Asian Cardiovascular and Thoracic Annals recent issues

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

Biointegration and Growth of Porcine Valved Pulmonary Conduits in a Sheep Model [ORIGINAL ARTICLE]

Furlanetto, Passerino, Siegel, Chueng, Levitsky, Casagrande — Thu, 27 Aug 2009 07:48:48 PDT

As there is currently no suitable valved pulmonary conduit for small children, porcine conduits treated by the L-Hydro process were implanted into 9 newborn lambs to investigate growth potential. Of the 8 survivors, 7 were kept alive for 12 months after implantation. The diameter of the conduit and gradient across the valve were evaluated at surgery and at 3 and 9 months postoperatively using bidirectional echocardiographic and angiographic methods. After sacrifice, histological and radiological analyses were performed. The mean weight of the animals was 4.2 ± 1.1 kg at implantation and 43.1 ± 6.2 kg at sacrifice. There was a significant increase in mean valve area from 139.9 ± 18.0 mm² at implantation to 443.5 ± 89.2 mm² at 12 months. Pre-sacrifice angiography showed no transvalvular gradient, and radiographic analysis did not reveal significant conduit wall or leaflet calcification in any of the animals. Histological examination of the grafts demonstrated total integration, with native-like intact valve leaflets. Thus functional evaluation, echocardiography, and histology demonstrated growth of the grafts with completely endothelialized and apparently normal pulmonary valve leaflets without calcification.

Cervical Mediastinoscopic Lymphadenectomy for Accurate Staging in Lung Cancer [ORIGINAL ARTICLE]

Bar, Papiashvilli, Fink, Sandbank, Stav — Thu, 27 Aug 2009 07:48:48 PDT

Accurate preoperative staging of the mediastinum is important in the treatment of non-small-cell lung cancer. Enlarged mediastinal lymph nodes on chest computed tomography are positive for malignancy on mediastinoscopy in only half of these patients. After negative mediastinoscopy, some positive nodes are found at thoracotomy. The aim of this study was to attempt to remove all lymph nodes accessible by cervical mediastinoscopic lymphadenectomy and reevaluate the same mediastinal stations at thoracotomy for missed lymph nodes. Between 1999 and 2003, 30 patients with operable non-small-cell lung cancer and enlarged mediastinal lymph nodes (>1 cm in diameter on computed tomography) that were negative on cervical mediastinoscopy underwent pulmonary resection with complete lymph node dissection. The total number of lymph nodes dissected in these 30 patients was 329 (143 at mediastinoscopy and 186 at thoracotomy); the mean numbers of nodes dissected were 4.8 at mediastinoscopy and 6.2 at thoracotomy. Ten (6.5%) residual lymph nodes were detected at thoracotomy in mediastinal stations R4, L4, and 7. The low number of missed lymph nodes demonstrates the accuracy of the technique of cervical mediastinoscopic lymphadenectomy.

Current Practice and Outcomes of Off-pump Multivessel Coronary Artery Bypass [ORIGINAL ARTICLE]

Sun, Lim, Hill, Haile, Corso, Garcia — Thu, 27 Aug 2009 07:48:48 PDT

Outcomes of off-pump multivessel coronary artery bypass were compared with those of the on-pump procedure. From July 2001 to June 2006, 3,637 patients with multivessel coronary disease underwent off-pump coronary artery bypass, and 3,586 patients had on-pump coronary artery bypass in our center. The rates of operative mortality, permanent stroke, renal failure and perioperative myocardial infarction were significantly lower in the off-pump group, and these patients required fewer blood transfusions, shorter durations of ventilatory support, and shorter hospital stays. However, the patients who underwent on-pump coronary artery bypass were considered more high-risk and tended to have more complex procedures.

Is 6% Hydroxyethyl Starch 130/0.4 Safe in Coronary Artery Bypass Graft Surgery? [ORIGINAL ARTICLE]

Ooi Su Min, Ramzisham, Zamrin — Thu, 27 Aug 2009 07:48:48 PDT

The aim of this study was to compare 6% hydroxyethyl starch 130/0.4 with 4% succinylated gelatin for priming the cardiopulmonary bypass circuit and as volume replacement in patients undergoing coronary artery bypass, in terms of postoperative bleeding, blood transfusion requirements, renal function, and outcome after surgery. Forty-five patients received 6% hydroxyethyl starch 130/0.4 (Voluven) and another 45 were given 4% succinylated gelatin (Gelofusine) as the priming solution for the cardiopulmonary bypass circuit as well as for volume replacement. Postoperative bleeding was quantified from the hourly chest drainage in the first 4 h and at 24 h postoperatively. The baseline characteristics of both groups were similar. In the hydroxyethyl starch group, the total amount of colloid used was 1.9 ± 1.0 L, while the gelatin group had 2.0 ± 0.7 L. There was no significant difference in hourly chest drainage between groups. Blood transfusion requirements, estimated glomerular filtration rate, extubation time, intensive care unit and hospital stay were similar in both groups. It was concluded that 6% hydroxyethyl starch 130/0.4 is a safe alternative colloid for priming the cardiopulmonary bypass circuit and volume replacement in patients undergoing coronary artery bypass surgery.

Aortic Replacement via Median Sternotomy with Left Anterolateral Thoracotomy [ORIGINAL ARTICLE]

Yamashiro, Kuniyoshi, Arakaki, Inafuku, Morishima, Kise — Thu, 27 Aug 2009 07:48:48 PDT

Prevention of cerebral injury is an important consideration during repair of aortic arch aneurysm, and the major goal of cerebral protection techniques. We describe our surgical strategy for treatment of extended thoracic aortic aneurysms. Between January 2001 and June 2008, 17 men and 6 women, with a mean age of 67.9 ± 8.3 years, underwent total replacement of the arch and descending aorta. Six (26.1%) patients required emergency surgery. A median sternotomy with a left anterolateral thoracotomy provided a good visual field, and bilateral axillary arteries were preferentially used for systemic as well as selective cerebral perfusion. Two (8.7%) patients died in hospital. Prolonged mechanical ventilation was required for 7.3 ± 8.4 days after surgery in 17 patients who all recovered uneventfully. Permanent neurological dysfunction developed in 1 (4.3%) patient who died of sepsis 2 years after the operation. Our results suggest that total arch replacement through a median sternotomy plus a left anterolateral thoracotomy is helpful for extended replacement of the thoracic aorta as well as distal reoperation for dissecting type A aortic aneurysm. Perfusion via bilateral axillary arteries may improve cerebral protection.

Solitary Fibrous Tumor of the Pleura: Surgery and Clinical Course in 18 Cases [ORIGINAL ARTICLE]

Bini, Brandolini, Davoli, Dolci, Sellitri, Stella — Thu, 27 Aug 2009 07:48:48 PDT

Solitary fibrous tumors of the pleura are very rare neoplasms that can sometimes present with malignant features. Between 1984 and 2007, 18 cases were treated in our institution. There were 7 men and 11 women, with a median age of 56 years (range, 33–77 years). All patients underwent surgical treatment. Except for one case with hemangiopericytic features, all tumors were histologically the fibrous type of pleural mesothelioma. Resections were radical and there were no recurrences. There was no perioperative mortality. The outcome was excellent, and all patients have been followed up continuously. Survival rates at 3, 5, and 10 years were calculated as 86.7%, 75%, and 66.7%. One patient died after 18 months (malignant type of solitary fibrous tumor), and 2 died of unrelated disease after 24 and 53 months. Surgery is the treatment of choice, and careful long-term clinical follow-up is required.

Intramyocardial Angiogenic Cell Precursors in Nonischemic Dilated Cardiomyopathy [ORIGINAL ARTICLE]

Arom, Ruengsakulrach, Belkin, Tiensuwan — Thu, 27 Aug 2009 07:48:48 PDT

To determine the efficacy of intramyocardial injection of angiogenic cell precursors in nonischemic dilated cardiomyopathy, 35 patients with nonischemic dilated cardiomyopathy underwent injections of angiogenic cell precursors into the left ventricle (cell group). Seventeen patients with nonischemic dilated cardiomyopathy were matched from the heart failure database to form a control group that was treated medically. Angiogenic cell precursors were obtained from autologous blood, cultured in vitro, and injected into all free-wall areas of the left ventricle in the cell group. After these injections, New York Heart Association functional class improved significantly by 1.1 ± 0.7 classes at 284.7 ± 136.2 days, and left ventricular ejection fraction improved in 71.4% of patients (25/35); the mean increase in left ventricular ejection fraction was 4.4% ± 10.6% at 192.7 ± 135.1 days. Improved quality of life was demonstrated by better physical function, role-physical, general health, and vitality domains in a short-form health survey at the 3-month follow-up. In the control group, there were no significant improvements in left ventricular ejection fraction or New York Heart Association class which increased by 0.6 ± 0.8 classes. It was concluded that intramyocardial angiogenic cell precursor injection is probably effective in the treatment of nonischemic dilated cardiomyopathy.

Disclosures and Freedom of Investigation

Professor Michael Belkin is an advisory board member, a minor shareholder, and receives a consulting fee from TheraVitae Co. Ltd. However, the authors had full control of the study, methods used, outcome measurements, data analysis, and production of the written report.

Bispectral Index-Monitored Anesthesia Technique for Transsternal Thymectomy [ORIGINAL ARTICLE]

Maddali, Matreja, Zachariah — Thu, 27 Aug 2009 07:48:48 PDT

To evaluate the role of bispectral index monitoring as an adjunct to balanced anesthesia in patients with myasthenia gravis undergoing transsternal thymectomy without the use of neuromuscular blocking agents, 10 patients were enrolled into this prospective observational study. After oral midazolam premedication, general anesthesia was induced with fentanyl, propofol, and sevoflurane. Tracheal intubation was performed without neuromuscular blocking agents. During maintenance, continuous monitoring of physiological and bispectral index parameters was used to titrate the doses of remifentanil, propofol, and sevoflurane. Sevoflurane concentration and propofol doses were adjusted to achieve bispectral index values in the high 30s to low 40 s. Propofol was discontinued when the sternum was approximated. Remifentanil infusion was stopped on subcutaneous tissue closure, and sevoflurane was switched off when nearing completion of skin closure. Tracheal extubation was performed when extubation criteria were met. On extubation, bispectral index levels were above 90. The median time from extubation to discontinuation of propofol was 28 ± 4 min, that of remifentanil was 21 ± 4 min, and it was 9 ± 5 min for sevoflurane. Bispectral index monitoring provided excellent hemodynamic control during surgery, and allowed early problem-free tracheal extubation.

Temporary Right Ventricular Support with Impella Recover RD Axial Flow Pump [ORIGINAL ARTICLE]

Sugiki, Nakashima, Vermes, Loisance, Kirsch — Thu, 27 Aug 2009 07:48:48 PDT

Post-cardiotomy right ventricular failure is a serious complication that frequently results in adverse outcomes. We reviewed our experience with the Impella Recover RD (Impella Cardiosystems GMbH, Aachen, Germany). From January 2007 to December 2007, 7 patients (5 males, 54 +7 years old) had this device implanted for temporary support after heart transplantation in 4, after repeat mitral valve replacement in 2, and with a left ventricular assist device in 1. Devices were implanted during initial operation (n =5) or shortly thereafter (n =2). Six patients underwent implantation without cardiopulmonary bypass. Effective support with pump flows of 4.0–4.5 L · min^–1 and adequate unloading (central venous pressure decreased from 15.3 ± 1.4 to 9.4 ± 1.2 mm Hg) was achieved in all patients. Patients were assisted for a mean duration of 4.9 ± 4.5 days. Three patients could be weaned after 7.0 ± 5.6 days of support and underwent device explantation without cardiopulmonary bypass. One of these patients died of recurrent right ventricular failure, 2 remained stable but died later of sepsis. The patient with a left ventricular assist device was switched to an alternative device for prolonged support. Two patients experienced pump dysfunction. Our preliminary experience shows that the Impella Recover RD is an effective device that can be easily implanted and explanted. However, its mechanical reliability needs to be improved.

Hypothermic Circulatory Arrest: Renal Protection by Atrial Natriuretic Peptide [ORIGINAL ARTICLE]

Ohno, Omoto, Fukuzumi, Oi, Ishikawa, Tedoriya — Thu, 27 Aug 2009 07:48:48 PDT

Moderate hypothermic circulatory arrest with selective cerebral perfusion has been developed for cerebral protection during thoracic aortic surgery. However, visceral organs, particularly the kidneys, suffer greater tissue damage under moderate hypothermic circulatory arrest, and acute renal failure after hypothermic circulatory arrest is an independent risk factor for early and late mortality. This study investigated whether atrial natriuretic peptide could prevent the reduction in renal perfusion and protect renal function after moderate hypothermic circulatory arrest. Twelve pigs cooled to 30°C during cardiopulmonary bypass were randomly assigned to a peptide-treated group of 6 and a control group of 6. Moderate hypothermic circulatory arrest was induced for 60 min. Systemic arterial mean pressure and renal artery flow did not differ between groups during the study. However, renal medullary blood flow increased significantly in the peptide-treated group after hypothermic circulatory arrest. Myeloperoxidase activity was significantly reduced in the medulla of the peptide-treated group. Renal medullary ischemia after hypothermic circulatory arrest was ameliorated by atrial natriuretic peptide which increased medullary blood flow and reduced sodium reabsorption in the medulla. Atrial natriuretic peptide also reduced the release of an inflammatory marker after ischemia in renal tissue.

Eight-Year Experience of Intraoperative Aortic Dissection [ORIGINAL ARTICLE]

Lin, Chen, Chiu, Hsu, Yu, Wang — Thu, 27 Aug 2009 07:48:48 PDT

Aortic dissection is a rare but devastating complication of cardiac operations. The purpose of this investigation was to assess the occurrence of aortic dissection during elective cardiac operations and the usefulness of intraoperative transesophageal echocardiography for the diagnosis and management of this complication. Data of consecutive adult patients undergoing elective cardiac surgery with transesophageal echocardiographic monitoring during an 8-year period were studied retrospectively. Aortic dissection was identified in 7 (0.13%) of 5,247 patients, and diagnosed immediately by transesophageal echocardiography in 5 of them; 2 were diagnosed later by transesophageal echocardiography. All aortic dissections were type A and they occurred after completion of the primary procedure. Two patients treated conservatively died within 5 days. Four of the 5 patients who underwent immediate reoperation survived with serious postoperative complications. Transesophageal echocardiography should be carried out when there is a risk of aortic dissection during cardiac operations, especially in the posterior wall of the ascending aorta, to avoid missing the diagnosis and delaying treatment.

Distal Aortopulmonary Window: a Morphological Variation [CASE STUDIES]

Chaudhari, Hasan — Thu, 27 Aug 2009 07:48:48 PDT

Several variations in the morphology of aortopulmonary window have been documented. We describe a unique variation of a large aortopulmonary window, and its successful surgical correction.

Deep Hypothermic Arrest for Aortic Valve Replacement in Case of Porcelain Aorta [CASE STUDIES]

Iliopoulos, Deveja, Satratzemis, Koudoumas — Thu, 27 Aug 2009 07:48:48 PDT

A 71-year-old man presented with severe aortic stenosis and a heavily calcified aorta. Cardiopulmonary bypass was established with arterial cannula via the distal aortic arch. Deep hypothermic circulatory arrest and retrograde cerebral perfusion were initiated for excision of the ascending aorta. A tube graft was anastomosed to the proximal aortic arch, circulation was reestablished, the aortic valve was replaced with a bioprosthesis, and proximal anastomosis to the sinotubular junction was preformed.

Mycotic Ascending Aortic Pseudoaneurysm at Aortic Cannulation Site [CASE STUDIES]

Sirin, Yilmaz, Demirsoy, Alan, Soybir, Sonmez — Thu, 27 Aug 2009 07:48:48 PDT

Mycotic aneurysm of the aorta is a rare but highly fatal complication of coronary bypass surgery. A 49-year-old man developed mycotic pseudoaneurysm in the ascending aorta after coronary bypass in another hospital. Computed tomography showed the pseudoaneurysm originated from the previous aortic cannulation site. The defect was successfully repaired with pericardial-pledgeted sutures.

Dual Inferior Venae Cavae with Mitral Stenosis [CASE STUDIES]

Tambe, Sinha, Bhupali — Thu, 27 Aug 2009 07:48:48 PDT

A 34-year old woman with rheumatic mitral stenosis was found to have complete dual inferior venae cavae with bilateral infrarenal and suprarenal segments, on balloon mitral valvuloplasty. The bilateral, renal, and gonadal veins drained separately on the ipsilateral side. The left inferior vena cava was larger than the right, and the right inferior vena cava had an aneurysmal dilatation near its origin. The left inferior vena cava drained into the superior vena cava-right atrial junction.

Aortic Relocation for Transposition Complex with Aortic Arch Obstruction [CASE STUDIES]

Tateishi, Kawada, Morita, Kasahara, Sano — Thu, 27 Aug 2009 07:48:48 PDT

We describe successful primary repair of 2 cases of transposition complex with aortic arch obstruction. A new aortic arch was reconstructed by direct anastomosis between the well-mobilized ascending aorta and the descending aorta. The neoaortic root with transferred coronary arteries was subsequently anastomosed to the undersurface of this new aortic arch. This technique deals with the significant size discrepancy between the 2 great arteries, and anomalous coronary artery patterns.

Aortic Relocation for Transposition Complex with Aortic Arch Obstruction [INVITED REVIEW]

Corno — Thu, 27 Aug 2009 07:48:48 PDT

Impact of Video-Assisted Thoracoscopic Major Lung Resection on Immune Function [REVIEW PAPER]

Ng, Wan, Yim — Thu, 27 Aug 2009 07:48:48 PDT

Video-assisted thoracoscopic major lung resection for early stage non-small-cell lung carcinoma has been associated with less postoperative pain, better preserved pulmonary function, shorter hospital stay, and enhanced tolerance of adjuvant chemotherapy compared to thoracotomy. Initial concerns regarding safety, oncological clearance, and cost effectiveness were unfounded. Several recent trials have reported improved long-term survival in patients with early stage non-small-cell lung carcinoma undergoing video-assisted thoracoscopic major lung resection, compared to the open technique, although there are inconsistencies. Interestingly, the immune status and autologous tumor killing ability of lung cancer patients have previously been associated with long-term survival. Video-assisted thoracoscopic lung resection results in an attenuated postoperative inflammatory response, but more importantly, it better preserves postoperative immune function. Circulating natural killer and T-cell numbers, T-cell oxidative activity, and levels of immunochemokines such as insulin growth factor binding protein-3 are higher after video-assisted thoracoscopic surgery than after thoracotomy. Recently, interest has developed in the role of the angiogenesis factor, vascular endothelial growth factor, after cancer surgery. Whether differences in immunological and biochemical mediators contribute towards improved long-term survival following video-assisted thoracoscopic major lung resection for cancer remains to be confirmed.

Double Aortic Arch with Tetralogy of Fallot: a Rare Association [IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY]

Singh — Thu, 27 Aug 2009 07:48:48 PDT

Pleomorphic Rhabdomyosarcoma Pulmonary Embolism [IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY]

Buklas, Kaili, Taberlet, Cordier, Chocron — Thu, 27 Aug 2009 07:48:48 PDT

Primary Giant Cardiac Lymphoma Occupying Right Atrium [IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY]

Ohashi, Yoshida, Oka, Tazawa, Hirai, Oyoshi — Thu, 27 Aug 2009 07:48:48 PDT

Surgical Release of Trapped Guidewire after Coronary Angioplasty and Stenting [IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY]

Kotoulas, Stathopoulos, Koukis, Patris — Thu, 27 Aug 2009 07:48:48 PDT

Renal Outcome Following On- and Off-pump Coronary Artery Bypass Graft Surgery: Few Patients, Cautious Conclusions [LETTER TO THE EDITOR]

Lema — Thu, 27 Aug 2009 07:48:48 PDT

The Ideal Graft of the Future: a Prospect of Messianic Proportions? [EDITORIAL]

Klima, Kofidis — Thu, 30 Jul 2009 06:07:04 PDT

Importance of Strain Imaging in Cardiac Rehabilitation [ORIGINAL ARTICLE]

Claessens, Meulendijks, Claessens, Claessens, Claessens, Claessens — Thu, 30 Jul 2009 06:07:04 PDT

Cardiac rehabilitation improves the subjective condition of the patient; but are there associated structural and functional cardiac adaptations? The study group consisted of 39 patients with an inferior infarction and 21 patients with an anterior infarction, treated by surgical revascularization followed by 4 months of cardiac rehabilitation. Maximal exercise testing and Doppler echocardiography were performed before and after the rehabilitation program. Performance capacity was significantly improved after cardiac rehabilitation, but left ventricular function remained unchanged on Doppler imaging. Only by analyzing the subgroups using strain imaging significant differences were noted after cardiac rehabilitation: patients with an inferior infarction exhibited improved strain values in the anterior wall; those with an anterior infarction had improved strain values in the inferior wall. Strain values in the infarcted regions were worse after cardiac rehabilitation. Strain imaging indicated that cardiac rehabilitation could bring about improvements in cardiac function exclusively in the healthy non-infarcted myocardium, while there were signs of further deterioration of myocardial function in the highly ischemic zones.

Impact of Coronary Disease After Aortic Valve Replacement [ORIGINAL ARTICLE]

Grunenfelder, Kilb, Plass, Cominelli, Zeller, Genoni — Thu, 30 Jul 2009 06:07:04 PDT

Left ventricular dimensions tend to reduce after aortic valve replacement in patients with aortic stenosis. Whether concomitant coronary artery disease has an influence on postoperative ventricular dimensions has not been evaluated. Between 1998 and 2002, 112 patients underwent aortic valve replacement for aortic stenosis; 68 had isolated aortic valve replacement, and 44 had combined coronary artery bypass grafting. Left ventricular dimensions were assessed by echocardiography preoperatively and at 3 and 12 months postoperatively. Transvalvular mean gradient, left ventricular end-diastolic diameter, and left ventricular mass index decreased significantly postoperatively, while left ventricular ejection fraction improved. Preoperative left ventricular dimensions in patients with isolated aortic stenosis were worse than in those with aortic stenosis and coronary artery disease. After aortic valve replacement with coronary artery bypass, left ventricular mass index regression was less than that after valve replacement alone, and there was no improvement in ejection fraction. This suggests that coronary artery disease has a negative impact on postoperative myocardial recovery.

Impact of Gender on Outcome After Coronary Artery Bypass Surgery [ORIGINAL ARTICLE]

Ennker, Albert, Pietrowski, Bauer, Ennker, Florath — Thu, 30 Jul 2009 06:07:04 PDT

Following recent studies concerning the increased risk of coronary artery bypass surgery for women, the impact of sex is still a controversial issue. Between 1996 and 2006, 9,527 men and 3,079 women underwent isolated coronary artery bypass in our institute. To adjust for dissimilarities in preoperative risk profiles, propensity score-based matching was applied. Before adjustment, clinical outcomes in terms of operative mortality, arrhythmias, intensive care unit stay, and maximum creatine kinase-MB levels were significantly different for men and women. After balancing the preoperative characteristics, including height, no significant differences in clinical outcomes were observed. However, there was decreased use of internal mammary artery, less total arterial revascularization, and increasing creatine kinase-MB levels with decreasing height. This study supports the theory that female sex per se does not increase operative risk, but shorter height, which is more common in women, affects the outcome, probably due to technical difficulties in shorter patients with smaller internal mammary arteries and coronary vessels. Thus women may especially benefit from sequential arterial grafting.

Effect on the Brain of Two Techniques of Myocardial Protection [ORIGINAL ARTICLE]

Stygall, Suvarna, Harrington, Hayward, Walesby, Newman — Thu, 30 Jul 2009 06:07:04 PDT

This study compared the occurrence of intraoperative microemboli and postoperative changes in neuropsychological performance in 195 patients undergoing coronary artery bypass grafting who were randomized to intermittent crossclamp fibrillation or cardioplegic arrest. Cerebral microemboli were recorded from cannulation to 15 min after decannulation, using transcranial Doppler in 166 patients. Microemboli in relation to 9 surgical events were also noted. Neuropsychological change scores were obtained by comparing cognitive performance preoperatively with that at 6–8 weeks after surgery. The median number of microemboli detected was 105 (range, 9–1,757) in the fibrillation group, and 110 (range, 1–1,306) in the cardioplegia group, with no significant difference between groups. There was also no significant difference between groups in the generation of microemboli during any of the surgical events. Neuropsychological tests were completed postoperatively by 177 participants, with no significant differences in performance found between the 2 groups. Given the equivalence of the effect of intermittent crossclamp fibrillation and cardioplegic arrest on microemboli and neuropsychology, consideration of which form of myocardial protection to employ should perhaps focus more on which method affords most protection to the heart.

Scimitar Syndrome: Experience With 6 Patients [ORIGINAL ARTICLE]

Baskar Karthekeyan, Saldanha, Sahadevan, Rao, Vakamudi, Rajagopal — Thu, 30 Jul 2009 06:07:04 PDT

Scimitar syndrome is a rare congenital anomaly characterized by anomalous pulmonary venous drainage to the inferior vena cava, causing a left-to-right shunt. Six patients with scimitar syndrome were diagnosed in our hospital between 2002 and 2008. There were 4 girls and 2 boys; 4 < 5 kg in weight, 2 < 8 kg in weight. Scimitar syndrome was suspected in 5 cases because of dextroversion, and diagnosed by color Doppler echocardiography in all 6 when a scimitar vein was detected entering the inferior vena cava. Computed tomography confirmed the diagnosis in all patients. Two patients had horseshoe lung, 2 had a unilobar right lung, 1 had a hypoplastic right lung, and 1 had a hypoplastic right lower lobe. Three patients had severe pulmonary arterial hypertension, 2 had moderate pulmonary arterial hypertension, and one had normal pulmonary arterial pressure. All patients had lower respiratory tract infections, volume loss of the right lung, a normal or hyperinflated left lung, dextroversion of the heart, and scimitar arteries from the descending aorta. Pneumonectomy was performed in 3 patients, lobectomy in 1, ligation of anomalous vessels in 1, and 1 died before surgery.

Is Age Over 70 Years a Risk Factor for Pneumonectomy? [ORIGINAL ARTICLE]

Annessi, Paci, Ricchetti, Ferrari, Formisano, Sgarbi — Thu, 30 Jul 2009 06:07:04 PDT

The lengthening of life expectancy has led to more surgical procedures in elderly patients. The aim of this work was to determine whether age >70 years is a risk factor for pneumonectomy. All cases of pneumonectomy from January 1999 to December 2006 were retrospectively reviewed. The 40 patients aged >70 years were compared with a group of 70 patients aged 40–68 years matched for sex, physical status, respiratory function, side of pneumonectomy, and pathologic stage. Postoperatively, significantly more older patients had atrial fibrillation (24% vs. 5.6%). There was a low incidence of respiratory complications in both groups, and reduced respiratory function did not increase respiratory morbidity. Thirty-day mortality was not significantly different (2.5% in older vs. 1.4% in younger patients), but long-term mortality rates evaluated at December 31, 2007 were 50% for those aged <70 years (35 patients) and 72.5% for the older group. Although age is a risk factor for morbidity and mortality in pneumonectomy, the risk is acceptable.

Leaflet Suspension and Subvalvular Annuloplasty in Aortic Valve Prolapse [ORIGINAL ARTICLE]

Izumoto, Kawazoe, Oka, Ishibashi, Yamamoto, Yamamoto — Thu, 30 Jul 2009 06:07:04 PDT

We have utilized the combined techniques of subvalvular annuloplasty and leaflet suspension since 1999 to repair prolapsing aortic valves. We reviewed our short-term results to assess perioperative echocardiographic changes and repair durability. Nineteen patients (15 men and 4 women; mean age, 60.7 years) underwent this operation between July 1999 and June 2002. All were interviewed to establish their latest functional status, reoperation and survival rates. After a mean follow-up of 40.1 months, all patients were alive and in New York Heart Association functional class I. The echocardiographic grade of aortic regurgitation decreased from 3.2 preoperatively to 1.6 at follow-up. Left ventricular end-diastolic dimension shortened significantly from 6.2 to 5.2 cm. Left ventricular end-systolic dimension decreased from 4.1 to 3.3 cm. Annulus size was also significantly less at 2.2 cm from 2.5 cm preoperatively. At 48 months, freedom from reoperation was 88.9% ± 7.4%. The follow-up was 100% complete. Repair of a prolapsing aortic valve with leaflet suspension and subvalvular annuloplasty is a good procedure and the short-term results are satisfying.

Can Chest Trauma Patients Provide Breath Sample With Lion SD-400 Alcometer? [ORIGINAL ARTICLE]

Rathinam, Luke, Nanjaiah, Kalkat, Steyn — Thu, 30 Jul 2009 06:07:04 PDT

Various investigators have addressed the minimum lung function required to activate breathalyzers, and the impact of comorbid respiratory illness. We postulated that subjects with significant chest trauma may have difficulty in providing an adequate breathalyzer sample. A prospective self-controlled study of 20 patients who underwent thoracotomy was conducted between August 2005 and December 2005, using a Lion Alcometer SD-400. The mean age of the patients was 69.3 years (range, 37–83 years). Preoperatively, their mean forced expiratory volume was 1.97 L (range, 1.19–2.46 L), and peak expiratory flow rate was 240 L min^–1 (range, 126–520 L min^–1). Postoperatively, mean forced expiratory volume was 1.14 L (range, 0.34–2.2 L) and peak expiratory flow rate was 179 L min^–1 (range, 36–492 L min^–1). These decreases were highly significant. All patients activated the breathalyzer device preoperatively, but only 2 (10%) could activate it postoperatively. Extrapolating this to patients with chest injury, most may find it impossible to activate breathalyzers.

Establishment of Rat Model of Cardiopulmonary Bypass in Pulmonary Hypertension [ORIGINAL ARTICLE]

Liu, Zhang, Wang, Dong, Jing — Thu, 30 Jul 2009 06:07:04 PDT

An experimental model of cardiopulmonary bypass in rats with pulmonary hypertension is necessary to understand underlying mechanisms and develop protective strategies. Male Sprague-Dawley rats were randomly divided into a sham group, cardiopulmonary bypass group, pulmonary hypertension group, and pulmonary hypertension with cardiopulmonary bypass group. Both groups with pulmonary hypertension received a subcutaneous injection of monocrotaline 60 mg · kg^–1 on day 0. Cardiopulmonary bypass was instituted in one of them 21 days later. The sham and pulmonary hypertension control groups underwent cannulation only. Cardiopulmonary bypass was conducted for 60 min at a flow rate of 100 mL · kg^–1 · min^–1. Hemodynamic investigations, blood gas analysis, interleukin-6, tumor necrosis factor-, and survival studies were performed subsequently. Time-dependent increases of serum interleukin-6 and tumor necrosis factor- were found after cardiopulmonary bypass in both groups. This model allows the study of multiple organ pathophysiological processes after cardiopulmonary bypass in rats with pulmonary hypertension, as well as the evaluation of possible protective strategies.

Squamous Cell Carcinoma of the Lung in Association With Sarcoidosis [CASE STUDIES]

Tatebe, Oka, Toda, Watanabe, Shinonaga, Kuraoka — Thu, 30 Jul 2009 06:07:04 PDT

A 76-year-old man who was known to have sarcoidosis, developed a lung tumor. He had previously undergone cardiac and abdominal vascular surgery, at which sarcoidosis was confirmed by lymph node biopsy. A right lower lobectomy was carried out. Postoperative pathology showed limited disease, but cancer recurred 1 year later. Issues regarding the combination of sarcoidosis and a malignant tumor are discussed.

Surgical Repair of Mitral and Tricuspid Valves After Cardiac Transplantation [CASE STUDIES]

Yoshikawa, Tomari, Usui, Ueda — Thu, 30 Jul 2009 06:07:04 PDT

A 43-year-old man underwent mitral valve repair for mitral valve insufficiency due to infective endocarditis, and tricuspid valve repair for iatrogenic chordal rupture due to multiple endomyocardial biopsies after orthotopic cardiac transplantation. Valve repair using no artificial material is feasible, instead of valve replacement, to decrease the risk of recurrent infective endocarditis and enable further biopsies.

Emergency Surgical Embolectomy for Pulmonary Emboli After Failed Thrombolysis [CASE STUDIES]

Chu, Andrews, Watanabe — Thu, 30 Jul 2009 06:07:04 PDT

A 34-year-old man presented in cardiogenic shock secondary to massive pulmonary embolism. Surgical embolectomy was performed after failed thrombolysis. Intraoperatively, a right atrial lesion and pulmonary emboli were removed. Histopathology revealed myxoma complicated by pulmonary emboli. The patient made a good recovery. This case suggests that surgical embolectomy should be considered as first-line treatment for all patients with acute massive pulmonary embolism, and not reserved for those with severe hemodynamic compromise or failed conservative management.

Middle Lobectomy After Pneumonectomy [CASE STUDIES]

Quiroga, Prim, Moldes, Ledo — Thu, 30 Jul 2009 06:07:04 PDT

A 59-year-old man underwent a successful middle lobectomy to treat metastasis from a pulmonary adenocarcinoma resected previously by left pneumonectomy.

Adult Patent Ductus Arteriosus: Successful Surgery With Mitral Valvuloplasty [CASE STUDIES]

Hobo, Hanayama, Umezu, Shimada, Toyama, Takazawa — Thu, 30 Jul 2009 06:07:04 PDT

The development of left ventricular dysfunction is a serious complication of longstanding patent ductus arteriosus. An 80-year-old woman who underwent patent ductus arteriosus ligation 13 years previously developed congestive heart failure and mitral regurgitation. She underwent surgical repair with transpulmonary ductus closure and mitral valve annuloplasty under cardiopulmonary bypass. She made a full recovery with improved left ventricular function.

Coronary-to-Pulmonary Artery Collateral in Tetralogy of Fallot [CASE STUDIES]

Agarwal, Mishra, Mukherjee, Satsangi — Thu, 30 Jul 2009 06:07:04 PDT

Angiography in a 14-year-old boy with cyanosis since birth confirmed the diagnosis of tetralogy of Fallot with a subaortic ventricular septal defect, large overriding aorta, severe pulmonary stenosis, and a large collateral arising from the left circumflex artery. The collateral was isolated and ligated at its origin, and the patient underwent an uneventful repair with ventricular septal defect patch closure, infundibular resection, pulmonary valvotomy, and right ventricular outflow tract reconstruction with an autologous pericardial patch.

Carinoplasty With Telescope Anastomosis for Tuberculous Bronchial Stenosis [CASE STUDIES]

Tanaka, Ohta, Matsumura, Ikeda, Kitahara, Iuchi — Thu, 30 Jul 2009 06:07:04 PDT

A 25-year-old women developed severe stenosis of the right main bronchus after medical treatment for pulmonary tuberculosis in the right upper lobe. She underwent a right upper sleeve lobectomy with partial excision of the right main bronchus and right side of the carina. Reconstruction was performed using telescopic anastomosis between the carina and intermediate bronchus. Her symptoms improved immediately.

Primary Tuberculous Sternal Osteomyelitis: A Clinical Rarity [CASE STUDIES]

Bhatia, Aggarwal, Sharma, Gupta — Thu, 30 Jul 2009 06:07:04 PDT

Primary tuberculous sternal osteomyelitis is a rare condition, presenting as painful swelling and discharging sinuses over the chest wall. Diagnosis is based on radiological findings and histological examination of debrided infected tissues, with specific cultures for mycobacteria. Two cases were successfully treated by surgical debridement and reconstruction using pectoralis major muscle flaps, followed by antituberculous therapy.

Video-Assisted Surgery for Lung Cancer. State of the Art and Personal Experience [INVITED REVIEW]

Loscertales, Jimenez-Merchan, Congregado, Ayarra, Gallardo, Trivino — Thu, 30 Jul 2009 06:07:04 PDT

This paper reviews the role of videothoracoscopy in lung cancer, highlighting its utility in definitive staging, diagnosis, and treatment. We show exploratory videothoracoscopy to be the perfect technique for last-minute staging, looking for tumor invasion, especially parietal T3 and vascular T4 (due to videopericardioscopy), management of solitary pulmonary nodules, and the possibility of radical treatment with video-assisted thoracoscopic lobectomy. We perform an overview of the literature and analyze our experience of 1,381 patients with lung cancer. In 1,277 of them, the final decision on resectability was made by exploratory videothoracoscopy, including 91 by videopericardioscopy (only 30 were considered non-resectable on videopericardioscopy). Solitary pulmonary nodules were diagnosed in 382 cases (190 were cancer), and we performed 260 major lung resections by video-assisted thoracoscopic surgery (22 pneumonectomies, 238 lobectomies/bilobectomies).

Traumatic Extrapleural Haematoma Imitating Pericardial and Pleural Pathology [IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY]

Khalil, Jutley, Waller, Hadjinikolaou — Thu, 30 Jul 2009 06:07:05 PDT

Solitary Intrapulmonary Nodular Amyloidoma [IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY]

Singh, Rana — Thu, 30 Jul 2009 06:07:05 PDT

Severely Protruding Descending Aortic Atheroma [IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY]

Matsuyama, Narita, Ueda — Thu, 30 Jul 2009 06:07:05 PDT

Left Ventricular Aneurysm [IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY]

Alotti, Kecskes — Thu, 30 Jul 2009 06:07:05 PDT

New Application Form from Issue 3 [NOTE TO OUR READERS]

Thu, 30 Jul 2009 06:07:05 PDT