lesion in Aortocoronary Saphenous Vein Graft [IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY]

Jim, Yiu, Ko, Siu, Chow — Thu, 12 Nov 2009 07:32:36 PST

Cerebral Air Embolism, the Potential of Arterial and Venous Ascent [LETTER TO THE EDITOR]

Schlimp, Lederer — Thu, 12 Nov 2009 07:32:36 PST