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Kinds of Surg Selected AbstractsVentricular Volume Reduction ProceduresJOURNAL OF CARDIAC SURGERY, Issue 2003Akira T. Kawaguchi M.D. Other volume reduction procedures have become popular with renewed interest in ventricular reshaping to improve function. Although recent refined selection criteria have improved survival with PLV, earlier unpredictable results prompted less invasive procedures based on the same physiologic concept of reducing radius or wall tension by wrapping, piercing, or clasping. These new techniques are not only less invasive but also reversible and adjustable and appear safer for less symptomatic patients at risk of progressive heart failure. Nonetheless, mechanisms of action and degrees of volume reduction and/or restriction need to be delineated before widespread clinical application. (J CARD SURG 2003;18 (Suppl 2):S69-S75) [source] Does Repair of Mitral Regurgitation Eliminate the Need for Left Ventricular Volume Reduction?JOURNAL OF CARDIAC SURGERY, Issue 2003Akira T. Kawaguchi M.D. Methods: Among patients undergoing PLV, 120 had paired pre- and postoperative (<1 week) Doppler echocardiograms. Effects of preoperative MR were studied by comparing 45 patients with no preoperative MR (MR,) and 75 patients with significant MR (MR+; MR = 1.51 when MR is enumerated as none = 0, mild = 1, moderate = 2). Results: MR, patients as compared with the MR+ group were older (53.8 vs. 49.2 years, P = 0.047), had less frequent dilated cardiomyopathy (33.3% vs 49.3%,P <0.01), similar ventricular dimension (72.3 mm vs 73.0 mm), septal thickness (9.5 mm vs 9.6 mm), posterior wall, fractional shortening (15.9% vs 16.8%) and ventricular mass (330 g vs 345 g), resulting in comparably reduced functional capacity (NYHA 3.40 vs 3.67). Although the MR, group required significantly less frequent mitral procedure (64.4% vs 84.0%, P < 0.01) and shorter cardiac arrest time, they had similar postoperative MR (0.22 vs 0.39), highly significant parallel reduction in ventricular dimension (P < 0.001 in either group), and improved %FS (P <0.001 in either group), resulting in similar hospital survival (87.1% vs 86.4%) and 90-day survival (71.1% vs 78.7%) with significantly comparable improvement in functional class (P = 0.011 in both groups). Histological severity of interstitial fibrosis (P = 0.80), weight (P = 0.93), and thickness (P = 0.76) of excised myocardium was comparable between the two groups. Conclusion: Patients with no preoperative MR were found to benefit from PLV as did patients with significant MR. Beneficial effects of PLV appeared to derive mainly from volume reduction rather than abolished MR in this study.(J CARD SURG 2003;18 (Suppl 2):S95-S100) [source] Quantitative Analysis of Cytokine mRNA Expression in Hearts from Patients with Nonischemic Dilated Cardiomyopathy (DCM)JOURNAL OF CARDIAC SURGERY, Issue 2003Akira Ukimura To evaluate the role of cytokines in nonischemic DCM, we analyzed the relative quantity of cytokine mRNA expression in the hearts from DCM patients with refractory heart failure, using the ABI PRISM7700 real-time PCR system. We used heart tissues resected from 32 DCM patients at the time of elective partial ventriculectomy (PLV), and five biopsy specimens with normal histological findings as control. Results and Discussion: Interleukin (IL)-1,, IL-10, and Tumor Necrosis Factor (TNF)-, mRNA were expressed at low levels in all normal hearts. The number of IL-10-positive DCM cases was significantly smaller than normal controls (P = 0.0036). One (10%) of 10 DCM patients with IL-10 mRNA expression died after PLV, and 10 (45%) of 22 DCM patients without IL-10 mRNA expression died. IL-1, mRNA was overexpressed (over twice the mean of control subjects) in 15 of 32, and TNF-, mRNA in 10 of 32 patients. We propose the classification of DCM patients into subgroups on the basis of cytokine mRNA expression. Anticytokine therapy or cytokine therapy may have potential in improving the condition of heart failure in certain subgroups of DCM patients. Conclusions: We suggest that DCM patients with heart failure deteriorate without IL-10 mRNA expression in the myocardium. The classification of DCM patients into subgroups on the basis of cytokine mRNA expression may have great value in considering the treatment of this heterogeneous disease state. (J CARD SURG 2003;18 (Suppl 2):S101-S108) [source] NON-GYNAECOLOGICAL CYTOLOGY: THE CLINICIAN'S VIEWCYTOPATHOLOGY, Issue 2006I. Penman There is increased recognition of the importance of accurate staging of malignancies of the GI tract and lung, greater use of neoadjuvant therapies and more protocol-driven management. This is particularly important where regional lymph node involvement significantly impacts on curability. Multidetector CT and PET scanning have resulted in greater detection of potential abnormalities which, if positive for malignancy, would change management. There is also a greater recognition that many enlarged nodes may be inflammatory and that size criteria alone are unreliable in determining involvement. In other situations, especially pancreatic masses, not all represent carcinoma as focal chronic pancreatitis, autoimmune pancreatitis etc can catch out the unwary. A preoperative tissue diagnosis is essential and even if unresectable, oncologists are increasingly reluctant to initiate chemotherapy or enroll patients into trials without this. The approach to obtaining tissue is often hampered by the small size or relative inaccessibility of lesions by percutaneous approaches. As such novel techniques such as endoscopic ultrasound (EUS) guided FNA have been developed. A 120cm needle is passed through the instrument and, under real-time visualisation, through the gastrointestinal wall to sample adjacent lymph nodes or masses. Multiple studies have demonstrated the safety and performance of this technique. In oesophageal cancer, confirmation of node positivity by has a major negative influence on curative resection rates and will often lead to a decision to use neoadjuvant chemotherapy or a non-operative approach. Sampling of lymph nodes at the true coeliac axis upstages the patient to M1a status (stage IV) disease and makes the patient incurable. In NSCLC, subcarinal lymph nodes are frequently present but may be inflammatory. If positive these represent N2 (stage IIIA) disease and in most centres again makes the patient inoperable. Access to these lymph nodes would otherwise require mediastinosocopy whereas this can be done simply, safely and quickly by EUS. Overall the sensitivity for EUS , FNA of mediastinal or upper abdominal lymph nodes is 83,90% with an accuracy of 80,90%. In pancreatic cancer performance is less good but pooled analysis of published studies indicates a sensitivity of 85% and accuracy of 88%. In a recent spin-off from EUS, endobronchial ultrasound (EBUS) instruments have been developed and the ability to sample anterior mediastinal nodes has been demonstrated. It is likely that this EBUS , FNA technique will become increasingly utilised and may replace mediastinoscopy. The development of techniques such as EUS and EBUS to allow FNA sampling of lesions has increased the role of non-gynaecological cytology significantly in recent years. Cytology therefore remains important for a broad range of specialties and there is ongoing need for careful and close co-operation between cytologists and clinicians in these specialties. References:, 1. Williams DB, Sahai AV, Aabakken L, Penman ID, van Velse A, Webb J et al. Endoscopic ultrasound guided fine needle aspiration biopsy: a large single centre experience. Gut. 1999; 44: 720,6. 2. Silvestri GA, Hoffman BJ, Bhutani MS et al. Endoscopic ultrasound with fine-needle aspiration in the diagnosis and staging of lung cancer. Ann Thorac Surg 1996; 61: 1441,6. 3. Rintoul RC, Skwarski KM, Murchison JT, Wallace WA, Walker WS, Penman ID. Endobronchial and endoscopic ultrasound real-time fine-needle aspiration staging of the mediastinum ). Eur Resp J 2005; 25: 1,6. [source] Zygomaticomaxillary buttress reconstruction of midface defects with the osteocutaneous radial forearm free flapHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 10 2008Patricio Andrades MD Abstract Background. The purpose of this study was to evaluate morbidity, functional, and aesthetic outcomes in midface zygomaticomaxillary buttress reconstruction using the osteocutaneous radial forearm free flap (OCRFFF). Methods. A retrospective review of 24 consecutive patients that underwent midface reconstruction using the OCRFFF was performed. All patients had variable extension of maxillectomy defects that requires restoration of the zygmatico-maxillary buttress. After harvest, the OCRFFF was fixed transversely with miniplates connecting the remaining zygoma to the anterior maxilla. The orbital support was given by titanium mesh when needed that was fixed to the radial forearm bone anteriorly and placed on the remaining orbital floor posteriorly. The skin paddle was used for intraoral lining, external skin coverage, or both. The main outcome measures were flap success, donor-site morbidity, orbital, and oral complications. Facial contour, speech understandability, swallowing, oronasal separation, and socialization were also analyzed. Results. There were 6 women and 18 men, with an average age of 66 years old (range, 34,87). The resulting defects after maxillectomy were (according to the Cordeiro classification; Disa et al, Ann Plast Surg 2001;47:612,619; Santamaria and Cordeiro, J Surg Oncol 2006;94:522,531): type I (8.3%), type II (33.3%), type III (45.8%), and type IV (12.5%). There were no flap losses. Donor-site complications included partial loss of the split thickness skin graft (25%) and 1 radial bone fracture. The most significant recipient-site complications were severe ectropion (24%), dystopia (8%), and oronasal fistula (12%). All the complications occurred in patients with defects that required orbital floor reconstruction and/or cheek skin coverage. The average follow-up was 11.5 months, and over 80% of the patients had adequate swallowing, speech, and reincorporation to normal daily activities. Conclusions. The OCRFFF is an excellent alternative for midface reconstruction of the zygomaticomaxillary buttress. Complications were more common in patients who underwent resection of the orbital rim and floor (type III and IV defects) or external cheek skin. © 2008 Wiley Periodicals, Inc. Head Neck, 2008 [source] Surgical treatment of migraine headaches.HEADACHE, Issue 3 2003B Guyuron Plast Reconstr Surg. 2002 Jun;109(7):2183-2189 This prospective study was conducted to investigate the role of removal of corrugator supercilii muscles, transection of the zygomaticotemporal branch of the trigeminal nerve, and temple soft-tissue repositioning in the treatment of migraine headaches. Using the criteria set forth by the International Headache Society, the research team's neurologist evaluated patients with moderate to severe migraine headaches, to confirm the diagnosis. Subsequently, the patients completed a comprehensive migraine headaches questionnaire and the team's plastic surgeon injected 25 units of botulinum toxin type A (Botox) into each corrugator supercilii muscle. The patients were asked to maintain an accurate diary of their migraine headaches and to complete a monthly questionnaire documenting pertinent information related to their headaches. Patients in whom the injection of Botox resulted in complete elimination of the migraine headaches then underwent resection of the corrugator supercilii muscles. Those who experienced only significant improvement underwent transection of the zygomaticotemporal branch of the trigeminal nerve with repositioning of the temple soft tissues, in addition to removal of the corrugator supercilii muscles. Once again, patients kept a detailed postoperative record of their headaches. Of the 29 patients included in the study, 24 were women and five were men, with an average age of 44.9 years (range, 24 to 63 years). Twenty-four of 29 patients (82.8 percent, p < 0.001) reported a positive response to the injection of Botox, 16 (55.2 percent, p < 0.001) observed complete elimination, eight (27.6 percent, p < 0.04) experienced significant improvement (at least 50 percent reduction in intensity or severity), and five (17.2 percent, not significant) did not notice a change in their migraine headaches. Twenty-two of the 24 patients who had a favorable response to the injection of Botox underwent surgery, and 21 (95.5 percent, p < 0.001) observed a postoperative improvement. Ten patients (45.5 percent, p < 0.01) reported elimination of migraine headaches and 11 patients (50.0 percent, p < 0.004) noted a considerable improvement. For the entire surgical group, the average intensity of the migraine headaches reduced from 8.9 to 4.1 on an analogue scale of 1 to 10, and the frequency of migraine headaches changed from an average of 5.2 per month to an average of 0.8 per month. For the group who only experienced an improvement, the intensity fell from 9.0 to 7.5 and the frequency was reduced from 5.6 to 1.0 per month. Only one patient (4.5 percent, not significant) did not notice any change. The follow-up ranged from 222 to 494 days, the average being 347 days. In conclusion, this study confirms the value of surgical treatment of migraine headaches, inasmuch as 21 of 22 patients benefited significantly from the surgery. It is also evident that injection of Botox is an extremely reliable predictor of surgical outcome. Comment: Many small placebo-controlled studies and much anecdotal literature suggests that botulinum toxin may be effective in prevention of migraine, perhaps to the same extent as conventional prophylactic treatment. Larger, randomized clinical trials are underway to resolve this issue. In the meantime, those who believe in the effectiveness of botulinum toxin prophylaxis argue about how it works, that is whether its antinociceptive properties are due to peripheral effects, central or presynaptic effects, or both. Dr. Guyuron's group favors the idea that botulinum toxin interrupts a reflex arc between the central nervous system (CNS) and peripheral musculature, and that after establishing efficacy by low dose botulinum injection in the corrugator supercilii muscles, surgical resection of these muscles results in prolonged and effective prophylaxis. The idea is radical but intriguing and should not be dismissed out of hand. However, a trial is necessary in which both the botulinum toxin injections are blinded with vehicle, and the study of the surgery involves a sham surgery control group with extended long-term follow-up, before these forms of prophylaxis can be recommended to patients. SJT [source] ACQUIRED CARDIOVASCULAR DISEASE Original Articles: A Prospective Observational Study to Compare Conventional Coronary Artery Bypass Grafting Surgery with Off-Pump Coronary Artery Bypass Grafting on Basis of EuroSCOREJOURNAL OF CARDIAC SURGERY, Issue 5 2010Pawan Singhal M.Ch. Off-pump coronary bypass (OPCAB) surgery has become a widely used technique during recent years. EuroSCORE risk scale is the most rigorously evaluated scoring system in cardiac surgery to preoperatively quantify the risk of death and other serious postoperative complications. The aim of this prospective observational study was to compare the mortality and morbidity between OPCAB and conventional CABG in three major preoperative groups as assessed by EuroSCORE. Material and Method: All consecutive patients undergoing isolated coronary artery bypass surgery between January 2003 and December 2004 at Wellington Hospital were included. In this period, 347 patients had conventional CABG and 254 patients had OPCAB. Data were prospectively collected according to Australasian Society of Cardiothoracic Surgeons' cardiac surgery data set. The preoperative additive EuroSCORE was computed in each patient and the patients were divided into three risk groups. Results of OPCAB and conventional CABG were compared on basis of EuroSCORE group. Results: OPCAB surgery is preferably performed in patients with low-risk. OPCAB group had lesser number of grafts per patient. When adjusted with risk score, there was no statistically significant difference in mortality in any of the three groups. No significant difference was found for stroke, renal dysfunction, atrial fibrillation, re-exploration for bleeding, deep sternal wound infection, or pulmonary complications in either of three groups. However, inotropic requirement and requirements of blood products were less in OPCAB group. Conclusion: OPCAB does not offer any significant advantage in terms of mortality and morbidity over conventional CABG.,(J Card Surg 2010;25:495-500) [source] Total Arch Replacement with Open Stent-Grafting for Aneurysm of Ductus Arteriosus After Surgery for Patent Ductus ArteriosusJOURNAL OF CARDIAC SURGERY, Issue 5 2010Kosaku Nishigawa M.D. An enhanced computed tomography of the chest revealed a saccular aneurysm measuring a maximum diameter of 28 mm in the lesser curvature of the distal aortic arch; she was diagnosed with an aneurysm of ductus arteriosus after surgery for PDA. We performed total aortic arch replacement with open stent-grafting through median sternotomy. This approach enabled us to avoid the risk of dissecting adhesions around the aneurysm and clamping the aorta distal to the aneurysm.,(J Card Surg 2010;25:557-559) [source] Giant Aneurysm After Aortic Coarctation: Repair without Circulatory ArrestJOURNAL OF CARDIAC SURGERY, Issue 5 2010D.E.S.A., Gabor Erdoes M.D. Using the hemi-clamshell approach, the entire aortic arch was replaced and the supraaortic branches were reimplanted. The applied surgical technique using hypothermic extracorporeal circulation without cardiac arrest allowed an uninterrupted cerebral and spinal cord perfusion due to stepwise clamping of the aortic arch during reconstruction and resulted in an excellent neurologic outcome at six-month follow-up.,(J Card Surg 2010;25:560-562) [source] TRANSPLANTATION AND MECHANICAL SUPPORT Original Articles: Heart Transplantation Techniques after Hybrid Single-Ventricle PalliationJOURNAL OF CARDIAC SURGERY, Issue 5 2010Vinod A. Sebastian M.D. The hybrid palliative strategy of pulmonary artery banding and ductal stenting has emerged as an alternative treatment for neonates with HLHS. Neonates who have undergone a hybrid Norwood but are not candidates for the three-stage single-ventricle pathway may need heart transplantation. Patients who have undergone hybrid Norwood or those with visceral heterotaxy who have undergone ductal stenting and bilateral PA bands represent a technically challenging group of patients for heart transplantation, but it appears to be a favorable approach and we describe our experience with three patients who underwent heart transplant after a hybrid Norwood procedure. (J Card Surg 2010;25:596-600) [source] Left Ventricle and Left Atrium Remodeling after Mitral Valve Replacement in Case of Mixed Mitral Valve Disease of Rheumatic OriginJOURNAL OF CARDIAC SURGERY, Issue 4 2010n Ender Topal M.D. Methods: Thirty consecutive elective patients with MVR for mixed mitral disease of rheumatic origin formed the study group. Of these, 21 (70%) were women and the mean age was 37 years. Transthoracic echocardiography was performed prior to surgery, at three-month follow-up, and at three-year follow-up except for the latest nine patients. Results: The mean duration of follow-up was 3.6 ± 1.8 years. MVR surgery improved the functional class (mean New York Heart Association [NYHA] class) at three-year follow-up (p = 0.008). LV end-diastolic diameter and LA sizes decreased after MVR. Total chordal preservation causes better outcome, regarding to LV ejection fraction (LVEF) and NYHA functional class of patients. Preoperative high NYHA class, low LVEF, and high LV end-systolic diameter (LVESd) resulted with postoperative LV dysfunction (p were < 0.001, < 0.001, and 0.006, respectively). Conclusion: In patients with mixed mitral valve disease, MVR enhanced LV and LA remodeling resulting in better NYHA function. Preoperative NYHA, LVEF, and LVESd were significant predictors of postoperative LV function. (J Card Surg 2010;25:367-372) [source] Access Platform Techniques for Transcatheter Aortic Valve ReplacementJOURNAL OF CARDIAC SURGERY, Issue 4 2010Jacques Kpodonu M.D. Aim of study: A large number of the high-risk patients with critical aortic stenosis referred for transcatheter valve implantation approach may not be candidates for the femoral approach due to peripheral vascular disease with the morbidity and mortality increased severalfold in patients who develop access related complications. Method & Results: A thorough knowledge and review of various alternate access site techniques and trouble shooting are therefore important and required by the implanting cardiac surgeons involved in transcatheter aortic valve therapy. Conclusion: The article review highlights the various percutaneous, hybrid, and surgical access techniques platforms available as well as options for implantation of these devices. (J Card Surg 2010;25:373-380) [source] Safety and Efficacy of Arterial Switch Operation in Previously Inoperable PatientsJOURNAL OF CARDIAC SURGERY, Issue 4 2010Liu Ying-long M.D. This study aimed to evaluate the safety and efficacy of ASO in these selected subset patients. Methods: The records of 86 patients older than six months with complete transposition of the great arteries and ventricular septal defect or Taussig-Bing anomaly and severe PAH who underwent ASO at our institution from May 2000 to October 2008 were reviewed retrospectively. Eighty survivors were followed-up. Results: There were six hospital deaths (7.0%, 95% confidence limit 1.6 to 12.4%). From January 2006 to October 2008, 46 consecutive ASOs were performed with no death. Operative mortality and mobility decreased significantly (p = 0.008 and p = 0.046, respectively). The median duration of follow-up was 42.1 ± 28.8 months (range, 2.0 to 99.5). Two late deaths occurred. Latest follow-up data showed that 2.8% of survivors were in New York Heart Association (NYHA) class II and 97.2% were in NYHA class I. Conclusions: Excellent early and mid-term results of ASO are obtained from patients older than six months with complete transposition of the great arteries and ventricular septal defect or Taussig-Bing anomaly and severe PAH in current era, and ASO is safe and effective in these selected subset patients. (J Card Surg 2010;25:400-405) [source] An Alternative Technique for the Atrial Switch Operation for Transposition of the Great Arteries in an Unoperated Adult PatientJOURNAL OF CARDIAC SURGERY, Issue 4 2010Sachin Talwar M.Ch. The relevant literature on late natural survivors with this condition is reviewed and the technical aspects of an alternative technique for accomplishing a successful atrial switch in this situation are discussed. (J Card Surg 2010;25:406-409) [source] Mechanical Circulatory Support for AMI and Cardiogenic ShockJOURNAL OF CARDIAC SURGERY, Issue 4 2010Yasir Abu-Omar D.Phil. The dismal prognosis associated with post-MI cardiogenic shock, allied with surgical and technological advancements, has shifted the treatment paradigm toward wider use of mechanical circulatory support devices (MCSD). Current experience demonstrates that better outcomes may be achieved with early MCSD deployment (prior to the onset of end-organ dysfunction). However, perceived limitations with existing devices mean that they remain infrequently applied. There is an urgent need for increased awareness of MCSD options among clinicians treating post-MI shock patients. (J Card Surg 2010;25:434-441) [source] Mechanical Support for Postcardiotomy Cardiogenic Shock: Has Progress Been Made?JOURNAL OF CARDIAC SURGERY, Issue 4 2010Erik A. Sylvin M.D. A previous review of this topic by our group suggested that regardless of device, only 25% of patients survived to hospital discharge. In the interim, newer technologies have entered the clinical arena. Additional contributions have been made to the literature and new databases are collecting data that are likely to provide more robust guidance for the management of these very complex patients. In this review, we update the experience of mechanical support in the PCCS patient and provide a strategy to maximize survival for a patient who develops PCCS in the community cardiac surgery center. (J Card Surg 2010;25:442-454) [source] Early Pulmonary Embolectomy for Acute Pulmonary Embolus: An Operation Whose Time Has ComeJOURNAL OF CARDIAC SURGERY, Issue 3 2010Harold L. Lazar M.D. (J Card Surg 2010;25:259-260) [source] Pulmonary Embolectomy: Recommendation for Early Surgical InterventionJOURNAL OF CARDIAC SURGERY, Issue 3 2010Enisa M. Carvalho M.D. Despite all efforts at improving outcomes, there is no consensus on the management of acute severe PE. Methods: From May 2000 to June 2009, 16 consecutive patients underwent surgical pulmonary embolectomy at our institution. Mean age was 45 ± 17 years (range, 14 to 76) with nine (56%) males and seven (43%) females. Preoperatively, all cases were classified as massive PE; seven (43%) patients were in hemodynamic collapse and emergently underwent operation while receiving cardiopulmonary resuscitation. Results: There were nine (56%) urgent/emergent and seven (44%) salvage patients undergoing surgical pulmonary embolectomy. Of nine nonsalvage patients, seven (77%) patients presented with moderate to severe right ventricular (RV) dilation/dysfunction. Mean cardiopulmonary bypass time was 43 ± 41 minutes (range, 9 to 161). Mean follow-up duration was 48 ± 38 months (range: 0.3 to 109), with seven in-hospital deaths (43%): mortality was 11% (1/9) in emergent operations and 85% (6/7) in salvage operations. Conclusions: Surgical pulmonary embolectomy should be considered early in the management of hemodynamically stable patients with PE who show evidence of RV dilation and/or failure, as it is associated with satisfactory outcomes. Conversely, pulmonary embolectomy has dismal results under salvage conditions. Revision of current guidelines for the surgical management of this condition may be warranted. (J Card Surg 2010;25:261-266) [source] Transient Global Amnesia as the Presenting Feature of Heparin-Induced ThrombocytopeniaJOURNAL OF CARDIAC SURGERY, Issue 3 2010Chun Huat Teh M.B.Ch.B. Both immunoglobulin G-specific enzyme-linked immunosorbent assay and serotonin release assay were strongly positive for the antibodies that cause heparin-induced thrombocytopenia. The patient's cognitive functions returned to normal following discontinuation of unfractionated heparin and warfarin and commencement of lepirudin infusion.,(J Card Surg 2010;25:300-302) [source] Right Ventricular Perforation due to Migration of a Ventricular LeadJOURNAL OF CARDIAC SURGERY, Issue 3 2010Fabien Doguet M.D. (J Card Surg 2010;25:303) [source] Partial Aortic Root Remodeling with an Adventitial Inversion Technique for an Acute Type A Aortic DissectionJOURNAL OF CARDIAC SURGERY, Issue 3 2010Junji Yunoki M.D. Postoperative computed tomography at six months showed no dissection or pseudoaneurysm in the aortic root.,(J Card Surg 2010;25:327-329) [source] Congenital Left Ventricular AneurysmJOURNAL OF CARDIAC SURGERY, Issue 3 2010Jian-ying Deng M.D. (J Card Surg 2010;25:351) [source] Increased Incidence of Gastrointestinal Bleeding Following Implantation of the HeartMate II LVADJOURNAL OF CARDIAC SURGERY, Issue 3 2010David R. Stern M.D. To avoid device-related thromboembolic complications, antiplatelet, and anticoagulation therapy are routinely administered. A worrisome frequency of gastrointestinal (GI) bleeding events has been observed. Methods: A retrospective review of all 33 patients undergoing long-term LVAD implantation between June 1, 2006 and July 31, 2008 at our institution for any indication was conducted. Anticoagulation consisted of heparin (intravenous or subcutaneous) followed by transition to Coumadin therapy to a target INR of two to three. Antiplatelet therapy consisted of low-dose aspirin and dipyridamole. Results: Twenty patients received the HMII and 13 patients received other devices. Eight (40%) HMII recipients suffered at least one episode of GI bleeding while no GI bleeding occurred in recipients of other devices (p = 0.012). Of 17 total bleeding episodes, no definitive source could be identified in 11 instances (65%). Conclusions: Although definitive source identification remains elusive, we believe that the majority of bleeding arises in the small bowel, possibly due to angiodysplasias, similar to the pathophysiology encountered in patients with aortic stenosis and GI bleeding. As we move toward wider use of the HMII and other axial continuous-flow devices in both bridge-to-transplant patients and for destination therapy, more studies will be necessary to understand the mechanisms of this obscure GI bleeding and develop treatment strategies to minimize its development.,(J Card Surg 2010;25:352-356) [source] Bilateral Axillary Artery Perfusion to Reduce Brain Damage during Cardiopulmonary BypassJOURNAL OF CARDIAC SURGERY, Issue 2 2010Kazuhiro Kurisu M.D. The aim of the present study was to examine the value of bilateral axillary artery perfusion during thoracic aortic and cardiac surgery, and to evaluate the clinical results with a particular focus on cerebral damage. Methods: From March 2002 through December 2007, 24 patients (16 male and eight female; age range, 43 to 84 years) underwent bilateral axillary artery perfusion through side grafts during cardiopulmonary bypass. Aortic surgery, including total arch replacement, hemiarch replacement, and ascending aortic replacement, was performed in 21 patients. Bilateral axillary artery perfusion was also used in three complicated valve surgeries after expanding its indication to cardiac pathology with a diseased aorta, two redo cases with severe atherosclerotic vascular disease, and one case with a porcelain aorta. Results: Bilateral axillary artery perfusion was successful in all patients. There were no complications related to this procedure except in one patient, who suffered from a local fluid retention in one wound, requiring puncture drainage. There was no hospital mortality. No strokes were identified by either clinical assessments or diagnostic imaging. Conclusions: Bilateral axillary artery perfusion is a useful method for protection of the brain during either thoracic aortic or cardiac surgery when the patients have an extensively diseased aorta.,(J Card Surg 2010;25:139-142) [source] Combined Medical and Surgical Treatment of Intracardiac Hydatid Cysts in 11 PatientsJOURNAL OF CARDIAC SURGERY, Issue 2 2010Alireza Molavipour M.D. We report 11 cases of cardiac hydatidosis who were treated medically and surgically. Patients and methods: Eleven patients diagnosed with cardiac echinococcosis were referred to the Cardiac Surgery Department of Shahid Madani Hospital from 1992 to 2004. Symptoms included dyspnea, palpitation, limb ischemia, fever, weight loss, hemiplegia, and loss of consciousness. Patients underwent surgical removal of the cyst followed by medical treatment until the titer of echinococcus hemaglutination test came to normal. Results: Hospital stay and recovery time were uneventful in nine patients. One patient died due to acute renal failure before hospital discharge (9%) and another patient experienced cerebral hydatidosis 12 months after surgery (probably due to cyst embolism). The other nine patients had no complications during five years of follow-up. Conclusion: Surgical excision using cardiopulmonary bypass combined with medical therapy provides the most optimal treatment for cardiac echinococcosis.,(J Card Surg 2010;25:143-146) [source] Superior Vena Cava Syndrome post Minimally Invasive Mitral Valve RepairJOURNAL OF CARDIAC SURGERY, Issue 2 2010Turki B. Albacker M.D. The tamponade was caused by local compression of junction between the right atrium and superior vena cava. This case illustrates the importance of using transesophageal echocardiogram in postoperative management of cardiac surgery patients.,(J Card Surg 2010;25:174-175) [source] Subclavian Artery Stenosis Detected with Transit-Time Flowmeter during OPCABJOURNAL OF CARDIAC SURGERY, Issue 2 2010Vassilios Economopoulos M.D. (J Card Surg 2010;25:176-177) [source] Anterior Aortic Reimplantation of Anomalous Left Coronary Artery from the Pulmonary Artery (ALCAPA) Originating from the Nonfacing Sinus in an AdultJOURNAL OF CARDIAC SURGERY, Issue 2 2010Panagiotis G. Sfyridis M.D. Intraoperative findings and surgical technique are discussed.,(J Card Surg 2010;25:214-217) [source] Mycotic Aneurysm of the Descending Thoracic Aorta Caused by Haemophilus InfluenzaeJOURNAL OF CARDIAC SURGERY, Issue 2 2010Ph.D., Yosuke Takahashi M.D. Because of suspected infectious or inflammatory etiology, he was managed with a combination of emergency aortic repair using prosthetic graft with omental flap and antibiotic chemotherapy. Haemophilus influenzae was identified from perioperative specimens and the postoperative course was uneventful.,(J Card Surg 2010;25:218-220) [source] Mechanical Support for Patients with End-Stage Heart Failure during Noncardiac Surgical ProceduresJOURNAL OF CARDIAC SURGERY, Issue 2 2010Michael K. Pasque M.D. (J Card Surg 2010;25:236-237) [source] | ||||||||||