Journal of Cardiothoracic Surgery via MedWorm.com

Coronary artery bypass grafting associated to aortic valve replacement in the elderly: survival and quality of life

Journal of Cardiothoracic Surgery — Mon, 06 Feb 2012 05:00:00 +0100

Myocardial ischemia is often associated to aortic valve stenosis in the elderly. Aim of this study was to evaluate the impact on survival and quality of life of CABG associated to aortic valve replacement in the septuagenarians and octogenarians.Between January 1991 and January 2010, 520 patients ageing >70 years underwent aortic valve replacement with a mechanical prosthesis in two Institutions. They were divided into 2 groups: Group A included 406 patients undergoing isolated aortic valve replacement; Group B 114 patients receiving aortic valve replacement and CABG. A comparative analysis of long-term survival and quality of life (SF-36 test) was performed.Mean age was 74.2+/-3.6 years (74.3+/-3.6 in Group A, 74+/-3.3 in Group B; p=0.33). Hospital mortality was 9.5% (46 patients). Twenty...

Cardiac Tamponade from A Giant Thymoma: Case report

Journal of Cardiothoracic Surgery — Mon, 06 Feb 2012 05:00:00 +0100

This report presents a patient who had hemorrhagic pericardial tamponade that likely resulted from the largest symptomatic mixed type (type AB) thymoma described in the literature . (Source: Journal of Cardiothoracic Surgery)

Feasibility and efficacy of bypassing the right ventricle and pulmonary circulation to treat right ventricular failure: an experimental study

Journal of Cardiothoracic Surgery — Mon, 06 Feb 2012 05:00:00 +0100

Conclusions: Bypassing the right ventricle and pulmonary circulation with an oxygenating assist device, which may offer the advantages of enhanced right ventricular decompression and augmented left atrial filling, is feasible and effective in the treatment of acute RVF. Long time experiments are needed. (Source: Journal of Cardiothoracic Surgery)

Various clinical scenarios leading to development of the string sign of the internal thoracic artery after coronary bypass surgery: the role of competitive flow, a case series

Journal of Cardiothoracic Surgery — Mon, 30 Jan 2012 05:00:00 +0100

Conclusions: The most common cause of the development of the string sign of a LIMA graft due to competitive flow is overassessment of the lesion of the LAD. Regression of a previous lesion or some other neighboring graft can also cause the phenomenon. (Source: Journal of Cardiothoracic Surgery)

Pleurotomy with subxyphoid pleural drain affords similar effects to pleural integrity in pulmonary function after off-pump coronary artery bypass graft.

Journal of Cardiothoracic Surgery — Wed, 25 Jan 2012 05:00:00 +0100

Conclusion: Subxyphoid insertion of pleural drain provides similar effects to preserved pleural integrity in pulmonary function, clinical outcomes, and thoracic pain after OPCAB. Therefore, our results support the hypothesis that once pleural cavities are incidentally or purposely opened during LITA dissection, subxyphoid placement of the pleural drain is recommended. (Source: Journal of Cardiothoracic Surgery)

Atypical presentation and transabdominal treatment of chylothorax complicating esophagectomy for cancer

Journal of Cardiothoracic Surgery — Tue, 24 Jan 2012 05:00:00 +0100

We report a case of a young adult male who underwent neoadjuvant chemoradiationtherapy followed by Ivor-Lewis esophagectomy for a squamous-cell carcinoma of the distal esophagus. During the postoperative course the patient presented recurrent episodes of hemodynamic instability mimicking cardiac tamponade, secondary to compression of the left pulmonary vein and the left atrium by a mediastinal chylocele. Mediastinal drainage and ligation of the cisterna chyli and the thoracic duct was successfully performed through a transhiatal approach. (Source: Journal of Cardiothoracic Surgery)

The use of Ligasure Vessel Sealing System in Ivor Lewis Esophagectomy

Journal of Cardiothoracic Surgery — Tue, 24 Jan 2012 05:00:00 +0100

Conclusions: The use of LVSS was associated with a significant reduction in the operative time and the rate of intra-operative complications. (Source: Journal of Cardiothoracic Surgery)

The management of bronchus intermedius complications after lung transplantation: A retrospective study

Journal of Cardiothoracic Surgery — Fri, 20 Jan 2012 05:00:00 +0100

Conclusion: BI complications after lung transplantation are still a significant problem. Stenosis or malacia following lung transplantation could be well managed with modified Montgomery T-tube. (Source: Journal of Cardiothoracic Surgery)

Oxidative and pre-inflammatory stress in wedge resection of pulmonary parenchyma using the radiofrequency ablation technique in a swine model.

Journal of Cardiothoracic Surgery — Thu, 19 Jan 2012 05:00:00 +0100

Conclusion: Our data indicate that RFA-assisted wedge lung resection in a swine model increases regional MDA and TNF-a factors affecting by this oxidative and pre-inflammatory stress of the procedure. Although RFA-assisted liver resection can be well tolerated in humans, the possible use of this method to the lung has to be further investigated in terms of regional and systemic reactions and the feasibility of performing larger lung resections. (Source: Journal of Cardiothoracic Surgery)

Predicting restoration of kidney function during CRRT-free intervals

Journal of Cardiothoracic Surgery — Wed, 18 Jan 2012 05:00:00 +0100

Conclusion: Restoration of kidney function during CRRT-free periods can be predicted with an index calculated from three variables. Prospective trials in other hospitals must clarify whether our results are generally transferable to other patient populations. (Source: Journal of Cardiothoracic Surgery)

Acute post-cardiopulmonary bypass left atrial thrombosis after mitral valvuloplasty and left atrial thrombectomy

Journal of Cardiothoracic Surgery — Wed, 11 Jan 2012 05:00:00 +0100

A patient with mitral stenosis and multiple left atrial thrombi underwent valvuloplasty and thrombectomy. While closing the sternum after completing the cardiopulmonary bypass, a new left atrial thrombus was detected by transesophageal echocardiography. We used heparin for the prevention of new thrombus formation and closed the wound after meticulous bleeding control. Three months later, there was no residual thrombus in the left atrium according to the echocardiographic study. (Source: Journal of Cardiothoracic Surgery)

Atrial fibrillation after pulmonary lobectomy for lung cancer affects long-term survival in a prospective single-center study

Journal of Cardiothoracic Surgery — Tue, 10 Jan 2012 05:00:00 +0100

Conclusions: AF after pulmonary lobectomy for lung cancer, in addition to causing higher hospital morbidity and mortality, predicts poorer long-term outcome in 5-year survivors. (Source: Journal of Cardiothoracic Surgery)

Ischemia-modified albumin use as a prognostic factor in coronary bypass surgery

Journal of Cardiothoracic Surgery — Thu, 05 Jan 2012 05:00:00 +0100

Conclusions: IMA is an early-rising marker of cardiac ischemia and enables providing a direction for the treatment at early phases. (Source: Journal of Cardiothoracic Surgery)

Alveolar adenoma of the lung: unusual diagnosis of a lesion positive on PET scan. A case report.

Journal of Cardiothoracic Surgery — Tue, 03 Jan 2012 05:00:00 +0100

The authors report a clinical case of alveolar adenoma presenting as a solitary pulmonary nodule which was positive to PET and deeply located in the lung. Few cases of alveolar adenomas have been reported in literature; these lesions are considered pulmonary neoplasms with benign behaviour, usually presenting as a peripheral or subpleural coin lesion; the PET activities of such neoplasms were unknown.The present clinical case was singular for the deep location of the nodule and its tight adhesion to left inferior pulmonary vein requiring a lobectomy. In addition, alveolar adenoma PET behaviour has been reported as light positivity. (Source: Journal of Cardiothoracic Surgery)

Decreased pre-surgical CD34+/CD144+ cell number in patients undergoing coronary artery bypass grafting compared to coronary artery disease-free valvular patients.

Journal of Cardiothoracic Surgery — Tue, 03 Jan 2012 05:00:00 +0100

Conclusions: Pre-surgical CD34+/CD144+ numbers are decreased in CABG patients, compared to valvular patients with absence of coronary disease. (Source: Journal of Cardiothoracic Surgery)

Intraoperative device closure of perimembranous ventricular septal defects in the young children under transthoracic echocardiographic guidance; initial experience

Journal of Cardiothoracic Surgery — Wed, 28 Dec 2011 05:00:00 +0100

Conclusions: Minimally invasive transthoracic device closure of perimembranous VSDs is safe and feasible, using a domestically made device under transthoracic echocardiographic guidance, without the need for cardiopulmonary bypass. This technique should be considered an acceptable alternative to surgery or device closure guided by transesophageal echocardiography in selected young children. However, a long-term evaluation of outcomes is necessary. (Source: Journal of Cardiothoracic Surgery)

Successful Treatment of Novel H1N1 Influenza related Fulminant Myocarditis with Extracorporeal Life Support

Journal of Cardiothoracic Surgery — Tue, 20 Dec 2011 05:00:00 +0100

We report a case of fulminant myocarditis associated with this virus treated successfully using extra-corporal membrane oxygenator. (Source: Journal of Cardiothoracic Surgery)

The Scandinavian Multicenter Hemodynamic Evaluation of the SJM Regent Aortic Valve

Journal of Cardiothoracic Surgery — Mon, 19 Dec 2011 05:00:00 +0100

Background: 112 patients who received small and medium sized St.Jude Regent heart valves (19-25 mm) at 7 Scandinavian centers were studied between January 2003 and February 2005 to obtain non-invasive data regarding the hemodynamic performance at rest and during Dobutamine stress echocardiography (DSE) testing one year after surgery.Material and methods46 woman and 66 men, aged 61.8+/-9.7 (18-75) years, were operated on for aortic regurgitation (17), stenosis (65), or mixed dysfunction (30). Valve sizes were 19 mm (6), 21 mm (33), 23 mm (41), 25 mm (30). Two patients receiving size 27 valves were excluded from the hemodynamic evaluation. Pledgets were used in 100 patients, everted mattress in 66 and simple interrupted sutures in 21. Valve orientation varied and was dependent on the surgeon...

A long-term study assessing the factors influencing survival and morbidity in the surgical management of bronchiectasis

Journal of Cardiothoracic Surgery — Sun, 11 Dec 2011 05:00:00 +0100

Conclusions: Surgical treatment of bronchiectasis can be performed with acceptable morbidity and mortality at any age. The involved bronchiectatic sites should be resected completely for the optimum control of symptoms. (Source: Journal of Cardiothoracic Surgery)

Intimal aortic sarcoma mimicking ruptured thoracoabdominal type IV aneurysm. A rare case report and review of the literature.

Journal of Cardiothoracic Surgery — Sun, 11 Dec 2011 05:00:00 +0100

Primary intimal aortic sarcoma represents a very rare and highly lethal medical entity. Diagnosis is made either by embolic events caused by the tumor or by surrounding tissue symptoms such as pain. Herein we report an extremely rare case of a 51-year-old man previously operated for ascending aortic aneurysm, who presented with clinical and radiological findings suggestive of a ruptured thoracoabdominal type IV aneurysm. The patient underwent radical resection of the aorta and surrounding tissue with placement of a composite 4-branched graft. The diagnosis was made by frozen section and regular histopathologic examination of the specimen and the patient received adjuvant chemotherapy. Nine months after surgery the patient is still alive and has no signs of recurrence. We review the literat...

First Experience With a New Negative Pressure Incision Management System on Surgical Incisions After Cardiac Surgery in High Risk Patients

Journal of Cardiothoracic Surgery — Tue, 06 Dec 2011 05:00:00 +0100

Conclusions: The PrevenaTM system appears to be safe, easy to use and may help achieve uncomplicated wound healing in patients at risk of developing wound complications after cardiothoracic surgery. (Source: Journal of Cardiothoracic Surgery)

Fulminant Myocarditis managed with Pulsatile Extracorporeal Life Support; use of Twin Pulse Life support (T-PLS(R))

Journal of Cardiothoracic Surgery — Thu, 24 Nov 2011 05:00:00 +0100

We report on two cases of fulminant myocarditis successfully treated with pulsatile extracorporeal life support (T-PLS(R), Twin Pulse Life support, New heart bio.BHK, Seoul, Korea). With T-PLS, we were able to provide mechanical support to patients until they recovered completely. (Source: Journal of Cardiothoracic Surgery)

Coming from behind to win - A Qualitative research about psychological conditions of adolescents who have undergone open-heart surgery for single ventricle between the ages 0-5

Journal of Cardiothoracic Surgery — Wed, 23 Nov 2011 05:00:00 +0100

Early recognition of congenital cardiac pathologies and their treatment by means of palliative or corrective surgery at birth or infancy has vital importance. Successful repair of congenital cardiac defects by surgical methods has gained importance especially during the last twenty years. As the scope of the surveillance increased so did the interest in the outcomes of these treatments when the patients had reached puberty and adulthood. The purpose of our research was to study the psychological framework of the adolescents who had experienced these surgeries by listening both the children and the parents talk about their feelings and experiences. Our data was accumulated through interviews with 17 adolescents and their families, using qualitative methods. The main theme at the end of the ...

Extrathoracic chronic heamatoma presenting as a chest wall tumor 2 years after a blunt thoracic injury

Journal of Cardiothoracic Surgery — Wed, 23 Nov 2011 05:00:00 +0100

We report the case of a patient who was presented with a giant posterior extrathoracic chest wall tumor. The mass was proven to be a chronic heamatoma possibly developed after a blunt thoracic injury which took place 2 years before presentation and was growing thereafter. Clinicians should have high suspicion of rare entities which mimic tumors and consider any information reported by the patient's history in their diagnostic process. (Source: Journal of Cardiothoracic Surgery)

Risk Factors For Recurrent Stroke After Coronary Artery Bypass Grafting

Journal of Cardiothoracic Surgery — Wed, 23 Nov 2011 05:00:00 +0100

Conclusion: Unstable angina, LVEF [less than or equal to]50%, post-operative AF, and post-operative hypotension are independent risk factors of recurrent stroke in CABG patients with a previous history of stroke. (Source: Journal of Cardiothoracic Surgery)

Prolonged ventilation post cardiac surgery - tips and pitfalls of the prediction game

Journal of Cardiothoracic Surgery — Wed, 23 Nov 2011 05:00:00 +0100

Objectives: Few available models aim to identify patients at risk of prolonged ventilation after cardiac surgery. We compared prediction models developed in ICU in two adjacent periods of time, when significant changes were observed both in population characteristics and the perioperative management. Methods: We performed a retrospective review of two cohorts of patients in our department in two subsequent time periods (July 2007 - December 2008, n=2165; January 2009 - July 2010, n=2192). The study was approved by the Institutional Ethics Committee and the individual patient consent was not required. Patients were divided with regard to ventilation time of more or less than 48 hours. Preoperative and procedure-related variables for prolonged ventilation were identified and multivariate log...

A case report and review of the literature on bilateral retinal infarction following cardiopulmonary bypass for coronary artery bypass grafting

Journal of Cardiothoracic Surgery — Mon, 21 Nov 2011 05:00:00 +0100

Postoperative visual loss is a devastating perioperative complication. The commonest aetiologies are anterior ischaemic optic neuropathy (AION), posterior ischaemic optic neuropathy (PION), and central retinal artery occlusion (CRAO). These appear to be related to certain types of operation, most commonly spinal and cardiac bypass procedures; with the rest divided between: major trauma causing excessive blood loss; head/neck and nasal or sinus surgery; major vascular procedures (aortic aneurysm repair, aorto-bifemoral bypass); general surgery; urology; gynaecology; liposuction; and liver transplantation. The non-surgical risk factors are multifactorial: advanced age, prolonged postoperative anaemia, positioning (supine v prone), alteration of venous drainage of the retina, hypertension, sm...

Single Stage Repair of a Complex Pathology: End Stage Ischaemic Cardiomyopathy, Ascending Aortic Aneurysm and Thoracic Coarctation

Journal of Cardiothoracic Surgery — Sun, 20 Nov 2011 05:00:00 +0100

The not uncommon combination of ascending aortic pathology with late presenting coarctation is a difficult surgical challenge. The two stage approach is usually adopted. The necessity for cardiac transplantation adds to the complexity: a trans-sternal approach and single stage repair become mandatory. (Source: Journal of Cardiothoracic Surgery)

Brief review on systematic hypothermia for the protection of central nervous system during aortic arch surgery: a double-sword tool?

Journal of Cardiothoracic Surgery — Sun, 20 Nov 2011 05:00:00 +0100

Antegrade selective cerebral perfusion in conjunction with hypothermia attenuate postoperative neurological injury, which in turn still remains the main cause of mortality and morbidity following aortic arch surgery. Hypothermic circulatory arrest however could be a useful tool during arch surgery, surgery for chronic thromboembolic disease, air on the arterial line during CPB, during cavotomy for extraction of renal cell carcinoma with level IV extension, or when dealing with difficult trauma to the SVC or IVC. Cerebral protective effects with hypothermic procedures including inhibition of neuron excitation, and discharge of excitable amino acids, and thereby, prevention of an increase in intercellular calcium ions, hyperoxidation of lipids in cell membranes, and free radical production.T...

Repeated mitral valve replacement in a patient with extensive annular calcification

Journal of Cardiothoracic Surgery — Mon, 14 Nov 2011 05:00:00 +0100

Conclusion: Mitral valve replacement using a bioprosthesis with equine pericardial patches was useful to overcome recurrent paravalvular leak due to severe mitral annular calcification. (Source: Journal of Cardiothoracic Surgery)

Myocardial recovery in peri-partum cardiomyopathy after continuous flow left ventricular assist device

Journal of Cardiothoracic Surgery — Mon, 14 Nov 2011 05:00:00 +0100

We describe the clinical course of severe peri-partum cardiomyopathy (PPCM) rescued with a continuous flow LVAD, who experienced recovery and explantation. We discuss assessment of and criteria for recovery. (Source: Journal of Cardiothoracic Surgery)

Are there independent predisposing factors for postoperative infections following open heart surgery?

Journal of Cardiothoracic Surgery — Mon, 14 Nov 2011 05:00:00 +0100

Conclusions: We concluded that diabetes mellitus, the duration of mechanical ventilation, the presence of complications irrelevant to the infection during CVICU stay and CVICU re-admission are independent risk factors for the development of postoperative infection in cardiac surgery patients. (Source: Journal of Cardiothoracic Surgery)

Several clinical interests regarding lung volume reduction surgery for severe emphysema: meta-analysis and systematic review of randomized controlled trials

Journal of Cardiothoracic Surgery — Thu, 10 Nov 2011 05:00:00 +0100

Conclusions: LVRS offers the more benefits regarding survival, lung function, gas exchange, exercise capacity and QOL, despite the higher mortality in initial three postoperative months. LVRS, with the optimization of surgical approach and material for reinforcement of the staple lines, should be recommended to patients suffering from severe heterogeneous emphysema. (Source: Journal of Cardiothoracic Surgery)

Intra aortic Balloon Pump: Literature review of risk factors related to complications of the Intraaortic Balloon Pump

Journal of Cardiothoracic Surgery — Wed, 02 Nov 2011 04:00:00 +0100

This report has looked at the current literature and attempt to identify incremental risk factors related to the development of adverse effects during support with an intaaortic balloon pump. The paper concludes that in contrary to early reports, newer studies have shown that complications following intraaortic balloon pump treatment, is decreasing. Moreover the literature suggests that the thrombosis and infective complications are relevant to the duration of the pump treatment, while the ischemic problems of the limbs are mostly linked to the atherosclerotic status of the common femoral artery. (Source: Journal of Cardiothoracic Surgery)

How many lobes do you see?

Journal of Cardiothoracic Surgery — Wed, 26 Oct 2011 04:00:00 +0100

This report aims to present a rare intraoperative finding of an anatomic malformation of the right lung in a 19-year old male patient with recurrent pneumothorax who underwent a surgical repair. An accessory fissure which was separating the superior segment of the lower lobe from the basal segments gave to the whole lung the unique image of a four-lobed one. A profound knowledge of the accessory fissures, even if they are incidentally discovered, is of pivotal importance for the thoracic surgeon and leads to optimal operative assessment and strategic planning. (Source: Journal of Cardiothoracic Surgery)

Double Shunt technique for hybrid palliation of hypoplastic left heart syndrome : a case report.

Journal of Cardiothoracic Surgery — Wed, 26 Oct 2011 04:00:00 +0100

We report a technique to palliate hypoplastic left heart syndrome, with no PDA stenting, but with double polytetrafluoroethylene shunt from pulmonary artery to ascending and descending aorta by combined thoracotomies. A 30-day-old female was operated with this technique. Five months after first operation, the child was submitted to Glenn/Norwood operation. Good hemodinamic recovery and initial clinical evolution was observed. The child was extubated in 8th post operatory day and reentubated in the next day due to pulmonary infection. Despite antibiotic treatment, the child died after systemic infectious complications. (Source: Journal of Cardiothoracic Surgery)

Clinical significance in the number of involved lymph nodes in patients that underwent surgery for pathological stage III-N2 non-small cell lung cancer

Journal of Cardiothoracic Surgery — Tue, 25 Oct 2011 04:00:00 +0100

Conclusion] Surgery appears to be preferable as a one arm of multimodality therapy in p-stage III/N2 patients with single or 2 involved lymph nodes. The optimal incorporation of surgery into the multimodality approach therefore requires further clinical investigation. (Source: Journal of Cardiothoracic Surgery)

Off-pump or Minimized On-pump Coronary Surgery - Initial experience with Circulating Endothelial Cells (CEC) as a supersensitive marker of tissue damage

Journal of Cardiothoracic Surgery — Wed, 19 Oct 2011 04:00:00 +0100

Conclusion: Conceptional advantages of minimized CPB systems (ROCsafeTM) result in morbidity and mortality comparable with OPCAB procedures. Mini-HLM therefore minimizes CPB-related systemic and organ injury as demonstrated by low CEC-values which indicates intact endothelial integrity. Furthermore, Mini-HLM combines OPCAB-benefits with low morbidity in high-risk patients while facilitating more complete revascularization in complex patients. (Source: Journal of Cardiothoracic Surgery)

Acute pressure overload of the right ventricle. Comparison of two models of right-left shunt. Pulmonary artery to left atrium and right atrium to left atrium: experimental study

Journal of Cardiothoracic Surgery — Wed, 19 Oct 2011 04:00:00 +0100

Conclusion: The PA-LA shunt can effectively reverse the catastrophic effects of acute RVF offering better hemodynamic characteristics than an interatrial shunt. (Source: Journal of Cardiothoracic Surgery)

Phase 1 cardiovascular rehabilitation: be aggressive?

Journal of Cardiothoracic Surgery — Mon, 17 Oct 2011 04:00:00 +0100

N/A (Source: Journal of Cardiothoracic Surgery)

Hyperbaric Oxygen Therapy as an Adjunctive Treatment for Sternal Infection and Osteomyelitis after Sternotomy and Cardiothoracic Surgery

Journal of Cardiothoracic Surgery — Mon, 17 Oct 2011 04:00:00 +0100

Conclusions: In addition to primary treatment with debridement and antibiotic use, HBO2 therapy may be used as an adjunctive and safe treatment to improve clinical outcomes in patients with sternal infection and osteomyelitis after sternotomy and cardiothoracic surgery. (Source: Journal of Cardiothoracic Surgery)

Bacterial and fungal microflora in surgically removed lung cancer samples

Journal of Cardiothoracic Surgery — Fri, 14 Oct 2011 04:00:00 +0100

Conclusions: A diversity of pathogens could be identified in surgically extracted tissue samples of patients with lung cancer, with mycoplasma strains being present in all samples. These results point to an etiologic role for chronic infection in lung carcinogenesis. Confirmation of these observations and additional studies are needed to further characterize the etiologic role of inflammation in lung carcinogenesis. (Source: Journal of Cardiothoracic Surgery)

Safety and Effectiveness of two treatment regimes with tranexamic acid to minimize inflammatory response in elective cardiopulmonary bypass patients: a randomized double-blind, dose-dependent, phase IV clinical trial.

Journal of Cardiothoracic Surgery — Fri, 14 Oct 2011 04:00:00 +0100

Background: In cardiopulmonary bypass (CPB) patients, fibrinolysis may enhance postoperative inflammatory response. We aimed to determine whether an additional postoperative dose of antifibrinolytic tranexamic acid (TA) reduced CPB-mediated inflammatory response (IR). Methods: We performed a randomized, double-blind, dose-dependent, parallel-groups study of elective CPB patients receiving TA. Patients were randomly assigned to either the single-dose group (40 mg/Kg TA before CPB and placebo after CPB) or the double-dose group (40 mg/Kg TA before and after CPB). Results: 160 patients were included, 80 in each group. The incident rate of IR was significantly lower in the double-dose-group TA2 (7.5% vs. 18.8% in the single-dose group TA1; P=0.030). After adjusting for hypertension, total prot...

Comparative Evaluation of Left Ventricular Mass Regression after Aortic Valve Replacement: A Prospective randomized Analysis

Journal of Cardiothoracic Surgery — Thu, 13 Oct 2011 04:00:00 +0100

Conclusions: Clinical outcomes justify valve replacement with either valve substitute in the respective age groups. The PA hemodynamically outperformed the MPs. Stentless valves however, did not demonstrate significantly superior hemodynamics or outcomes in comparison to stented bioprosthesis or MPs. (Source: Journal of Cardiothoracic Surgery)

Surgical treatment for pulmonary metastases from esophageal carcinoma after definitive chemoradiotherapy: Experience from a single institution

Journal of Cardiothoracic Surgery — Wed, 12 Oct 2011 04:00:00 +0100

Conclusions: Surgical treatment should be considered for patients with pulmonary metastases from esophageal carcinoma who previously received CRT and achieved a CR, because it provides not only a longer survival, but also a good postoperative PS for some patients. (Source: Journal of Cardiothoracic Surgery)

Mucoepidermoid carcinoma of the lung: a case report

Journal of Cardiothoracic Surgery — Tue, 11 Oct 2011 04:00:00 +0100

Mucoepidermoid carcinoma of the lung (MEC) is a tumor of low malignant potential of bronchial gland origin. MEC and adenoid cystic carcinoma are both considered to be salivary gland-type neoplasms. MECs are comparatively rare with an incidence of all lung cancers. We recently encountered a case of this type of lung cancer. A 60-year-old man was found to have an abnormal shadow in the left lower lung field on a regular check-up for lung cancer at his company. Chest radiography and CT revealed a mass shadow measuring 30 mm in diameter in the left lower lung field. Bronchoscopy revealed a protuberant tumor in the S9 bronchus, leading to a diagnosis of low-grade MEC by transbronchial lung biopsy. He underwent left lower lobe resection and mediastinal lymph node dissection using VATS. Tumor cel...

Delayed intracardial shunting and hypoxemia after massive pulmonary embolism in a patient with a biventricular assist device

Journal of Cardiothoracic Surgery — Tue, 11 Oct 2011 04:00:00 +0100

We describe the interdisciplinary management of a 34-year-old woman with dilated cardiomyopathy three months postpartum on a cardiac biventricular assist device (BVAD) as bridge to heart transplantation with delayed onset of intracardial shunting and subsequent hypoxemia due to massive pulmonary embolism. After emergency surgical embolectomy pulmonary function was highly compromised (PaO2 / FiO2 54) requiring bifemoral veno-venous extracorporeal membrane oxygenation. Transesophageal echocardiography detected atrial level hypoxemic right-to-left shunting through a patent foramen ovale (PFO). Percutaneous closure of the PFO was achieved with a PFO occluder device. After placing the PFO occluder device oxygenation increased significantly (delta paO2 119 Torr). The patient received heart trans...

Surgical treatment of aortobronchial fistula after thoracic endograft failure

Journal of Cardiothoracic Surgery — Tue, 11 Oct 2011 04:00:00 +0100

Endovascular stent grafting has been recently considered as a less invasive alternative to either medical therapy or open surgical treatment for many patients with descending thoracic aortic disease. Late complications are rarely described in literature. Herein, we described the occurrence of an aorto-bronchial fistula and a retro-A dissection in a 73-year-old man after stent-grafting for a penetrating atherosclerotic ulcer (PAU) of the descending thoracic aorta and the successful surgical technique adopted in order to remove the stent-graft. (Source: Journal of Cardiothoracic Surgery)

Prosthetic Valve Endocarditis Caused by Staphylococcus Capitis: Report of 4 Cases

Journal of Cardiothoracic Surgery — Fri, 07 Oct 2011 04:00:00 +0100

Although Staphylococcus capitis is considered to be a rare causative organism for prosthetic valve endocarditis, we report 4 such cases that were encountered at our hospital over the past 2 years. Case 1 was a 79-year-old woman who underwent aortic valve replacement with a bioprosthetic valve and presented with fever 24 days later. Transesophageal echocardiography revealed an annular abscess in the aorto-mitral continuity and mild perivalvular regurgitation. We performed emergency surgery 5 days after the diagnosis of prosthetic valve endocarditis was made. Case 2 was a 79-year-old woman presenting with fever 40 days after aortic valve replacement with a bioprosthesis. Transesophageal echocardiography showed vegetation on the valve, and she underwent urgent surgery 2 days after prosthetic ...

Complex pleural empyema can be safely treated with Vacuum-Assisted Closure

Journal of Cardiothoracic Surgery — Thu, 06 Oct 2011 04:00:00 +0100

Conclusion: VAC therapy was effective and safe in the treatment of complicated pleural empyema. The presence of smaller bronchial stump fistula and of residual lung tissue are not a contraindication for VAC therapy. (Source: Journal of Cardiothoracic Surgery)

Cavernostomy x Resection for Pulmonary Aspergilloma: A 32-Year History

Journal of Cardiothoracic Surgery — Wed, 05 Oct 2011 04:00:00 +0100

Conclusions: Older patients with severe preoperative respiratory malfunction and peripheral pulmonary aspergilloma should be submitted to cavernostomy. The remaining patients can be treated by pulmonary resection. (Source: Journal of Cardiothoracic Surgery)

Cystic mucinous adenocarcinoma of the lung: a case report.

Journal of Cardiothoracic Surgery — Tue, 04 Oct 2011 04:00:00 +0100

We report the case of a patient with a clinically benign cystic lesion that post-operatively showed to be consistent with an invasive adenocarcinoma arising in a mucinous cystadenoma of the lung,We underline the difficulty of the clinical pre-operative diagnosis of this cystic neoplasia radiologically mimicking a hydatid cyst, and we report the negative TTF1 immunostaining potentially misleading in the differential diagnosis with metastatic mucinous carcinomas. Finallly, we evidence the presence of a pre-existing mucinous benign lesion suggesting early and complete resection of benign appearing lung cysts because they can undergo malignant transformation if left untreated or they can already harbor foci of invasive carcinoma at the time of the presentation.Even if a good prognosis , better...

Prognostic factors of atrial fibrillation following elective coronary artery bypass grafting: the impact of quantified intraoperative myocardial ischemia.

Journal of Cardiothoracic Surgery — Mon, 03 Oct 2011 04:00:00 +0100

This study focuses on both pre- and peri-operative factors that may affect the occurrence of AF. The aim is to identify those patients at higher risk to develop AF after CABG.Patients and methodsTwo patient cohorts undergoing CABG were retrospectively studied. The first group (group A) consisted of 157 patients presenting AF after elective CABG. The second group (group B) consisted of 191 patients without AF postoperatively. Results: Preoperative factors presenting significant correlation with the incidence of post-operative AF included: 1) age >65 years (p=0.029), 2) history of AF (p=0.022), 3) chronic obstructive pulmonary disease (p=0.008), 4) left ventricular dysfunction with ejection fraction < 40% (p=0.015) and 5) proximal lesion of the right coronary artery (p=0.023). The intraopera...

Long-term myocardial recovery after mitral valve replacement in noncompaction cardiomyopathy

Journal of Cardiothoracic Surgery — Fri, 30 Sep 2011 04:00:00 +0100

Isolated noncompaction of the left ventricle is a congenital cardiomyopathy, which has been described recently, with literature limited to case reports and case series. Even though various complications have been reported with noncompaction cardiomyopathy, among them severe mitral regurgitation has been reported recently in a few cases. There is no great evidence in the literature about its management, apart from some cases of mitral valve repair and replacement in young patients. We are reporting a case of an elderly lady with isolated left ventricular noncompaction cardiomyopathy associated with severe mitral regurgitation treated with mitral valve replacement with one year of follow up demonstrating significant myocardial recovery. (Source: Journal of Cardiothoracic Surgery)

Surgery for pseudoaneurysm of the ascending aorta under moderate hypothermia

Journal of Cardiothoracic Surgery — Fri, 30 Sep 2011 04:00:00 +0100

Pseudoaneurysm of the ascending aorta is a rare complication after cardiac surgery. Particularly, pseudoaneurysm due to postoperative infection in the ascending aorta requires surgical treatment with antibiotics. If a large sized pseudoaneurysm is located at the retrosternal space, then there is a very high risk of massive bleeding from rupture during performance of resternotomy. To avoid this risk, we performed femoro-femoral bypass under moderate hypothermia with transient circulatory arrest, and we report here on the successful result of this case. (Source: Journal of Cardiothoracic Surgery)

Partial anomalous pulmonary venous return and atrial septal defect in adult patients de-tected with 128-slice multidetector computed tomography

Journal of Cardiothoracic Surgery — Fri, 30 Sep 2011 04:00:00 +0100

The present series describes a group of adults with left-to-right shunts including partial anomalous pulmonary venous return PAPVR and/or an atrial septal defect (ASD) evaluated with ECG-gated 128-slice multidetector computed tomography (MDCT). PAPVR is defined as a left-to-right shunt where one or more, but not all, pulmonary veins drain into a systemic vein or the right atrium. PAPVR involving the right upper pulmonary vein can be associated with a sinus venosus ASD. The presence, course, number of anomalous veins and associated cardiovascular defects can be reliably observed by 128-slice MDCT angiography. (Source: Journal of Cardiothoracic Surgery)

Major bleeding during Negative Pressure Wound/ V.A.C.(R)- Therapy for Postsurgical Deep Sternal Wound Infection - a critical appraisal.

Journal of Cardiothoracic Surgery — Thu, 29 Sep 2011 04:00:00 +0100

Negative-pressure wound therapy, commercially known as vacuum-assisted closure (V.A.C.) therapy, has become one of the most popular (and efficacious) interim (prior to flap reconstruction) or definite methods of managing deep sternal wound infection. Complications such as profuse bleeding, which may occur during negative-pressure therapy but not necessarily due to it, are often attributed to a single factor and reported as such. However, despite the wealth of clinical experience internationally available, information regarding certain simple considerations is still lacking. Garnering information on all the factors that could possibly influence the outcome has become more difficult due to a (fortunate) decrease in the incidence of deep sternal wound infection. If more insight is to be gaine...

A Silent Gigantic Solitary Fibrous Tumor of the Pleura: Case Report

Journal of Cardiothoracic Surgery — Thu, 29 Sep 2011 04:00:00 +0100

Solitary fibrous tumor of the pleura is a rare mesenchymal tumor, representing less than 5% of all neoplasms associated with the pleura. A 57-year-old man had general malaise without chest symptoms for 1 month. A chest roentgenogram and computed tomography showed a giant mass in the left thorax. Although the tumor compressed the descending aorta and other mediastinal structures strongly, thereby shifting them to the right side, the patient had no symptoms except malaise. The tumor was successfully resected via two separate thoracotomies. The tumor was measured (20 cm x 19 cm x 15 cm) and weighed (2150 g). The tumor was histologically and immunohistochemically diagnosed as benign. Although SFT is benign, a long follow-up period is essential as even patients with complete resection are at ri...

Intraoperative Device Closure of Atrial Septal Defects in the Older Population

Journal of Cardiothoracic Surgery — Thu, 29 Sep 2011 04:00:00 +0100

This study sought to prove the safety and feasibility of intraoperative device closure of atrial septal defect (ASD) with transthoracic minimal invasion in the older patients.Methods From January 2006 to December 2009, 47 patients aged 50 years or more and suffered from atrial septal defect were enrolled in our institution. Patients were divided into two groups, 27 of which in group I with intraoperative device closure and the other 20 in group II with surgical closure. In group I, the method involved a minimal intercostal incision, which was performed after full evaluation of the atrial septal defect by transthoracic echocardiography, and the insertion of the device through the delivery sheath to occlude the atrial septal defect.Results In group I, implantation was ultimately successful i...

Surgical treatment of giant plexiform neurofibroma associated with pectus excavatum

Journal of Cardiothoracic Surgery — Wed, 28 Sep 2011 04:00:00 +0100

Plexiform neurofibromas are benign tumours originating from subcutaneous or visceral peripheral nerves, which are usually associated with neurofibromatosis type 1. They are almost always congenital lesions and often cause the surrounding soft tissue and bone to grow aberrantly. We treated a 12-year-old boy who presented with asymmetric pectus excavaum and an anterior chest wall plexiform neurofibroma. The pectus excavaum was corrected by modified Nuss procedure, followed by simultaneous resection of the giant mass. The patient is doing well at the 4 years follow-up visit. (Source: Journal of Cardiothoracic Surgery)

Thrombotic Gene Polymorphisms and Postoperative Outcome after Coronary Artery Bypass Graft Surgery

Journal of Cardiothoracic Surgery — Wed, 28 Sep 2011 04:00:00 +0100

Background: Emerging perioperative genomics may influence the direction of risk assessment and surgical strategies in cardiac surgery. The aim of this study was to investigate whether single nucleotide polymorphisms (SNP) affect the clinical presentation and predispose to increased risk for postoperative adverse events in patients undergoing coronary artery bypass grafting surgery (CABG). Methods: A total of 220 patients undergoing first-time CABG between January 2005 and May 2008 were screened for factor V gene G1691A (FVL), prothrombin/factor II G20210A (PT G20210A), angiotensin I-converting enzyme insertion/deletion (ACE-ins/del) polymorphisms by PCR and Real Time PCR. End points were defined as death, myocardial infarction, stroke, postoperative bleeding, respiratory and renal insuffic...

Oesophageal Perforation: A diagnostic and therapeutic challenge in a resource limited setting. A report of three cases

Journal of Cardiothoracic Surgery — Sun, 25 Sep 2011 04:00:00 +0100

Conclusion: In a resource restricted setting, conservative management which includes enteral nutrition by feeding gastrostomy, tube thoracostomy to drain inter pleural contaminants, intravenous antibiotics and chest physiotherapy is a safe and effective treatment for oesophageal perforations. (Source: Journal of Cardiothoracic Surgery)

Intensified thermal management for patients undergoing transcatheter aortic valve implantation (TAVI)

Journal of Cardiothoracic Surgery — Sun, 25 Sep 2011 04:00:00 +0100

Conclusion: ITM during TAVI-TA reduces the incidence of hypothermia and allows for faster recovery with less need of ventilatory support. (Source: Journal of Cardiothoracic Surgery)

Thoracoscopic resection of thoracic esophageal duplication cyst containing ectopic pancreatic tissue in adult.

Journal of Cardiothoracic Surgery — Sun, 25 Sep 2011 04:00:00 +0100

We describe a case with esophageal duplication cyst, which contained the ectopic pancreatic tissue in the solid portion, resected under the thoracoscopic approach in adult. (Source: Journal of Cardiothoracic Surgery)

Total thoracoscopic lung segmentectomy of anterior basal segment of the right lower lobe (RS8) for NSCLC stage IA (case report)

Journal of Cardiothoracic Surgery — Sat, 24 Sep 2011 04:00:00 +0100

A 69-year-old woman with a pulmonary nodule in anterior basal segment of the right lower lobe (RS8) was referred to our department. The diameter of the tumor was 12 mm, and it had increased over a few months. First, video-assisted thoracoscopic lung surgery (VATS) biopsy of the pulmonary nodule was carried out. Frozen section examination of this nodule confirmed the diagnosis of bronchioloalveolar carcinoma (BAC). Segmentectomy of RS8 with lower mediastinal node dissection (ND2a-1) was performed. The intersegmental plane was identified using the intersegmental veins as landmarks and the demarcation between the resected (inflated) and preserved (collapsed) lungs. Electrocautery at 70 watts was used to divide the intersegmental plane. A vessel sealing system was used to seal and cut the pulm...

Outcomes of single-stage total arch replacement via clamshell incision

Journal of Cardiothoracic Surgery — Tue, 20 Sep 2011 04:00:00 +0100

Conclusions: The arch-first technique, combined with clamshell incision, provides expeditious replacement of the thoracic aorta with an acceptable duration of hypothermic circulatory arrest and minimizes the risk of retrograde atheroembolism by using antegrade perfusion. (Source: Journal of Cardiothoracic Surgery)

Video Assisted Thoracoscopic Resection of a Posterior Mediastinal Castleman's Tumor

Journal of Cardiothoracic Surgery — Tue, 20 Sep 2011 04:00:00 +0100

We describe a case report of a posterior mediastinal Castleman's tumor adherent to the esophagus, which was resected thoracoscopically and review the literature. (Source: Journal of Cardiothoracic Surgery)

Risk analysis and outcome of mediastinal wound and deep mediastinal wound infections with specific emphasis to omental transposition

Journal of Cardiothoracic Surgery — Mon, 19 Sep 2011 04:00:00 +0100

Conclusion: Post cardiac surgery sternal wound complications remain challenging. The role of multidisciplinary approach is fundamental, as is the importance of an aggressive early wound exploration especially for deep sternal infections. (Source: Journal of Cardiothoracic Surgery)

Treatment of gram-positive deep sternal wound infections in cardiac surgery -Experiences with daptomycin-

Journal of Cardiothoracic Surgery — Mon, 19 Sep 2011 04:00:00 +0100

The reported incidence of deep sternal wound infection (DSWI) after cardiac surgery is 0.4-5% with Staphylococcus aureus being the most common pathogen isolated from infected wound sternotomies and bacteraemic blood cultures. This infection is associated with a higher morbidity and mortality than other known aetiologies. Little is reported about the optimal antibiotic management. The aim of the study is to quantify the application of daptomycin treatment of DSWI due to gram-positive organisms post cardiac surgery.We performed an observational analysis in 23 cases of post sternotomy DSWI with gram-positive organisms February 2009 and September 2010. When the wound appeared viable and the microbiological cultures were negative, the technique of chest closure was individualised to the patient...

Logistic Organ Dysfunction Score (LODS): A reliable postoperative risk management score also in cardiac surgical patients?

Journal of Cardiothoracic Surgery — Fri, 16 Sep 2011 04:00:00 +0100

Conclusions: Although the LODS has not previously been validated for cardiac surgery patients it showed reasonable accuracy in prediction of ICU mortality in patients after cardiac surgery. (Source: Journal of Cardiothoracic Surgery)

Culture-negative bivalvular endocarditis with myocardial destruction in a patient with systemic lupus erythematosus: a case report

Journal of Cardiothoracic Surgery — Wed, 14 Sep 2011 04:00:00 +0100

We present a patient with destructive culture-negative endocarditis that remains without a microbial etiology despite an exhaustive workup using advanced diagnostic techniques in a patient with systemic lupus erythematosus. (Source: Journal of Cardiothoracic Surgery)

PEEP-ZEEP technique: Cardiorespiratory repercussions in mechanically ventilated patients submitted to a coronary artery bypass graft surgery.

Journal of Cardiothoracic Surgery — Tue, 13 Sep 2011 04:00:00 +0100

Background: :The PEEP-ZEEP technique is previously described as a lung inflation through a positive pressure enhancement at the end of expiration (PEEP), followed by rapid lung deflation with an abrupt reduction in the PEEP to 0 cmH2O (ZEEP), associated to a manual bilateral thoracic compression. AIM: To analyze PEEP-ZEEP technique's repercussions on the cardio-respiratory system in immediate postoperative artery graft bypass patients.Method:15 patients submitted to a coronary artery bypass graft surgery (CABG) were enrolled prospectively, before, 10 minutes and 30 minutes after the technique. Patients were curarized, intubated, and mechanically ventilated. To perform PEEP-ZEEP technique, saline solution was instilled into their orotracheal tube than the patient was reconnected to the vent...

Impact of repeated percutaneous coronary intervention on long-term survival after subsequent coronary artery bypass surgery

Journal of Cardiothoracic Surgery — Sat, 10 Sep 2011 04:00:00 +0100

Conclusions)Repeated PCI increased risk for long-term prognosis of subsequent CABG. (Source: Journal of Cardiothoracic Surgery)

Why are heart operations postponed?

Journal of Cardiothoracic Surgery — Mon, 05 Sep 2011 04:00:00 +0100

Conclusions. Heart operations are postponed due to organisatory as well as medical reasons, the latter mainly affecting older, morbid patients who therefore require advanced preoperative care. (Source: Journal of Cardiothoracic Surgery)

Multiple right-sided pulmonary nodules: metastatic cancer or resectable early stage tumor?

Journal of Cardiothoracic Surgery — Sun, 04 Sep 2011 23:00:00 +0100

The aim of this paper is to focus attention on complex cases of lung disease that may benefit from being managed outside formal guidelines. A 52 year-old man who had previously undergone a laryngectomy for squamous cell carcinoma, presented with a 1.2 cm nodule in the right upper pulmonary lobe. Three months later a new CT scan found that the nodule had slightly increased in size and also detected two new smaller nodules in the middle lobe. A PET/CT scan showed metabolic hyperactivity of all nodules. Since needle aspiration of the upper one revealed malignant cells, the patient was considered to be suffering from metastatic cancer and started on chemotherapy. At follow-up both CT and PET scans found a significant reduction in volume and activity of the lower nodules but no change in the up...

Prevalence of Dysglycemia Among Coronary Artery Bypass Surgery Patients with No Previous Diabetic History

Journal of Cardiothoracic Surgery — Thu, 01 Sep 2011 23:00:00 +0100

Conclusion: Among individuals undergoing CABG with no known history of diabetes, there is a substantial amount of undiagnosed dysglycemia. Even though labeling these patients as "diabetic" or "increased risk for diabetes" remains controversial in terms of perioperative management, pre-operative screening could lead to appropriate post-operative follow up to mitigate short-term adverse outcome and provide high priority medical referrals of this at risk population. (Source: Journal of Cardiothoracic Surgery)

Impact of aprotinin and renal function on mortality: a retrospective single center analysis

Journal of Cardiothoracic Surgery — Mon, 29 Aug 2011 23:00:00 +0100

Conclusions: Lessons learned from our experience using aprotinin in the perioperative setting as an antifibrinolytic during open cardiac surgery should guide us in testing future antifibrinolytic drugs for not only efficacy of preventing bleeding, but for overall safety to the whole organism using long-term clinical outcome studies, including those with varying degree of baseline kidney function. (Source: Journal of Cardiothoracic Surgery)

Acute heart failure caused by a giant hepatocellular metastatic tumor of the right atrium

Journal of Cardiothoracic Surgery — Thu, 25 Aug 2011 23:00:00 +0100

We present a symptomatic 40-year-old cirrhotic man who presented with sudden onsets of syncope. Echocardiography revealed right ventricular outflow track obstruction caused by a huge right atrial mass. The tumor was surgically excised under cardiopulmonary bypass. Although no primary cancerous lesion in the liver was detected, histopathology revealed that the mass was a metastatic hepatocellular carcinoma. The aim of this report is to show the value of urgent preoperative computed tomography and its contribution in the operative strategy. The importance of urgent surgical treatment with tricuspid valve sparing tumor resection is emphasized even though the prognosis for such patients is dismal. We also discuss the further management options of such rare cases (Source: Journal of Cardiothora...

A successfully thrombolysed acute inferior myocardial infarction due to type A aortic dissection with lethal consequences: the importance of early echocardiography.

Journal of Cardiothoracic Surgery — Tue, 23 Aug 2011 23:00:00 +0100

We report a case of a patient with an inferior STEMI thrombolysed with tenecteplase and followed by clinical and electrocardiographic evidence of successful reperfusion, which was found later to be a lethal acute aortic dissection. Prognostic implications of early diagnosis applying transthoracic echocardiography (TTE) are described. (Source: Journal of Cardiothoracic Surgery)

Subcoronary versus supracoronary aortic stenosis. An experimental evaluation.

Journal of Cardiothoracic Surgery — Sun, 21 Aug 2011 23:00:00 +0100

Conclusions: A human pathophysiologically compatible porcine model for valvular aortic stenosis was developed by performing subcoronary aortic banding. Sub- and supracoronary aortic banding induce an equal degree of left ventricular hypertrophy. This model may be valid for experimental investigations of aortic valve stenosis but studies of left ventricular hypertrophy can be studied equally well by graduated constriction of the ascending aorta. (Source: Journal of Cardiothoracic Surgery)

Effect of short-acting beta blocker on the cardiac recovery after cardiopulmonary bypass

Journal of Cardiothoracic Surgery — Thu, 18 Aug 2011 23:00:00 +0100

In conclusion: Esmolol has a positive effect on the cardiac recovery in cardiopulmonary bypass surgeries. (Source: Journal of Cardiothoracic Surgery)

Hand-grip strength is a simple and effective outcome predictor in esophageal cancer following esophagectomy with reconstruction: A prospective study

Journal of Cardiothoracic Surgery — Sun, 14 Aug 2011 23:00:00 +0100