MedWorm: Cardiovascular & Thoracic Surgery

Information for Readers

The Journal of Thoracic and Cardiovascular Surgery — Fri, 20 Nov 2009 16:22:55 +0100

Communications regarding original articles and editorial management should be addressed to Lawrence H. Cohn, MD, Editor, The Journal of Thoracic and Cardiovascular Surgery, American Association for Thoracic Surgery, 900 Cummings Center, Suite 221-U, Beverly, MA 01915; telephone: 978-299-4505; fax: 978-524-8890. Information for authors appears in each issue. Authors should consult these instructions before submitting manuscripts to this Journal. (Source: The Journal of Thoracic and Cardiovascular Surgery)

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JTCVS Disclosure Statement

The Journal of Thoracic and Cardiovascular Surgery — Fri, 20 Nov 2009 16:22:55 +0100

(Source: The Journal of Thoracic and Cardiovascular Surgery)

The Journal of Thoracic and Cardiovascular Surgery — Fri, 20 Nov 2009 16:22:55 +0100

(Source: The Journal of Thoracic and Cardiovascular Surgery)

Condensed Contents

The Journal of Thoracic and Cardiovascular Surgery — Fri, 20 Nov 2009 16:22:55 +0100

(Source: The Journal of Thoracic and Cardiovascular Surgery)

Requirements for Maintenance of Certification

The Journal of Thoracic and Cardiovascular Surgery — Fri, 20 Nov 2009 16:22:55 +0100

Diplomates of the American Board of Thoracic Surgery (ABTS) who plan to participate in the Maintenance of Certification (MOC) process must hold an unrestricted medical license in the locale of their practice and privileges in a hospital accredited by the JCAHO (or other organization recognized by the ABTS). In addition, a valid ABTS certificate is an absolute requirement for entrance into the Maintenance of Certification process. If your certificate has expired, the only pathway for renewal of a certificate is to take and pass the Part I (written) and the Part II (oral) certifying examinations. (Source: The Journal of Thoracic and Cardiovascular Surgery)

Notices

The Journal of Thoracic and Cardiovascular Surgery — Fri, 20 Nov 2009 16:22:55 +0100

The part I (written) examination was held on December 3. It is planned that this examination will be given at multiple sites throughout the United States using an electronic format. The closing date for registration is August 1 each year. Those wishing to be considered for examination must apply online at www.abts.org. (Source: The Journal of Thoracic and Cardiovascular Surgery)

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Applications for Membership

The Journal of Thoracic and Cardiovascular Surgery — Fri, 20 Nov 2009 16:22:55 +0100

Applications for membership in the Association must be received by the Membership Committee Chair no later than March 1, 2010 to be considered at the 2010 Annual Meeting. Applicants must be sponsored by three members of the Association who are not members of the Membership Committee. Application forms will be issued only to sponsoring members. (Source: The Journal of Thoracic and Cardiovascular Surgery)

2010 Summer Intern Scholarship Applications Now Available

The Journal of Thoracic and Cardiovascular Surgery — Fri, 20 Nov 2009 16:22:55 +0100

The American Association for Thoracic Surgery (AATS) Summer Intern Scholarship program introduces the field of cardiothoracic surgery to first- and second-year medical students from North American medical institutions. By providing an opportunity to spend 8 weeks during the summer working in an AATS member's cardiothoracic surgery department, the summer intern scholarship provides medical students with insight into the scientific investigation and study of cardiothoracic surgery. (Source: The Journal of Thoracic and Cardiovascular Surgery)

AATS Meetings and Sponsored Events

The Journal of Thoracic and Cardiovascular Surgery — Fri, 20 Nov 2009 16:22:55 +0100

February February 6–9, 2010 (Source: The Journal of Thoracic and Cardiovascular Surgery)

Aortic Symposium 2010

The Journal of Thoracic and Cardiovascular Surgery — Fri, 20 Nov 2009 16:22:55 +0100

April 29–30, 2010 Sheraton New York Hotel and Towers (Source: The Journal of Thoracic and Cardiovascular Surgery)

AATS 90th Annual Meeting

The Journal of Thoracic and Cardiovascular Surgery — Fri, 20 Nov 2009 16:22:55 +0100

May 1–5, 2010 Metro Toronto Convention Centre (Source: The Journal of Thoracic and Cardiovascular Surgery)

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Meetings and Courses

The Journal of Thoracic and Cardiovascular Surgery — Fri, 20 Nov 2009 16:22:55 +0100

The Kuala Lumpur Valve Summit 2009 will be held December 3-5, 2009, at the Shangri-La Hotel, Kuala Lumpur, Malaysia. For information, contact: Secretariat - Marini Kamarudin (telephone: +603 26178515; Fax: +603 26928418; E-mail: klvs2009@ijn.com.my). Additional information: http://www.ijn.com.my/klvs2009/klvs/ (Source: The Journal of Thoracic and Cardiovascular Surgery)

Reply to the Editor

The Journal of Thoracic and Cardiovascular Surgery — Fri, 20 Nov 2009 16:22:55 +0100

We would like to thank Soueidi and colleagues for their thoughtful comments on our work. We agree that the decision to proceed with a Fontan operation is a delicate one with major implications for the child's future course. It is standard clinical practice to perform cardiac catheterization for preoperative evaluation. However, this practice is based on data from the 1970s and does not take into consideration advances in noninvasive imaging and changes in the characteristics of subjects presenting for a Fontan operation. Although cardiac catheterization is the reference standard for hemodynamic assessment, it is invasive and costly and carries several risks, including exposure to ionizing radiation. (Source: The Journal of Thoracic and Cardiovascular Surgery)

A new diagnostic algorithm for assessment of patients with single ventricle before a Fontan operation

The Journal of Thoracic and Cardiovascular Surgery — Fri, 20 Nov 2009 16:22:55 +0100

To the Editor: We read with interest the article of Prakash and associates entitled “A new diagnostic algorithm for assessment of patients with single ventricle before Fontan operation.” We found it appealing to spare these children invasive and costly procedures in the era of rampant health care costs. In their retrospective study the authors developed an algorithm that identifies high-risk patients for the completion of partial cavopulmonary connection. This algorithm is based on clinical and noninvasive imaging criteria and limits cardiac catheterization only to high-risk patients. (Source: The Journal of Thoracic and Cardiovascular Surgery)

Reply to the Editor

The Journal of Thoracic and Cardiovascular Surgery — Fri, 20 Nov 2009 16:22:55 +0100

We thank Dr Durandy very much for her comments. We completely agree that performing transfusion-free surgery cannot be a goal in itself. There are convincing data from the adult world and first data from the pediatric world of cardiac surgery showing that transfusion of allogeneic blood impairs clinical outcomes. However, the small scale of our investigation and the great heterogeneity of cardiac malformations meant that the study was not powered to perform an assessment in this regard. (Source: The Journal of Thoracic and Cardiovascular Surgery)

Pediatric cardiac surgery: Effect of a miniaturized bypass circuit in reducing homologous blood transfusion

The Journal of Thoracic and Cardiovascular Surgery — Fri, 20 Nov 2009 16:22:55 +0100

To the Editor: I read with great interest the excellent article by Koster and colleagues. We have recently published our experience in treating 150 pediatric patients with a 120-mL prime volume miniaturized bypass circuit, vacuum-assisted venous drainage, and intermittent warm blood microplegia. Our results, although less impressive than those of Koster and colleagues, confirmed the efficiency of a small prime volume for reduction of allogeneic blood transfusion. With a nadir hemoglobin value of 8 g/dL during cardiopulmonary bypass, we demonstrated the good tolerance of hemodilution using 2 markers: preoperative and postoperative lactate levels (which were lower in patients undergoing bloodless surgery than in transfused patients) and time to extubation (which was shorter in patients unde...

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Posttransplant survival is not diminished in heart transplant recipients bridged with implantable left ventricular assist devices

The Journal of Thoracic and Cardiovascular Surgery — Fri, 20 Nov 2009 16:22:52 +0100

Conclusion: The use of implantable left ventricular assist devices as bridges to transplantation, including both intracorporeal and paracorporeal devices, is not associated with diminished posttransplant survival. However, 90-day survival was diminished in recipients bridged with extracorporeal devices. (Source: The Journal of Thoracic and Cardiovascular Surgery)

Discussion

The Journal of Thoracic and Cardiovascular Surgery — Fri, 20 Nov 2009 16:22:52 +0100

Dr Michael Mulligan (Seattle, Wash). I would like to thank the association for inviting me to discuss this paper and Dr Khan and his colleagues for sending me the manuscript in advance. Congratulations on a fine presentation and for conducting a prospective randomized trial in an attempt to answer a timely question. You added 50% more patients between submission of the abstract and the manuscript, so I paid attention and I think I understand your take-home message but let's work through this. (Source: The Journal of Thoracic and Cardiovascular Surgery)

A prospective, randomized, crossover pilot study of inhaled nitric oxide versus inhaled prostacyclin in heart transplant and lung transplant recipients

The Journal of Thoracic and Cardiovascular Surgery — Fri, 20 Nov 2009 16:22:52 +0100

Conclusion: In heart transplant and lung transplant recipients, nitric oxide and prostacyclin similarly reduce pulmonary artery pressures and central venous pressure, and improve cardiac index and mixed venous oxygen saturation. Inhaled prostacyclin may offer an alternative to nitric oxide in the treatment of pulmonary hypertension in thoracic transplantation. (Source: The Journal of Thoracic and Cardiovascular Surgery)

Discussion

The Journal of Thoracic and Cardiovascular Surgery — Fri, 20 Nov 2009 16:22:51 +0100

Dr John S. Ikonomidis (Charleston, SC). I have no relationships to disclose. Gorav, this was a very interesting presentation. I have several questions for you. (Source: The Journal of Thoracic and Cardiovascular Surgery)

Smooth muscle phenotypic modulation is an early event in aortic aneurysms

The Journal of Thoracic and Cardiovascular Surgery — Fri, 20 Nov 2009 16:22:51 +0100

Conclusions: Aneurysms demonstrate smooth muscle cell phenotypic modulation characterized by downregulation of smooth muscle cell marker genes and upregulation of matrix metalloproteinases. These events in experimental models occur before aneurysm formation. Targeting smooth muscle cells to a reparative phenotype might provide a novel therapy in the treatment of aortic aneurysms. (Source: The Journal of Thoracic and Cardiovascular Surgery)

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Aspirin and clopidogrel use in the early postoperative period following on-pump and off-pump coronary artery bypass grafting

The Journal of Thoracic and Cardiovascular Surgery — Fri, 20 Nov 2009 16:22:51 +0100

Conclusions: Early postoperative clopidogrel combined with aspirin may be safe and beneficial compared with perioperative aspirin treatment alone, in both on-pump and off-pump coronary artery bypass grafting. However, a possibility of selection bias calls for randomized controlled trials to confirm our findings. (Source: The Journal of Thoracic and Cardiovascular Surgery)

Discussion

The Journal of Thoracic and Cardiovascular Surgery — Fri, 20 Nov 2009 16:22:50 +0100

Dr Giancarlo Roviaro (Milan, Italy). I would like to thank Dr Schuchert and coworkers for presenting this good experience in anatomic segmentectomies, which once again seems to confirm the validity of VATS in the treatment of early-stage lung cancer. The paper is good, well done, and the analysis of the patients, of the outcomes and of survival, is totally correct. Before asking you my questions, I would like to make some personal observations regarding the so-called VATS lobectomies and anatomic resections. (Source: The Journal of Thoracic and Cardiovascular Surgery)

Anatomic segmentectomy for stage I non–small-cell lung cancer: Comparison of video-assisted thoracic surgery versus open approach

The Journal of Thoracic and Cardiovascular Surgery — Fri, 20 Nov 2009 16:22:50 +0100

Conclusions: Video-assisted thoracic surgery segmentectomy can be performed with acceptable morbidity, mortality, recurrence, and survival. The video-assisted thoracic surgery approach affords a shorter length of stay and fewer postoperative pulmonary complications compared with open techniques. The potential benefits and limitations of segmentectomy will need to be further evaluated by prospective, randomized trials. (Source: The Journal of Thoracic and Cardiovascular Surgery)

Discussion

The Journal of Thoracic and Cardiovascular Surgery — Fri, 20 Nov 2009 16:22:50 +0100

Dr Michael Weyant (Aurora, Colo). Good morning. I would like to first thank the Western for inviting me to discuss this paper, and I would also like to thank the authors for sending me the manuscript well in advance. (Source: The Journal of Thoracic and Cardiovascular Surgery)

Recurrence after neoadjuvant chemoradiation and surgery for esophageal cancer: Does the pattern of recurrence differ for patients with complete response and those with partial or no response?

The Journal of Thoracic and Cardiovascular Surgery — Fri, 20 Nov 2009 16:22:50 +0100

Conclusions: Most esophageal cancer recurrences after neoadjuvant therapy and surgery are distant, and survival time after recurrence is short regardless of pathologic response. Fewer patients achieving complete response had recurrences, and distant recurrences in these patients manifest later than in patients showing partial response and those showing no response. Only pathologic response is significantly associated with disease recurrence, suggesting that tumor biology and chemosensitivity are critical in long-term patient outcome. (Source: The Journal of Thoracic and Cardiovascular Surgery)

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Morphologic spectrum of truncal valvar origin relative to the ventricular septum: Correlation with the size of ventricular septal defect

The Journal of Thoracic and Cardiovascular Surgery — Fri, 20 Nov 2009 16:22:50 +0100

Conclusion: Origin of the truncal valve demonstrated a morphologic spectrum and correlated with the size of ventricular septal defect that was the main or even sole exit from the left ventricle in hearts with right ventricular origin. Truncal origin, therefore, requires recognition to optimize surgery. (Source: The Journal of Thoracic and Cardiovascular Surgery)

2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (Updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (Updating the 2005 Guideline and 2007 Focused Update)

Catheterization and Cardiovascular Interventions — Thu, 19 Nov 2009 00:00:00 +0100

No abstract (Source: Catheterization and Cardiovascular Interventions)

Feasibility of ablation as an alternative to surgical metastasectomy in patients with unresectable sarcoma pulmonary metastases [Case report - Thoracic oncologic]

Interactive CardioVascular and Thoracic Surgery — Tue, 17 Nov 2009 18:56:36 +0100

Percutaneous radiofrequency ablation (RFA) is an alternate treatment modality for pulmonary metastasis in non-surgical candidates. Four patients not suitable for surgery underwent percutaneous RFA for pulmonary metastases from leiomyosarcoma. Success of RFA was assessed with computed tomography (CT). The median length from the radiographic diagnosis of metastatic pulmonary disease (CT-scan) from the primary tumor diagnosis was 67.0 months with a range of 15.0–81.0 months. The median disease free interval following RFA was 19.0 months with a range of 4.0–35.0 months. Three of four patients underwent the procedure uneventfully. RFA is a safe and minimally invasive intervention in non-surgical candidates with sarcoma pulmonary metastases. (Source: Interactive C...

Splenic tear causing a hemoperitoneum after cardiac surgery [Case report - Cardiac general]

Interactive CardioVascular and Thoracic Surgery — Tue, 17 Nov 2009 18:56:36 +0100

We describe the first case of hemoperitoneum caused by a spontaneous rupture of the spleen. (Source: Interactive CardioVascular and Thoracic Surgery)

Syncope triggered by a giant unruptured sinus of Valsalva aneurysm [Case report - Cardiac general]

Interactive CardioVascular and Thoracic Surgery — Tue, 17 Nov 2009 18:56:36 +0100

We report a case of a single unruptured sinus of Valsalva aneurysm of a 54-year-old woman. (Source: Interactive CardioVascular and Thoracic Surgery)

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Splenic injury following diaphragmatic plication: an avoidable life-threatening complication [Case report - Thoracic non-oncologic]

Interactive CardioVascular and Thoracic Surgery — Tue, 17 Nov 2009 18:56:36 +0100

We report an unusual complication of left-sided diaphragmatic plication, namely bleeding from the spleen due to tearing of adhesions between the spleen and the abdominal aspect of the diaphragm. We believe that making a small incision in the diaphragm prior to the plication to identify and divide the adhesions could have prevented the complication, and that this manoeuvre should be a standard part of the operation. (Source: Interactive CardioVascular and Thoracic Surgery)

Peripheral venous embolized intracardiac foreign body [Case report - Cardiac general]

Interactive CardioVascular and Thoracic Surgery — Tue, 17 Nov 2009 18:56:36 +0100

We report a case of a peripheral venous embolized intracardiac metal foreign body after traumatic elbow injury. A review of the literature is therefore performed. Intracardiac foreign body removal must be considered when its diameter exceeds 5 mm, its shape is irregular or when symptomatic. (Source: Interactive CardioVascular and Thoracic Surgery)

Spontaneous circumferential esophageal dissection in a young man with eosinophilic esophagitis [Case report - Esophagus]

Interactive CardioVascular and Thoracic Surgery — Tue, 17 Nov 2009 18:56:36 +0100

We describe an unusual case of a young man with eosinophilic esophagitis who presented complaining of acute retrosternal pain, fever and vomiting. After a thorough evaluation including CT-scan and esophagogram, circumferential esophageal dissection and mediastinal abscess without visible perforation was observed. Abscess resolution and oral nutrition reintroduction was achieved with non-surgical management. Corticoid therapy was initiated for esophagitis treatment. (Source: Interactive CardioVascular and Thoracic Surgery)

Crutch-induced bilateral brachial artery aneurysms [Case report - Vascular general]

Interactive CardioVascular and Thoracic Surgery — Tue, 17 Nov 2009 18:56:36 +0100

A 57-year-old man, who was a chronic axillary crutch user as a result of childhood poliomyelitis, was referred to our hospital because of a sudden onset of right forearm ischemia. The right forearm had no pulse, and three-dimensional computed tomography (3DCT) showed an aneurysm of the right brachial artery associated with arterial occlusion. The thrombosed aneurysm of the brachial artery was resected and the brachial artery was successfully revascularized by interposing a saphenous vein graft. Postoperative 3DCT revealed an asymptomatic left brachial artery aneurysm. His postoperative course was uneventful under warfarin anticoagulation therapy. (Source: Interactive CardioVascular and Thoracic Surgery)

Surgical treatment of a rare case of tracheal inflammatory pseudotumor in pediatric age [Case report - Thoracic oncologic]

Interactive CardioVascular and Thoracic Surgery — Tue, 17 Nov 2009 18:56:36 +0100

We report the case of a 12-year-old male patient who presented to our institution with sudden dyspnoea after some months of wheezing and cough, wrongly considered and treated as asthma. Neck-chest CT-scan and fiberbronchoscopy showed an intraluminal tracheal mass, originating from the left antero-lateral wall at the level of the 5th cartilagineous tracheal ring, involving three rings, that was removed by rigid bronchoscopy. Histopathology revealed a tracheal IPT. Due to rapid tendency to recurrence of the lesion, two more endoscopic recanalizations were performed, but a new recurrence appeared, with CT evidence of transmural involvement of the tracheal wall. Resection of the three involved tracheal rings and termino-terminal tracheal anastomosis were successfully performed through cervicot...

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Concurrent benign schwannoma of oesophagus and posterior mediastinum [Case report - Thoracic oncologic]

Interactive CardioVascular and Thoracic Surgery — Tue, 17 Nov 2009 18:56:36 +0100

A 52-year-old female with recent onset dysphagia and haematemesis was found to have an intramural tumour of the oesophagus. A separate tumour in the posterior mediastinum was also detected. Both the tumours were immunohistochemically and histomorphologically compatible with benign schwannoma. Oesophageal schwannoma is extremely rare and its association with a concurrent schwannoma in posterior mediastinum is not reported earlier in the literature. (Source: Interactive CardioVascular and Thoracic Surgery)

Hamartoma of mature cardiac myocytes of the pulmonary infundibulum [Case report - Cardiac general]

Interactive CardioVascular and Thoracic Surgery — Tue, 17 Nov 2009 18:56:36 +0100

We describe the incidental finding and treatment of a very rare and voluminous cardiac tumour located near to the pulmonary infundibulum. The mass was surgically resected and final diagnosis was hamartoma of mature cardiac myocytes. Postoperative course was uneventful and the patient is asymptomatic after six months of follow-up. (Source: Interactive CardioVascular and Thoracic Surgery)

Primary synovial sarcoma of the lung as an incidental finding [Case report - Thoracic oncologic]

Interactive CardioVascular and Thoracic Surgery — Tue, 17 Nov 2009 18:56:36 +0100

Synovial sarcoma of the lung (SSL) is a very rare but aggressive primary lung tumor. Due to its unusual histological features, it can easily be misdiagnosed, if only small biopsies of the tumor are investigated. Here, we review two recent cases of SSL diagnosed and treated in our institution. The first case is a 37-year-old male with a round nodule in the right lower lobe; he underwent a lobectomy. Histologically, the nodule resembled a biphasic tumor. Cytogenetic analysis revealed a translocation t (X; 18), and the diagnosis of primary SSL could be established. The patient is alive and disease-free since 45 months following surgery. The second case is a 41-year-old male with a cystic lesion in the right lower lobe, removed by video-assisted thoracic surgery (VATS) segmentectomy. In t...

eComment: Heparin-induced thrombocytopenia [eComment]

Interactive CardioVascular and Thoracic Surgery — Tue, 17 Nov 2009 18:56:36 +0100

(Source: Interactive CardioVascular and Thoracic Surgery)

Heparin induced thrombocytopenia in a patient with factor V Leiden following cardiac surgery [Case report - Vascular general]

Interactive CardioVascular and Thoracic Surgery — Tue, 17 Nov 2009 18:56:36 +0100

We report a patient who died as a result of heparin induced thrombocytopenia (HIT) and arterial thromboses following cardiac surgery. The onset was three days after exposure to low molecular weight heparin on the eighth postoperative day. The patient was heterozygous for the factor V Leiden mutation. We have reviewed 15 patients previously diagnosed as HIT on clinical and laboratory criteria and found an incidence of 6.7% (1/15) activated protein C resistance. This second patient had a pulmonary embolus and HIT after only three days exposure to low molecular weight heparin. We postulate that factor V Leiden hastens the onset and magnifies the severity of HIT. (Source: Interactive CardioVascular and Thoracic Surgery)

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A technique of an upper V-type ministernotomy in the second intercostal space [Brief communication - Cardiac general]

Interactive CardioVascular and Thoracic Surgery — Tue, 17 Nov 2009 18:56:36 +0100

Since cardiac surgeons found themselves able to offer a less invasive access to heart and great vessels, one of the first techniques to satisfy the tendency of minimizing the surgical trauma during general cardiac surgical procedure was a ministernotomy. In the current paper, we present the technique of V-type ministernotomy in the 2nd intercostal space, which has been employed in our department from June 2007 in 85 consecutive patients (mean age: 58±18 years); those operations consisted of the aortic valve replacement (AVR), surgery of the ascending aorta and epiaortic arterial segment. (Source: Interactive CardioVascular and Thoracic Surgery)

eComment: Which functional tricuspid regurgitation should be surgically corrected? [eComment]

Interactive CardioVascular and Thoracic Surgery — Tue, 17 Nov 2009 18:56:36 +0100

(Source: Interactive CardioVascular and Thoracic Surgery)

Which patient undergoing mitral valve surgery should also have the tricuspid repair? [Best evidence topic - Valves]

Interactive CardioVascular and Thoracic Surgery — Tue, 17 Nov 2009 18:56:36 +0100

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was ‘Which patient undergoing mitral valve surgery should also have the tricuspid repair?’ Altogether 390 papers were found using the reported search, of which 17 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. While a general agreement exists for tricuspid valve (TV) repair in cases of severe regurgitation and concomitant multivalvular disease requiring surgical intervention, current guidelines provide more vague indications for patients with less severe tricuspid regurgitation (TR). Since this condition...

In patients with first-episode primary spontaneous pneumothorax is video-assisted thoracoscopic surgery superior to tube thoracostomy alone in terms of time to resolution of pneumothorax and incidence of recurrence? [Best evidence topic - Thoracic non-oncologic]

Interactive CardioVascular and Thoracic Surgery — Tue, 17 Nov 2009 18:56:36 +0100

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed whether video-assisted thoracoscopic surgery (VATS) was justifiable for first-episode primary spontaneous pneumothorax (PSP). Altogether 183 papers were found using the reported search, of which nine represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that VATS has superior outcomes in terms of recurrence rates of pneumothorax (from 0 to 13% according to several studies for VATS vs. 22.8 to 42% for tube thoracostomy alone), duration of chest tube drainage (CTD) (4.56 vs.7.6 days) and mean hospital stay (...

Can chronic neuropathic pain following thoracic surgery be predicted during the postoperative period? [Institutional report - Thoracic oncologic]

Interactive CardioVascular and Thoracic Surgery — Tue, 17 Nov 2009 18:56:36 +0100

Chronic pain following thoracic surgery is common and associated with neuropathic symptoms, however, the proportion of patients with neuropathic pain in the immediate postoperative period is unknown. We aimed to determine the proportion of patients who have neuropathic symptoms and signs immediately after, and at three months following thoracic surgery. The study was designed as a prospective observational cohort study. We identified patients with pain of predominantly neuropathic origin using the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) score in the immediate postoperative period and the self-report LANSS (S-LANSS) version three months after surgery. One hundred patients undergoing video assisted thoracic surgery (VATS) or thoracotomy completed LANSS scores preoperativel...

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Early outcomes of video-assisted thoracoscopic resection of thymus in 181 patients with myasthenia gravis: who are the candidates for the next morning discharge? [Institutional report - Thoracic non-oncologic]

Interactive CardioVascular and Thoracic Surgery — Tue, 17 Nov 2009 18:56:36 +0100

The aims of this study are to present the results of videothoracoscopic thymectomy in patients with myasthenia gravis (MG) and to predict the factors affecting the next morning discharge (NMD). This is a retrospective analysis of the prospectively recorded data of 181 consecutive myasthenic patients who underwent videothoracoscopic thymectomy from June 2002 to September 2009. Sixty-one patients (33.7%) were discharged on the next morning. Univariate and multivariate analyses were evaluated to determine the predictors for NMD. Mean calculated variables were: age (29.8 years), duration of symptoms (22.5 months), duration of surgery (51.3 min), postoperative stay (2.1) days, and visual analogue scale (2.1). No mortality occurred. Four patients were required to stay in intensive...

Long-term follow-up after minimal invasive direct coronary artery bypass grafting procedure: a multi-factorial retrospective analysis at 1000 patient-years [Institutional report - Cardiac general]

Interactive CardioVascular and Thoracic Surgery — Tue, 17 Nov 2009 18:56:36 +0100

We provide a multi-factorial long-term follow-up following minimal invasive direct coronary artery bypass grafting (MIDCABG) to evaluate the long-term efficacy. From 1996 onwards, 390 patients underwent MIDCABG (follow-up: 30.0±11.2 months). We analyzed peri-operative and postoperative complications (<30 days) and we obtained early and late angiography. Cumulative follow-up was 1000 patient-years. Early postoperative mortality was 0.8% and myocardial infarction occurred in 1.3% of all patients. Early postoperative angiography (<30 days) was obtained in 238 patients (66.3%) and revealed patency in 97.5% (232/238) including 211 (88.6%) who had no stenosis, 13 with a <50% stenosis (5.5%) and 8 with a >50% stenosis (3.4%), but a patent graft. Only six patients...

Urgent segmental resection as the primary strategy in management of benign tracheal stenosis. A single center experience in 164 consecutive cases [Institutional report - Thoracic non-oncologic]

Interactive CardioVascular and Thoracic Surgery — Tue, 17 Nov 2009 18:56:36 +0100

The report is a retrospective review of 238 benign tracheal stenoses of various etiologies treated between 1995 and 2008. To show that urgent segmental resection has complication rates similar to elective resection and, therefore, preoperative dilation is not necessary, we analysed records of patients who underwent either standard segmental resections with anterolateral mediastinal tracheal mobilization, single-suture anastomosis and neck flexion; or insertion of T-tube with oval-shaped horizontal arm. Primary segmental resection was performed in 164 patients (68.9%), including 14 cases with concomitant tracheo-esophageal fistula (TEF). T-tube as an initial treatment suited 74 (31.1%) patients. We encountered two partial and one complete anastomotic disruptions following subglottic resecti...

An observational study of CoSeal(R) for the prevention of adhesions in pediatric cardiac surgery [Institutional report - Congenital]

Interactive CardioVascular and Thoracic Surgery — Tue, 17 Nov 2009 18:56:36 +0100

We sought to evaluate the utility and safety of CoSeal® Surgical Sealant (Baxter) for the prevention of cardiac adhesions in children. Seven cardiac surgery centers in Europe recruited consecutive pediatric patients requiring primary sternotomy for staged repair of congenital heart defects. Exclusion criteria included immune system disorder, unplanned reoperation, or reoperation within three months of primary repair. CoSeal was sprayed onto the surface of the heart at the end of surgery. Evaluation of adhesions took place at first reoperation. Data on safety, duration of surgery, and ease of CoSeal use were also collected. Seventy-nine pediatric patients were recruited between February 2005 and September 2007. Of these, 76 underwent major surgery to repair a wide range of congenital he...

Air-leak management after upper lobectomy in patients with fused fissure and chronic obstructive pulmonary disease: a pilot trial comparing sealant and standard treatment [Institutional report - Thoracic non-oncologic]

Interactive CardioVascular and Thoracic Surgery — Tue, 17 Nov 2009 18:56:36 +0100

A pilot trial to compare the efficacy of two different procedures to prevent postoperative air-leak in chronic obstructive pulmonary disease (COPD) patients submitted to upper lobectomy for non-small cell lung cancer. Sixty patients with COPD and lung cancer at the upper pulmonary lobes eligible for lobectomy were enrolled and randomly assigned either to standard treatment (ST) with stapling device or to electrocautery dissection and application of a collagen patch coated with human fibrinogen and thrombin (TachoSil®) (experimental treatment [ET]) for the intra-operative completion of their fused fissures. Thirty patients were enrolled in each group during a three-year period. Preoperative characteristics were similar between the two groups. Statistically significant reduction of air-l...

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Effectiveness of sympathetic block by clipping in the treatment of hyperhidrosis and facial blushing [Institutional report - Thoracic non-oncologic]

Interactive CardioVascular and Thoracic Surgery — Tue, 17 Nov 2009 18:56:35 +0100

We present our experience with this technique. Sixty-one patients diagnosed for HH and/or FB were operated on VATS SN clipping. Clipping levels varied in function for the sort of disease: FB: T2, palmar HH: T3, axillary HH: T4, palmar-axillary HH: T3-4. Results were evaluated 1 week, 3 months and 12 months after surgery. Fifty-eight of the 61 patients showed improvement of their symptoms (95%). There were minor complications in three patients (5.5%). CS was seen in 38/61 (62.2%), being labelled as mild in 33/61 (54%) and severe in 5/61 patients (8.2%), no patient qualified it as intolerable and it was not necessary to remove the clips for CS in any case. SN clipping by VATS is a safe and effective procedure for the management of FB and palmar/axillary HH. Levels of CS are si...

The hemiclamshell approach in thoracic surgery: indications and associated morbidity in 50 patients [Institutional report - Thoracic oncologic]

Interactive CardioVascular and Thoracic Surgery — Tue, 17 Nov 2009 18:56:35 +0100

In conclusion, the HCS surgical approach was associated with an uncomplicated postoperative course. This anterior approach is suitable for apical tumours, tumours of the cervicothoracic junction and ‘bulky’ lung tumours, providing good access for control of the large vessels and radical mediastinal clearance. (Source: Interactive CardioVascular and Thoracic Surgery)

Malignant pleural effusion in the presence of trapped lung. Five-year experience of PleurX tunnelled catheters [Institutional report - Thoracic oncologic]

Interactive CardioVascular and Thoracic Surgery — Tue, 17 Nov 2009 18:56:35 +0100

We describe our five-year experience with the use of indwelling PleurX catheters in patients with malignant pleural effusions in the presence of confirmed trapped lung on radiological or VATS investigation. Patient health related quality of life was investigated by telephone questionnaire. The parameters analysed were symptomatic relief, mobility and ease of management following insertion. One hundred and sixteen patients underwent PleurX catheter insertion by a single operator, 48 questionnaires were completed. Of the 48 cases analysed, improvement in all three quality of life indices was recorded following catheter insertion. Ease of mobility was recorded as moderately satisfied and very satisfied in 50% and 15% of patients, respectively. Symptomatic improvement was found to have been in...

eComment: Monitoring of atrial fibrillation burden after surgical ablation [eComment]

Interactive CardioVascular and Thoracic Surgery — Tue, 17 Nov 2009 18:56:35 +0100

(Source: Interactive CardioVascular and Thoracic Surgery)

Monitoring of atrial fibrillation burden after surgical ablation: relevancy of end-point criteria after radiofrequency ablation treatment of patients with lone atrial fibrillation [Institutional report - Arrhythmia]

Interactive CardioVascular and Thoracic Surgery — Tue, 17 Nov 2009 18:56:35 +0100

Studies have shown that continuous rhythm monitoring enables the detection of significantly more atrial fibrillation (AF) episodes than routine follow-up of patients, i.e. based on perception of symptoms or on 24–48 h Holter monitoring. The positive outcome of radiofrequency ablation (RFA) may be easily overestimated, especially in patients with paroxysmal AF. Thirty-three consecutive patients, aged 59.4±8.9 years (range 38–75 years) participated in this study. All patients had documented AF episodes with an AF duration of 9.4±7.1 years (range 1.5–25 years). A new monitoring device, the AF-Alarm was used to more accurately assess the outcome after surgical isolation of pulmonary veins. The AF-Alarm was applied for a duration of 128±...

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Myocyte injury along myofibers in left ventricular remodeling after myocardial infarction [Institutional report - Cardiac general]

Interactive CardioVascular and Thoracic Surgery — Tue, 17 Nov 2009 18:56:35 +0100

Left ventricular (LV) remodeling following myocardial infarction (MI) is considered to contribute to cardiac dysfunction. Though myofiber organization is a key component of cardiac structure, functional and anatomical features of injured myofiber during LV remodeling have not been fully defined. We investigated myocyte injury after acute MI in a mouse model. Mice were subjected to surgical coronary occlusion/reperfusion by left anterior descending coronary artery (LAD) ligation and examined at 1 week and 4 weeks post-MI. Magnetic resonance imaging (MRI) analysis demonstrated a significant decrease in systolic regional wall thickening (WT) in the border and remote zones at 4 weeks post-MI compared to that at 1 week post-MI (–86% in border zone, P<0.05, and &ndas...

Endovascular treatment of thoracic aortic pathology in renal transplant recipients: early and intermediate-term results [Work in progress report - Aortic and aneurysmal]

Interactive CardioVascular and Thoracic Surgery — Tue, 17 Nov 2009 18:56:35 +0100

Endovascular correction of aorta thoracic pathology in renal transplant patients is a challenge. The aim of this study is to review early and intermediate-term results of endovascular repair of thoracic aorta pathology in patients with functioning previous renal transplant. The records of 81 patients submitted to a thoracic endograft between 2003 and 2008 were reviewed. Five patients with six previous renal transplants were submitted to six thoracic endografting. Two were women. The mean age was 55.4 years (range, 43–75 years). There were two patients with type B aortic dissection, one penetrating ulcer, one aneurysm of the aortic arch and one descending thoracic aorta aneurysm. Three patients underwent hybrid procedures: two total supra-aortic transpositions and one partia...

Effect of 5-azacytidine induction duration on differentiation of human first-trimester fetal mesenchymal stem cells towards cardiomyocyte-like cells [Work in progress report - Experimental]

Interactive CardioVascular and Thoracic Surgery — Tue, 17 Nov 2009 18:56:35 +0100

The aim of this study is to investigate effects of 5-azacytidine (5-aza) induction duration on differentiation of bone marrow mesenchymal stem cells (MSCs) from human first-trimester abortus (hfMSCs) towards cardiomyocyte-like cells. hfMSCs were stimulated with 10 µmol/l 5-aza for 24 h (group A), 48 h (group B) and 21 days (group C), respectively. During the induction, 30–40% of the cells gradually enlarged, elongated, connected with adjoining cells and formed myotube-like structures, branches and string-bead-like nuclei. Some of the cells congregated into cell clusters or strips. After the induction, numerous myofilaments in the cytoplasm and conjunction of intercalated disc-like structure between adjoining cells were observed. The induced cells expressed m...

Graft fixation with a side graft holder for sequential and composite graft anastomosis in coronary artery bypass surgery [Work in progress report - Coronary]

Interactive CardioVascular and Thoracic Surgery — Tue, 17 Nov 2009 18:56:35 +0100

The purpose of this study was to assess the feasibility and effectiveness of graft fixation with a novel side graft holder for sequential or composite graft anastomosis in coronary artery bypass grafting (CABG). Records of 34 patients who underwent CABG using sequential or composite graft anastomosis technique were reviewed. The device was used on 47 anastomoses (sequential=43; composite graft=4). Excellent fixation and visualization of the graft was obtained in all patients without graft injury. Postoperative angiographic patency rate of distal anastomoses was 95.2% (arterial, 91.2%; venous, 96.7%). All sequential and composite graft anastomoses were patent and without stenosis. One operative death occurred due to low cardiac output after emergent CABG for acute myocardial infarction. No ...

Influence of major pulmonary resection on postoperative daily ambulatory activity of the patients [Work in progress report - Thoracic non-oncologic]

Interactive CardioVascular and Thoracic Surgery — Tue, 17 Nov 2009 18:56:35 +0100

To describe and compare the daily ambulatory activity of the patients before and one month after major lung resection. Daily activity was measured using a pedometer (OMROM Walking Style PRO®) given preoperatively in a prospective way to a series of 21 consecutive cases scheduled for lobectomy or pneumonectomy. Analyzed variables were age, pulmonary function, mean number of total and aerobic steps per day, walked distance and mean daily time of aerobic activity. Activity variables were analyzed individually and as a new differential variable DELTA. Wilcoxon and Mann–Whitney nonparametric tests were used for comparison between groups. General series data: 19 male. Age: 63±10.9 years. FEV1%: 88.4±22.7. DLCO: 86.2±21.6. Eleven cases had COPD criteria. Type o...

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Controlled antegrade single lung reperfusion during double lung transplant [New ideas - Pulmonary]

Interactive CardioVascular and Thoracic Surgery — Tue, 17 Nov 2009 18:56:35 +0100

Prompt controlled reperfusion of a pulmonary allograft in a sequential double lung transplant may correct cellular ischemia prior to exposure to full hydrostatic pressures and minimize organ dysfunction. We reviewed the process of a sequential double lung transplant and describe the technique of controlled antegrade graft reperfusion of the initial implant as performed at our institution. (Source: Interactive CardioVascular and Thoracic Surgery)

Lung function evaluation before surgery in lung cancer patients: how are recent advances put into practice? A survey among members of the European Society of Thoracic Surgeons (ESTS) and of the Thoracic Oncology Section of the European Respiratory Society (ERS) [Editorial - Thoracic oncologic]

Interactive CardioVascular and Thoracic Surgery — Tue, 17 Nov 2009 18:56:35 +0100

(Source: Interactive CardioVascular and Thoracic Surgery)

Correction

Journal of the American College of Cardiology: Cardiovascular Interventions — Mon, 16 Nov 2009 22:01:57 +0100

(Source: Journal of the American College of Cardiology: Cardiovascular Interventions)

Translational Research: Then and Now

Journal of the American College of Cardiology: Cardiovascular Interventions — Mon, 16 Nov 2009 22:01:57 +0100

(Source: Journal of the American College of Cardiology: Cardiovascular Interventions)

Reply

Journal of the American College of Cardiology: Cardiovascular Interventions — Mon, 16 Nov 2009 22:01:57 +0100

(Source: Journal of the American College of Cardiology: Cardiovascular Interventions)

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The Relative Renal Safety of Iodixanol Compared With Low-Osmolar Contrast Media

Journal of the American College of Cardiology: Cardiovascular Interventions — Mon, 16 Nov 2009 22:01:57 +0100

(Source: Journal of the American College of Cardiology: Cardiovascular Interventions)

European Society of Cardiology Congress 2009: Update in Interventional Cardiology

Journal of the American College of Cardiology: Cardiovascular Interventions — Mon, 16 Nov 2009 22:01:57 +0100

(Source: Journal of the American College of Cardiology: Cardiovascular Interventions)

Successful Coronary Angioplasty Via the Radial Approach After Sealing a Radial Perforation

Journal of the American College of Cardiology: Cardiovascular Interventions — Mon, 16 Nov 2009 22:01:57 +0100

(Source: Journal of the American College of Cardiology: Cardiovascular Interventions)

Irrelevance of the Chromosome 9p21.3 Locus for Acute Cardiovascular Events and Restenosis

Journal of the American College of Cardiology: Cardiovascular Interventions — Mon, 16 Nov 2009 22:01:57 +0100

(Source: Journal of the American College of Cardiology: Cardiovascular Interventions)

No Association of Chromosome 9p21.3 Variation With Clinical and Angiographic Outcomes After Placement of Drug-Eluting Stents

Journal of the American College of Cardiology: Cardiovascular Interventions — Mon, 16 Nov 2009 22:01:57 +0100

Conclusions Specific polymorphisms in the chromosome 9p21.3 region that were shown to be associated with coronary heart disease in genomewide analyses were not related to the clinical and angiographic outcomes after the placement of drug-eluting stents in coronary arteries. (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)

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Long-Term Risk of Adverse Outcomes and New Malignancies in Patients Treated With Oral Sirolimus for Prevention of Restenosis

Journal of the American College of Cardiology: Cardiovascular Interventions — Mon, 16 Nov 2009 22:01:57 +0100

Conclusions The benefit in the reduced need for repeat intervention observed at 1 year with high-dose oral sirolimus therapy was attenuated over 4 years. Moreover, this regimen was associated with numerical yet not a significant increase in newly diagnosed malignancies without augmenting the malignancy-induced risk of death. (Oral Sirolimus for In-Stent Restenosis [OSIRUS] trial; NCT00859183) (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)

The Efficacy of a Bilateral Approach for Treating Lesions With Chronic Total Occlusions: The CART (Controlled Antegrade and Retrograde subintimal Tracking) Registry

Journal of the American College of Cardiology: Cardiovascular Interventions — Mon, 16 Nov 2009 22:01:57 +0100

Conclusions A bilateral approach for CTO lesions using the CART technique is feasible, safe, and has a higher success rate than previous approaches. These results indicate that a bilateral technique can solve a major dilemma that commonly affects CTO procedures. (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)

Evaluation of the Effect of a Concurrent Chronic Total Occlusion on Long-Term Mortality and Left Ventricular Function in Patients After Primary Percutaneous Coronary Intervention

Journal of the American College of Cardiology: Cardiovascular Interventions — Mon, 16 Nov 2009 22:01:57 +0100

Conclusions The presence of a CTO and not MVD alone is associated with long-term mortality even when early deaths are excluded from analysis. The presence of a CTO is associated with reduced LVEF and further deterioration of LVEF. (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)

In Search of an Algorithm to Prevent Acute Kidney Injury

Journal of the American College of Cardiology: Cardiovascular Interventions — Mon, 16 Nov 2009 22:01:57 +0100

(Source: Journal of the American College of Cardiology: Cardiovascular Interventions)

Sodium Bicarbonate Plus N-Acetylcysteine Prophylaxis: A Meta-Analysis

Journal of the American College of Cardiology: Cardiovascular Interventions — Mon, 16 Nov 2009 22:01:57 +0100

Conclusions Combination prophylaxis with NAC and NaHCO3 substantially reduced the occurrence of contrast-induced AKI overall but not dialysis-dependent renal failure. Combination prophylaxis should be incorporated for all high-risk patients (emergent cases or patients with chronic kidney disease) and should be strongly considered for all interventional radio-contrast procedures. (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)

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Are Our Patients Better Off With Drug-Eluting Stents in Saphenous Vein Grafts?

Journal of the American College of Cardiology: Cardiovascular Interventions — Mon, 16 Nov 2009 22:01:57 +0100

(Source: Journal of the American College of Cardiology: Cardiovascular Interventions)

Outcomes With Drug-Eluting Versus Bare-Metal Stents in Saphenous Vein Graft Intervention: Results From the STENT (Strategic Transcatheter Evaluation of New Therapies) Group

Journal of the American College of Cardiology: Cardiovascular Interventions — Mon, 16 Nov 2009 22:01:57 +0100

Conclusions Treatment of SVG lesions with DES vs. BMS is effective in reducing TVR at 9 months, although most of this advantage is lost at 2 years. The DES seem safe with less death or myocardial infarction, although selection bias might have affected these results. Our data suggest that DES might have short-term advantages over BMS in SVG lesions with diameter <3.5 mm. (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)

The Worry About Clopidogrel "Nonresponsiveness": Identification and Treatment in the Post-Percutaneous Coronary Intervention Patient

Journal of the American College of Cardiology: Cardiovascular Interventions — Mon, 16 Nov 2009 22:01:57 +0100

(Source: Journal of the American College of Cardiology: Cardiovascular Interventions)

Pharmacogenetic Testing for Clopidogrel Using the Rapid INFINITI Analyzer: A Dose-Escalation Study

Journal of the American College of Cardiology: Cardiovascular Interventions — Mon, 16 Nov 2009 22:01:57 +0100

Conclusions Increasing the dose of clopidogrel in patients with nonresponder polymorphisms can increase antiplatelet response. Personalizing clopidogrel dosing using pharmacogenomics may be an effective method of optimizing treatment. (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)

Antithrombin Therapy for Elective Percutaneous Coronary Intervention: Which Agent to Use? Does It Matter?

Journal of the American College of Cardiology: Cardiovascular Interventions — Mon, 16 Nov 2009 22:01:57 +0100

(Source: Journal of the American College of Cardiology: Cardiovascular Interventions)

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Enoxaparin Versus Unfractionated Heparin in Elective Percutaneous Coronary Intervention: 1-Year Results From the STEEPLE (SafeTy and Efficacy of Enoxaparin in Percutaneous coronary intervention patients, an internationaL randomized Evaluation) Trial

Journal of the American College of Cardiology: Cardiovascular Interventions — Mon, 16 Nov 2009 22:01:57 +0100

Conclusions The 1-year mortality rates were low and comparable between patients receiving enoxaparin and UFH during elective PCI. Periprocedural ischemic or bleeding events were the strongest independent predictors of 1-year mortality. (The STEEPLE Trial; NCT00077844) (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)

Prognostic Impact of Periprocedural Bleeding and Myocardial Infarction After Percutaneous Coronary Intervention in Unselected Patients: Results From the EVENT (Evaluation of Drug-Eluting Stents and Ischemic Events) Registry

Journal of the American College of Cardiology: Cardiovascular Interventions — Mon, 16 Nov 2009 22:01:57 +0100

Conclusions Among unselected PCI patients, both post-PCI bleeding and pMI are independently associated with increased 1-year mortality. Continued efforts to reduce these complications after PCI are warranted. (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)

Vascular Dysfunction of Brachial Artery After Transradial Access for Coronary Catheterization: Impact of Smoking and Catheter Changes

Journal of the American College of Cardiology: Cardiovascular Interventions — Mon, 16 Nov 2009 22:01:57 +0100

Conclusions Transradial catheterization not only leads to dysfunction of the RA but also the upstream BA, which is more severe and sustained in smokers and with increasing numbers of catheters. (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)

Transradial Access: Just Do It!

Journal of the American College of Cardiology: Cardiovascular Interventions — Mon, 16 Nov 2009 22:01:57 +0100

(Source: Journal of the American College of Cardiology: Cardiovascular Interventions)

Mechanism and Predictors of Failed Transradial Approach for Percutaneous Coronary Interventions

Journal of the American College of Cardiology: Cardiovascular Interventions — Mon, 16 Nov 2009 22:01:57 +0100

Conclusions Transradial approach PCI can be performed by low-to-intermediate volume operators with standard equipment with a low failure rate. Age >75 years, prior coronary artery bypass graft surgery, and short stature are independent predictors of TR-PCI failure. Appropriate patient selection and careful risk assessment are needed to maximize benefits offered by TR-PCI. (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)

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Cardiac Catheterization on the Road Less Traveled: Navigating the Radial Versus Femoral Debate

Journal of the American College of Cardiology: Cardiovascular Interventions — Mon, 16 Nov 2009 22:01:57 +0100

(Source: Journal of the American College of Cardiology: Cardiovascular Interventions)

A Randomized Comparison of Transradial Versus Transfemoral Approach for Coronary Angiography and Angioplasty

Journal of the American College of Cardiology: Cardiovascular Interventions — Mon, 16 Nov 2009 22:01:57 +0100

Conclusions The findings of the present study show that transradial coronary angiography and angioplasty are safe, feasible, and effective with similar results to those of the transfemoral approach. However, procedural duration and radiation exposure are higher using the transradial access. In contrast to the transfemoral route, the rate of major vascular complications was negligible using the transradial approach. (Source: Journal of the American College of Cardiology: Cardiovascular Interventions)

Intracoronary Optical Coherence Tomography: A Comprehensive Review: Clinical and Research Applications

Journal of the American College of Cardiology: Cardiovascular Interventions — Mon, 16 Nov 2009 22:01:57 +0100

Cardiovascular optical coherence tomography (OCT) is a catheter-based invasive imaging system. Using light rather than ultrasound, OCT produces high-resolution in vivo images of coronary arteries and deployed stents. This comprehensive review will assist practicing interventional cardiologists in understanding the technical aspects of OCT based upon the physics of light and will also highlight the emerging research and clinical applications of OCT. Semi-automated imaging analyses of OCT systems permit accurate measurements of luminal architecture and provide insights regarding stent apposition, overlap, neointimal thickening, and, in the case of bioabsorbable stents, information regarding the time course of stent dissolution. The advantages and limitations of this new imaging modality will...

Cardiowest temporary total artificial heart.

Perfusion — Mon, 16 Nov 2009 00:00:00 +0100

CONCLUSION: It is evident that the advancement of modern engineering and medicine has made way for a reliable and durable device that provides a promising future in the field of end-stage heart failure. PMID: 19917572 [PubMed - as supplied by publisher] (Source: Perfusion)

Venous rupture during percutaneous treatment of hemodialysis fistulas and grafts

Catheterization and Cardiovascular Interventions — Sat, 14 Nov 2009 00:00:00 +0100

Conclusions: Rupture or perforation is a rare complication of treatment of malfunctioning hemodialysis grafts and fistulas. The complication may be managed with nonsurgical methods and might be avoided by optimal balloon selection and sizing. © 2009 Wiley-Liss, Inc. (Source: Catheterization and Cardiovascular Interventions)

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Cardiac surgery in a patient with retroperitoneal fibrosis and heart valvulopathy, both due to pergolide medication for Parkinson's disease

Journal of Cardiothoracic Surgery — Fri, 13 Nov 2009 00:00:00 +0100

Retroperitoneal fibrosis is best described as a chronic inflammatory process which may be idiopathic, but can rarely be brought about by medications, such as pergolide, used for treating Parkinson's disease. Pergolide can produce a fibrotic process in heart valves, resulting in valve insufficiency in up to 25 % of cases. Herein we describe the case of a 68-year-old man who received pergolide for 2 years for Parkinson's disease. The patient developed retroperitoneal fibrosis resulting in renal failure from ureteral obstruction necessitating ureteral stenting, as well as significant aortic and mitral valve insufficiency. He successfully underwent surgery for combined aortic valve, mitral valve and ascending aorta replacement because of severe valve insufficiency and dilated (d=5.8 cm) ascend...

Transcatheter closure of postsurgical residual ventricular septal defects: Early and mid-term results

Catheterization and Cardiovascular Interventions — Thu, 12 Nov 2009 00:00:00 +0100

Conclusions: Transcatheter closure of postsurgical residual VSD is safe and efficacious management option and obviates the need for further surgery and by-pass. © 2009 Wiley-Liss, Inc. (Source: Catheterization and Cardiovascular Interventions)

Survival and relapse pattern after trimodality therapy for malignant pleural mesothelioma

General Thoracic and Cardiovascular Surgery — Wed, 11 Nov 2009 19:27:04 +0100

Conclusion Trimodality therapy showed a survival benefit in patients with stage III or lower malignant pleural mesothelioma. Most of the recurrences were local. Therefore, better local control is required to improve the prognosis of the disease. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s11748-009-0440-2Authors Kenichi Okubo, Kyoto University Hospital Department of Thoracic Surgery 54 Kawahara-cho, Shogoin, Sakyo-ku Kyoto 606-8507 JapanMakoto Sonobe, Kyoto University Hospital Department of Thoracic Surgery 54 Kawahara-cho, Shogoin, Sakyo-ku Kyoto 606-8507 JapanTakuji Fujinaga, Kyoto University Hospital Department of Thoracic Surgery 54 Kawahara-cho, Shogoin, Sakyo-ku Kyoto 606-8507 JapanTsuyoshi Shoji, Kyoto University Hospital Department of Thor...

Emergency off-pump complete arterial revascularization in a patient with dextrocardia

General Thoracic and Cardiovascular Surgery — Wed, 11 Nov 2009 19:27:04 +0100

We describe complete emergency arterial coronary artery bypass grafting performed on the beating heart of a 73-year-old man with situs inversus totalis and triple-vessel disease. The right internal mammary artery was anastomosed to the left anterior descending artery in situ. The first and second obtuse marginal branches of the circumflex coronary and the posterior descending branch of the right coronary artery were sequentially revascularized using the left internal mammary and radial arteries in situ. The only abnormality was that the position of the heart mirrored that of a normal heart. Beating heart surgery appears to be as safe in patients with dextrocardia as in the general population. However, the position of the surgeon must be reconsidered for optimal handling of stabilizer...

Minimally invasive cardiac surgery for atrial fibrillation complicated by coronary artery disease: combination of video-assisted pulmonary vein isolation and minimally invasive direct coronary artery bypass

General Thoracic and Cardiovascular Surgery — Wed, 11 Nov 2009 19:27:02 +0100

Abstract Here we report a minimally invasive cardiac surgery procedure without sternotomy combining video-assisted bilateral pulmonary vein isolation and minimally invasive direct coronary artery bypass as treatment for atrial fibrillation complicated by coronary artery disease. The patient’s chest was accessed through a left anterolateral thoracotomy over the fourth intercostal space, and the left internal thoracic artery (LITA) was harvested under direct vision. The left pulmonary veins were isolated electrically by a bipolar radiofrequency clamp. Subsequently, the harvested LITA graft was anastomosed to the left anterior descending artery. Right pulmonary vein isolation was then performed through a small thoracotomy at the right fourth intercostal region in the same m...

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Impact of main bronchial lymph node involvement in pathological T1-2N1M0 non-small-cell lung cancer: multi-institutional survey by the Japan National Hospital Study Group for Lung Cancer

General Thoracic and Cardiovascular Surgery — Wed, 11 Nov 2009 19:27:01 +0100

Conclusion Involvement of the main bronchial lymph nodes is a significant factor to predict a worse prognosis in pathological T1-2N1M0 patients with NSCLC. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s11748-009-0451-zAuthors Hajime Maeda, National Hospital Organization Toneyama Hospital Department of General Thoracic Surgery 5-1-1 Toneyama Toyonaka, Osaka 560-8552 JapanShimao Fukai, National Hospital Organization Toneyama Hospital Department of General Thoracic Surgery 5-1-1 Toneyama Toyonaka, Osaka 560-8552 JapanAkihide Matsumura, National Hospital Organization Toneyama Hospital Department of General Thoracic Surgery 5-1-1 Toneyama Toyonaka, Osaka 560-8552 JapanOsamu Kawashima, National Hospital Organization Toneyama Hospital Department of General...

Beginning and development of surgery for acquired valvular heart disease in Japan

General Thoracic and Cardiovascular Surgery — Wed, 11 Nov 2009 19:27:00 +0100

Abstract The initiation and development of surgery for acquired valvular heart disease in Japan was reviewed. The first series of attempts at closed valvular surgery were performed in 1951–1952 by collaboration between the brothers Tohru and Shigeru Sakakibara in patients with pulmonary or mitral stenosis. During the popularization of closed valvular surgery, open heart surgery under direct vision was successfully performed by Shigeru Sakakibara with cooling of the body in 1954 and by using cardiopulmonary bypass (CPB) in 1956. With the development of CPB and artificial heart valves, closed valvular heart surgery was replaced by open surgery, which expanded rapidly during the 1960s and 1970s. Along with the serial introduction and improvement of mechanical vales thereaft...

Congenital tracheoesophageal fistula in an elderly patient with thoracic empyema

General Thoracic and Cardiovascular Surgery — Wed, 11 Nov 2009 19:26:59 +0100

Abstract A congenital tracheoesophageal fistula is rare in elderly patients. An adult case of congenital tracheoesophageal fistula complicated with thoracic empyema was successfully treated by surgery. A 74-year-old woman was admitted with severe coughing and fever. The patient had experienced several episodes of pneumonia since childhood. Chest radiography showed left pleural effusion; and fiberoptic bronchoscopy and chest computed tomography demonstrated a tracheoesophageal fistula communicating between the upper intrathoracic esophagus and the distal portion of the trachea. Following tube drainage of the left thoracic empyema, transection of the fistula was performed. The postoperative course was uneventful, and she is doing well at 1 year after surgery without recurren...

Stromal aminopeptidase N expression: correlation with angiogenesis in non-small-cell lung cancer

General Thoracic and Cardiovascular Surgery — Wed, 11 Nov 2009 19:26:58 +0100

Conclusion That APN expression on stromal cells was observed predominantly in squamous cell carcinoma may account for the efficacy of ubenimex in the postoperative adjuvant setting for squamous cell carcinoma. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s11748-009-0445-xAuthors Shinya Ito, Kyoto University Department of Thoracic Surgery, Graduate School of Medicine Kyoto JapanRyo Miyahara, Kyoto University Department of Thoracic Surgery, Graduate School of Medicine Kyoto JapanRei Takahashi, Kyoto University Department of Pathology and Tumor Biology, Graduate School of Medicine Kyoto JapanShinjiro Nagai, Kyoto University Department of Thoracic Surgery, Graduate School of Medicine Kyoto JapanKazumasa Takenaka, Kyoto University Department of Thoracic ...

Intractable lung abscess successfully treated with cavernostomy and free omental plombage using microvascular surgery

General Thoracic and Cardiovascular Surgery — Wed, 11 Nov 2009 19:26:56 +0100

Abstract A 68-year-old man, complaining of fever and puriform sputum, was referred to our hospital. A giant abscess was detected in the upper lobe of the right lung. Percutaneous drainage of a lung abscess was carried out. When the pus collected was cultured, Candida was 1+ and Escherichia coli was 2+. Later, it became difficult to control the abscess by drainage, and cavernostomy was selected. The contents of the abscess cavity were removed, and the cavity was opened, followed by exchange of gauze every day. For 14 months after cavernostomy, once-weekly gauze exchange was continued at the outpatient clinic to clean the abscess cavity. Finally, the abscess was filled with a free greater omentum flap, accompanied by microvascular anastomosis. In this way, the intractable lun...

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Transapical aortic cannulation via left lateral thoracotomy for descending thoracic and thoracoabdominal aortic surgery

General Thoracic and Cardiovascular Surgery — Wed, 11 Nov 2009 19:26:56 +0100

Abstract Two patients underwent surgery for a chronic type B dissection using a total cardiopulmonary bypass (CPB) with transapical arterial cannulation. At surgery, a total CPB was established by cannulating the left femoral artery and the ascending aorta via the ventricular apex. The patients were cooled to 30°C. The proximal anastomosis was done after cross-clamping the aortic arch between the left carotid artery and the left subclavian artery in both cases. In the first case, the entire descending thoracic aorta was replaced, and two pairs of intercostal arteries were reconstructed. The other patient underwent replacement of the proximal descending thoracic aorta. Neither patient experienced any complications. Transapical aortic cannulation is a useful option during d...

Abnormal fluorine-18-fluorodeoxyglucose uptake in benign esophageal leiomyoma

General Thoracic and Cardiovascular Surgery — Wed, 11 Nov 2009 19:26:55 +0100

Abstract A benign esophageal leiomyoma with abnormally increased fluorine-18-fluorodeoxyglucose uptake on positron emission tomography (PET) was resected thoracoscopically. The tumor, of which the maximum standardized uptake value of the lesion was 4.7, was well defined and 38 mm in diameter. Neither mitotic activity nor degeneration was found histologically; and immunoreactivity for CD34, CD117, MIB-1, and glucose transporter-1 was negative immunohistochemically. A diagnosis of gastrointestinal stromal tumor was ruled out by an oncogenic kinase gene mutation study. This case cautions against PET-dependent evaluation for malignant potential of esophageal submucosal tumors. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s11748-009-0457-6Authors Kentaroh Miy...

Emergent coronary artery bypass grafting for cardiogenic shock caused by very late drug-eluting stent thrombosis

General Thoracic and Cardiovascular Surgery — Wed, 11 Nov 2009 19:26:54 +0100

We describe a case of cardiogenic shock caused by a very late drug-eluting stent (DES) thrombosis. The patient underwent emergent coronary artery bypass grafting (CABG) and was discharged home 15 days after the operation. The incidence of stent restenosis had been reduced by the use of DES, but the Achilles’ heel of DES is represented by a higher rate of stent thrombosis. In our case, the DES thrombosis occurred 5 years after its implantation, underlining the importance of prolonged dual antiplatelet therapy. Even though rare, this complication may be life-threatening. We believe that CABG provides better event-free survival than percutaneous coronary intervention in patients with multivessel coronary disease despite the use of DES. Content Type Journal ArticleCategory Case Repor...

Outcomes comparison of 5 coated cardiopulmonary bypass circuits versus an uncoated control group of patients undergoing cardiac surgery.

Perfusion — Wed, 11 Nov 2009 00:00:00 +0100

CONCLUSION: We compared all 5 coated circuits approved for clinical use in Canada against an uncoated control circuit. Three of the 5 coated circuits (Trillium, Phisio and Bioline BCC) were found to improve ventilator and ICU time compared to Control. Further studies are indicated to validate these results and their impact upon approval criteria, purchasing choices and safe clinical practice, especially as applied to higher risk diabetic patients. PMID: 19906771 [PubMed - as supplied by publisher] (Source: Perfusion)

Traumatic Right Ventricular Rupture after Recent Sternotomy

Journal of Cardiac Surgery — Wed, 11 Nov 2009 00:00:00 +0100

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Posterior Root Enlargement for Aortic Valve Replacement Associated with Unexpected Anomalous Right Coronary Artery

Journal of Cardiac Surgery — Wed, 11 Nov 2009 00:00:00 +0100

We present the case of a 21-year-old man with congenital aortic stenosis and small aortic root, who had an intraoperative diagnosis of ARCA. After posterior root enlargement through the noncoronary sinus, ARCA was mobilized from the aortic root and reimplanted into the right coronary sinus. Postoperative follow-up of the patient was uneventful. (J Card Surg ****;**:**-**) (Source: Journal of Cardiac Surgery)

Hybrid Repair of a Kommerell's Diverticulum Aneurysm

Journal of Cardiac Surgery — Wed, 11 Nov 2009 00:00:00 +0100

We report the case of a 77-year-old woman with a Kommerell's diverticulum aneurysm, who underwent a successful hybrid repair, combining surgical off-pump bypass of the aortic arch vessels followed by endovascular aneurysm repair. (J Card Surg ****;**:**-**) (Source: Journal of Cardiac Surgery)

Bronchopulmonary fistula closure with an Amplatzer Multi-Fenestrated Septal Occluder

Catheterization and Cardiovascular Interventions — Tue, 10 Nov 2009 00:00:00 +0100

Bronchopulmonary fistula, a communication between the bronchial airway and the pleural space, is associated with increased morbidity and mortality often requiring surgical therapy. A successful closure of a fistula from the posterior trachea to the right apical pleural space in a 60-year-old man with a history of Barrett's esophagus, esophagectomy, multiple pulmonary infections, and right upper lobectomy using an Amplatzer Multi-Fenestrated Septal Occluder via a transbronchial approach is reported. © 2009 Wiley-Liss, Inc. (Source: Catheterization and Cardiovascular Interventions)

Coronary arteriovenous fistulas in the adults: natural history and management strategies

Journal of Cardiothoracic Surgery — Fri, 06 Nov 2009 00:00:00 +0100

Conclusion: Because of the severe complications that may develop due to coronary arteriovenous fistula, we believe that every coronary artery fistula should be treated invasively by surgery or transcatheter closure. But both treatment modalities still need to be evaluated with randomized multicenter studies for long term survival and effectiveness. (Source: Journal of Cardiothoracic Surgery)

[Severity Related Differences in Lung Attenuation in Men With COPD.]

Archivos de Bronconeumologia — Wed, 04 Nov 2009 00:00:00 +0100

CONCLUSIONS: There are differences in lung attenuation measurements by HRCT between the varying levels of COPD severity as assessed by the GOLD scale. PMID: 19896258 [PubMed - as supplied by publisher] (Source: Archivos de Bronconeumologia)

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[Pulmonary Tuberculosis Associated to Adalimumab: a Study of 3 Cases.]

Archivos de Bronconeumologia — Wed, 04 Nov 2009 00:00:00 +0100

We present the cases of 2 patients with rheumatoid arthritis and one patient with ankylopoietic spondylitis on treatment with adalimumab, who developed pulmonary and disseminated tuberculosis despite following the screening and prophylaxis measures recommended in guidelines. We also review the association between treatment with tumour necrosis factor-alpha antagonists and tuberculosis. PMID: 19896259 [PubMed - as supplied by publisher] (Source: Archivos de Bronconeumologia)

Dose dependent effect of statins on postoperative atrial fibrillation after cardiac surgery among patients treated with beta blockers

Journal of Cardiothoracic Surgery — Wed, 04 Nov 2009 00:00:00 +0100

Conclusion: Among cardiac surgery patients treated with postoperative beta blockers Statin treatment reduces the incidence of postoperative AF when used at higher dosages (Source: Journal of Cardiothoracic Surgery)

Contralateral transradial approach for carotid artery stenting: A feasibility study

Catheterization and Cardiovascular Interventions — Wed, 04 Nov 2009 00:00:00 +0100

Conclusion: CAS using the contralateral transradial approach appears to be safe and technically feasible. The technique may be particularly useful in patients with right ICA lesions because of the favorable right CCA angle with the aortic arch. © 2009 Wiley-Liss, Inc. (Source: Catheterization and Cardiovascular Interventions)

[Primary Lung Sarcoma.]

Archivos de Bronconeumologia — Tue, 03 Nov 2009 00:00:00 +0100

Authors: Domínguez-Pérez AD, Ruiz-Guerrero CI, Alcázar Iribarren-Marín M PMID: 19892455 [PubMed - as supplied by publisher] (Source: Archivos de Bronconeumologia)

[Pneumonitis Due to Hypersensitivity in Infants.]

Archivos de Bronconeumologia — Tue, 03 Nov 2009 00:00:00 +0100

Authors: Dinis MJ, Teles A, Carvalho I PMID: 19892456 [PubMed - as supplied by publisher] (Source: Archivos de Bronconeumologia)

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Serum levels of matrix metalloproteinases -1,-2,-3 and -9 in thoracic aortic diseases and acute myocardial ischemia

Journal of Cardiothoracic Surgery — Tue, 03 Nov 2009 00:00:00 +0100

Background: Matrix metalloproteinases (MMPs) constitute a family of zinc-dependent proteases (endopeptidases) whose catalytic action is the degradation of the extracellular matrix components. In addition, they play the major role in the degradation of collagen and in the process of tissue remodeling. The present clinical study investigated blood serum levels of metalloproteinases- 1, -2, -3 and -9 in patients with acute and chronic aortic dissection, thoracic aortic aneurysm and acute myocardial ischemia compared to healthy individuals. Methods: The blood serum levels of MMP-1, -2, -3 and -9 were calculated in 31 patients with acute aortic dissection, 18 patients with chronic aortic dissection, 18 patients with aortic aneurysm and in 13 patients with acute myocardial ischemia, as well as i...

Adverse event rates in congenital cardiac catheterization - A multi-center experience

Catheterization and Cardiovascular Interventions — Tue, 03 Nov 2009 00:00:00 +0100

Objectives: To describe case mix variation among institutions, and report adverse event rates in congenital cardiac catheterization by case type. Background: Reported adverse event rates for patients with congenital heart disease undergoing cardiac catheterization vary considerably, due to non-comparable standards of data inclusion, and highly variable case mix. Methods: The Congenital Cardiac Catheterization Outcomes Project (C3PO) has been capturing case characteristics and adverse events (AE) for all cardiac catheterizations performed at six pediatric institutions. Validity and completeness of data were independently audited. Results: Between 2/1/07 and 4/30/08, 3855 cases (670 biopsy, 1037 diagnostic, and 2148 interventional) were recorded, median number of cases per site 480 (308 to 1...

Index

Thoracic Surgery Clinics — Sun, 01 Nov 2009 00:00:00 +0100

(Source: Thoracic Surgery Clinics)

Reconstructive Techniques After Diaphragm Resection

Thoracic Surgery Clinics — Sun, 01 Nov 2009 00:00:00 +0100

Diaphragm resection requires complete reconstruction to avoid respiratory compromise or herniation of abdominal contents into the chest. Primary reconstruction of the diaphragm is often possible, even with a large defect, as long as the tissue can come together without excessive tension. Larger defects or complete diaphragm resections necessitate reconstruction with synthetic material or autologous tissue. These reconstructions can be accomplished safely and effectively by following specific surgical tenets, and require an in-depth knowledge of the diaphragm's anatomy, innervation, blood supply, and adjacent organs. (Source: Thoracic Surgery Clinics)

Tumors of the Diaphragm

Thoracic Surgery Clinics — Sun, 01 Nov 2009 00:00:00 +0100

Primary tumors of the diaphragm are very rare. Benign tumors of the diaphragm are resected if symptomatic or if there is concern for malignancy. Malignant tumors are either primary, metastatic, or the result of direct extension to the diaphragm from adjacent malignancy. Malignant tumors are treated based on histology and response to chemotherapy, with surgical resection performed when feasible. (Source: Thoracic Surgery Clinics)

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Diaphragmatic Eventration

Thoracic Surgery Clinics — Sun, 01 Nov 2009 00:00:00 +0100

Diaphragmatic eventration is defined as thinning of the diaphragm secondary to a congenital deficiency in diaphragmatic muscle structure. Clinically, diaphragmatic eventration can be impossible to differentiate from acquired paralysis. Diaphragmatic plication is indicated for symptomatic patients and leads to significant improvement in symptoms, quality of life, and pulmonary function tests. (Source: Thoracic Surgery Clinics)

Acquired Paralysis of the Diaphragm

Thoracic Surgery Clinics — Sun, 01 Nov 2009 00:00:00 +0100

Acquired diaphragmatic paralysis is an uncommon cause of respiratory insufficiency in adults. Symptoms of diaphragmatic paralysis range in severity from mild alterations in exercise capacity to severe, life-threatening illness. For well-selected patients, diaphragmatic plication is indicated for symptomatic relief. Plication may be performed via standard thoracotomy or by video-assisted techniques. (Source: Thoracic Surgery Clinics)

Chronic Traumatic Diaphragmatic Hernia

Thoracic Surgery Clinics — Sun, 01 Nov 2009 00:00:00 +0100

Traumatic diaphragmatic hernia encompasses a spectrum of disease ranging from acute to chronic. Chronic traumatic diaphragmatic hernia is uncommon and associated with significant morbidity and mortality. Multiplanar CT with coronal, sagittal, and axial reconstructions is most effective in making this diagnosis. Once diagnosed, repair should be undertaken. Open transthoracic repair is preferred. Basic hernia repair principles apply including the construction of a tension-free repair, which may necessitate the use of prosthetics. (Source: Thoracic Surgery Clinics)

Acute Traumatic Diaphragmatic Injury

Thoracic Surgery Clinics — Sun, 01 Nov 2009 00:00:00 +0100

Acute diaphragmatic hernia is a result of diaphragmatic injury that accompanies severe blunt or penetrating thoracoabdominal trauma. The incidence, characteristics, and diagnosis of acute diaphragmatic hernia are discussed. Acute traumatic diaphragmatic injuries are treated by surgical reduction of the herniated organs, if present, and closure of the diaphragmatic defect. The various treatment options are discussed. Outcomes of acute diaphragmatic hernia repair are largely dictated by the severity of concomitant injuries, with the Injury Severity Score being the most widely recognized predictor of mortality. (Source: Thoracic Surgery Clinics)

Paraesophageal Hernia: Clinical Presentation, Evaluation, and Management Controversies

Thoracic Surgery Clinics — Sun, 01 Nov 2009 00:00:00 +0100

Few topics within thoracic surgery are as controversial as the management of paraesophageal hernias (PEH). In this article, the types of hiatal hernia are classified and the clinical presentation and evaluation of patients with PEH are discussed. Controversies in the management of PEH including the indications for surgery, the different operative approaches, and the role of esophageal shortening are reviewed. Finally, the evidence regarding the need for fundoplication or fixation of the stomach with gastropexy or gastrostomy and the use of prosthetic material in performing the hiatal closure are examined. (Source: Thoracic Surgery Clinics)

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Congenital Diaphragmatic Hernia in the Adult

Thoracic Surgery Clinics — Sun, 01 Nov 2009 00:00:00 +0100

Congenital diaphragmatic herniae (CDH) are uncommon in neonates and extremely rare in adults. The clinical presentation of CDH in adults tends to be very different from neonates. Many adults remain asymptomatic and CDH are diagnosed incidentally. All CDH should be repaired. Minimally invasive surgical approaches are now gaining popularity for the repair of CDH with excellent outcomes. (Source: Thoracic Surgery Clinics)

Foramen of Morgagni Hernia: Presentation and Treatment

Thoracic Surgery Clinics — Sun, 01 Nov 2009 00:00:00 +0100

The article discusses the presentation and treatment of foramen of Morgagni hernia. First, it describes the embryology of the diaphragm along with the incidence of associated anomalies. This is followed by the symptoms, diagnosis, and management. Morgagni hernias are rare and most often asymptomatic; however, there is always a concern about strangulated bowel. Diagnosis is usually by chest radiograph or CT scan. The surgical approach may be either transabdominal or thoracic. Experience is increasing with minimally invasive approaches, which has a low recurrence rate and an excellent prognosis. (Source: Thoracic Surgery Clinics)

Surgical Conditions of the Diaphragm: Posterior Diaphragmatic Hernias in Infants

Thoracic Surgery Clinics — Sun, 01 Nov 2009 00:00:00 +0100

This article reviews the diagnosis and management strategies of congenital diaphragmatic hernia and the outcomes of congenital diaphragmatic hernia patients. (Source: Thoracic Surgery Clinics)

Imaging the Diaphragm

Thoracic Surgery Clinics — Sun, 01 Nov 2009 00:00:00 +0100

This article describes the normal and abnormal position, motion and morphology of the diaphragm, on chest radiography and fluoroscopy, as well as on computed tomography and magnetic resonance imaging. (Source: Thoracic Surgery Clinics)

Surgical Conditions of the Diaphragm: Anatomy and Physiology

Thoracic Surgery Clinics — Sun, 01 Nov 2009 00:00:00 +0100

This article reviews the anatomic components of the diaphragm, its pivotal role in respiration and in the gastroesophageal mechanism, and the surgical implications of the anatomic structuring. (Source: Thoracic Surgery Clinics)

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Preface

Thoracic Surgery Clinics — Sun, 01 Nov 2009 00:00:00 +0100

The integrity and function of the diaphragm is essential to life because of its role in respiration. It is similar to the heart in that the muscle of the diaphragm must contract continuously throughout life. Any breach or dysfunction of the diaphragm may be a threat to life; hence, a thorough knowledge of the anatomy, physiology, and conditions of the diaphragm are essential to the practice of thoracic surgery. Thoracic surgeons must be able to repair or reconstruct the diaphragm when its integrity is breached by congenital abnormalities, acquired hernias, trauma, tumors, or surgical incisions. In acquired conditions that diminish diaphragmatic function, thoracic surgeons may be required to surgically modify the diaphragm to improve function. Knowledge of the innervation of the diaphragm a...

Forthcoming Issues

Thoracic Surgery Clinics — Sun, 01 Nov 2009 00:00:00 +0100

(Source: Thoracic Surgery Clinics)

Thoracic Surgery Clinics — Sun, 01 Nov 2009 00:00:00 +0100

(Source: Thoracic Surgery Clinics)

Plasma amyloid beta42 and amyloid beta40 levels are associated with early cognitive dysfunction after cardiac surgery.

The Annals of Thoracic Surgery — Sun, 01 Nov 2009 00:00:00 +0100

CONCLUSIONS: Decreased preoperative plasma levels of Abeta(42) and Abeta(40) in patients who exhibit postoperative cognitive dysfunction at 3 months suggest that postoperative cognitive dysfunction at this time may share a common mechanism with mild cognitive impairment and Alzheimer's disease. This process may be exacerbated by anesthesia. PMID: 19853085 [PubMed - indexed for MEDLINE] (Source: The Annals of Thoracic Surgery)

Preclinical evaluation of a new self-expanding device for closure of muscular ventricular septal defects in a pig model

Catheterization and Cardiovascular Interventions — Sat, 31 Oct 2009 00:00:00 +0100

Aim of our study was the preclinical evaluation of a new self expanding device for interventional closure of muscular ventricular septal defects (mVSDs) in an acute pig model.Devices currently in use for closure of mVSDs still have their limitations. The deployment of the disks is dependent from the expansion of the stent, which can be associated with problems for sufficient closure of the mVSDs. This was the reason for developing a modified device with only one diskThe device was constructed in a single wire technique with a unique configured retention disk. mVSDs were created in six pigs with a specially designed punch instrument, and subsequently closed with our new device during the same session using a jugular or femoral vein approach. Potential residual shunting volumes were estimate...

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Clinical evaluation of the new BMU 40 in-Line blood analysis monitor.

Perfusion — Fri, 30 Oct 2009 00:00:00 +0100

CONCLUSION: The BMU 40 is a precise, accurate and reliable continuous in-line blood parameter measuring system that can easily be used within a standard CPB setup. However, present data suggest an in vivo calibration of the BMU 40 should be performed. PMID: 19880664 [PubMed - as supplied by publisher] (Source: Perfusion)

Clinical and angiographic outcomes with an everolimus-eluting stent in large coronary arteries: The SPIRIT III 4.0 mm registry

Catheterization and Cardiovascular Interventions — Fri, 30 Oct 2009 00:00:00 +0100

Conclusions: In large coronary arteries, the 4.0 mm EES results in low rates of LL at 8 months and adverse clinical events at 1 year. © 2009 Wiley-Liss, Inc. (Source: Catheterization and Cardiovascular Interventions)

CPB-assisted aortic valve replacement in a pregnant 27 year old with endocarditis.

Perfusion — Thu, 29 Oct 2009 00:00:00 +0100

Authors: Marcoux J, Rosin M, Mycyk T A 27-year-old, G3P2A0 female with acute Staph aureus (SA) endocarditis successfully underwent CPB-assisted aortic valve replacement with a bioprosthetic aortic valve at 22 weeks' gestation. This patient's presentation of acute endocarditis complicated by septic shock, congestive heart failure, severe aortic insufficiency, multiple septic embolic events and borderline renal failure appeared on the daunting background of chronic heavy tobacco usage, hepatitis C positivity, longterm IV drug abuse and a pregnancy into its twenty-second week. Optimal treatment strategies implemented for both mother and fetus throughout the perioperative period contributed to a successful outcome for both. PMID: 19875626 [PubMed - as supplied by publisher] (Source: Pe...

[Unilateral Painful Diaphragm Paralysis as the Only Sign of Amyotrophic Neuralgia.]

Archivos de Bronconeumologia — Wed, 28 Oct 2009 00:00:00 +0100

We present a case of a patient with amyotrophic neuralgia in which the only sign was left phrenic involvement, and we highlight the resistance of the pain to analgesics, as well as the persistence of the symptoms and diaphragm problems for over 6 months. PMID: 19879033 [PubMed - as supplied by publisher] (Source: Archivos de Bronconeumologia)

[Incidence of Bronchopulmonary Cancer in Castilla y Leon and Cantabria in the Year 2007. A Study by the Castilla y Leon and Cantabria Respiratory Diseases Society (SOCALPAR).]

Archivos de Bronconeumologia — Wed, 28 Oct 2009 00:00:00 +0100

CONCLUSIONS: The incidence rates of bronchopulmonary cancer in 2007 were significantly higher in Cantabria than those of Castilla y Leon. The 2007 rates in this community were higher than in 1997 in both males and females. PMID: 19879034 [PubMed - as supplied by publisher] (Source: Archivos de Bronconeumologia)

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[Comparative Study Between Oral Azathioprine and Intravenous Cyclophosphamide Pulses in the Treatment of Idiopathic Pulmonary Fibrosis.]

Archivos de Bronconeumologia — Wed, 28 Oct 2009 00:00:00 +0100

CONCLUSIONS: Treatment with intravenous cyclophosphamide pulses produced a significant improvement in survival. There were no significant differences in the lung function parameters or gas exchange. Neither of the cytostatics had serious side effects. PMID: 19879035 [PubMed - as supplied by publisher] (Source: Archivos de Bronconeumologia)

[Use of Indwelling Pleural Catheter in the Outpatient Management of Recurrent Malignant Pleural Effusion.]

Archivos de Bronconeumologia — Wed, 28 Oct 2009 00:00:00 +0100

CONCLUSIONS: The use of an indwelling pleural catheter is an effective palliative treatment in the outpatient management for patients suffering malignant pleural effusion. It is also a simple treatment that can be easily applied, does not require hospitalisation and can be easily managed by the patient at home, with a low rate of complications. PMID: 19879036 [PubMed - as supplied by publisher] (Source: Archivos de Bronconeumologia)

Does CO2 flushing of the empty CPB circuit decrease the number of gaseous emboli in the prime?

Perfusion — Wed, 28 Oct 2009 00:00:00 +0100

In conclusion, CO2 flushing of the empty circuit decreases the number of gaseous emboli in the prime compared with a conventional circuit that contains air before being primed with fluid. Knocking of the oxygenator releases gaseous emboli and the duration of re-circulating the circuit with prime influences the number of microemboli. PMID: 19864467 [PubMed - as supplied by publisher] (Source: Perfusion)

Unusual Manifestations of Vascular Rings

Journal of Cardiac Surgery — Wed, 28 Oct 2009 00:00:00 +0100

Vascular rings are a relatively rare entity caused by abnormal development of the fetal aortic arches. Most patients with vascular rings present in infancy or early childhood with respiratory (inspiratory) symptoms. The treatment of patients with symptomatic vascular rings is generally straight-forward, focusing on surgical division of the ring. The majority of patients are "cured" by this simple procedure. However, a small percentage of patients do not follow this typical course. The purpose of this manuscript is to review and discuss three patients who demonstrated unusual manifestations of vascular rings. Two patients required reoperation after double aortic arch repair and one had successful treatment of an aberrant right subclavian artery. (J Card Surg ****;**:**-**) (Source: Journal ...

Spontaneous bleeding of an Abrikossoff's tumor - a case report

Journal of Cardiothoracic Surgery — Wed, 28 Oct 2009 00:00:00 +0100

Abrikossoff tumors are a rare tumor entity. The complication of a hemothorax has not been described in the literature so far. A 24-year-old patient presented with repeated hemoptysis and right thoracic pain. The initial CT-scan revealed a solid tumor mass in the right lower bronchus. After further diagnostics, the patient was discharged and surgical intervention was planned. He was readmitted 4 days after discharge with a spontaneous hemothorax.After the right lower lobectomy and an uneventful course the patient recovered well. (Source: Journal of Cardiothoracic Surgery)

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Covered Cheatham-Platinum stents for serial dilatation of severe native aortic coarctation

Catheterization and Cardiovascular Interventions — Wed, 28 Oct 2009 00:00:00 +0100

No abstract. (Source: Catheterization and Cardiovascular Interventions)

Re: Bronchiolo-alveolar lung cancer: occurrence, surgical treatment and survival [Letter to the Editor]

European Journal of Cardio-Thoracic Surgery — Tue, 27 Oct 2009 22:26:05 +0100

(Source: European Journal of Cardio-Thoracic Surgery)

A fully echo-guided trans-apical aortic valve implantation [Case reports]

European Journal of Cardio-Thoracic Surgery — Tue, 27 Oct 2009 22:26:05 +0100

We report the first successful TA-AVI procedure performed solely under trans-oesophageal echocardiogram control, in the absence of contrast medium injections. (Source: European Journal of Cardio-Thoracic Surgery)

Delayed dislocation of a transapically implanted aortic bioprosthesis [Case reports]

European Journal of Cardio-Thoracic Surgery — Tue, 27 Oct 2009 22:26:05 +0100

We report the case of a delayed upward displacement of a prosthesis after this procedure. It is hypothesised that the asymmetric calcification of the native valve and the presence of a mitral prosthesis caused the dislocation. (Source: European Journal of Cardio-Thoracic Surgery)

MedWorm: Cardiovascular & Thoracic Surgery

Information for Readers

JTCVS Disclosure Statement

Table of Contents

Condensed Contents

Requirements for Maintenance of Certification

Notices

Applications for Membership

2010 Summer Intern Scholarship Applications Now Available

AATS Meetings and Sponsored Events

Aortic Symposium 2010

AATS 90th Annual Meeting

Meetings and Courses

Reply to the Editor

A new diagnostic algorithm for assessment of patients with single ventricle before a Fontan operation

Reply to the Editor

Pediatric cardiac surgery: Effect of a miniaturized bypass circuit in reducing homologous blood transfusion

Posttransplant survival is not diminished in heart transplant recipients bridged with implantable left ventricular assist devices

Discussion

A prospective, randomized, crossover pilot study of inhaled nitric oxide versus inhaled prostacyclin in heart transplant and lung transplant recipients

Discussion

Smooth muscle phenotypic modulation is an early event in aortic aneurysms

Aspirin and clopidogrel use in the early postoperative period following on-pump and off-pump coronary artery bypass grafting

Discussion

Anatomic segmentectomy for stage I non–small-cell lung cancer: Comparison of video-assisted thoracic surgery versus open approach

Discussion

Recurrence after neoadjuvant chemoradiation and surgery for esophageal cancer: Does the pattern of recurrence differ for patients with complete response and those with partial or no response?

Morphologic spectrum of truncal valvar origin relative to the ventricular septum: Correlation with the size of ventricular septal defect

2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (Updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (Updating the 2005 Guideline and 2007 Focused Update)

Feasibility of ablation as an alternative to surgical metastasectomy in patients with unresectable sarcoma pulmonary metastases [Case report - Thoracic oncologic]

Splenic tear causing a hemoperitoneum after cardiac surgery [Case report - Cardiac general]

Syncope triggered by a giant unruptured sinus of Valsalva aneurysm [Case report - Cardiac general]

Splenic injury following diaphragmatic plication: an avoidable life-threatening complication [Case report - Thoracic non-oncologic]

Peripheral venous embolized intracardiac foreign body [Case report - Cardiac general]

Spontaneous circumferential esophageal dissection in a young man with eosinophilic esophagitis [Case report - Esophagus]

Crutch-induced bilateral brachial artery aneurysms [Case report - Vascular general]

Surgical treatment of a rare case of tracheal inflammatory pseudotumor in pediatric age [Case report - Thoracic oncologic]

Concurrent benign schwannoma of oesophagus and posterior mediastinum [Case report - Thoracic oncologic]

Hamartoma of mature cardiac myocytes of the pulmonary infundibulum [Case report - Cardiac general]

Primary synovial sarcoma of the lung as an incidental finding [Case report - Thoracic oncologic]

eComment: Heparin-induced thrombocytopenia [eComment]

Heparin induced thrombocytopenia in a patient with factor V Leiden following cardiac surgery [Case report - Vascular general]

A technique of an upper V-type ministernotomy in the second intercostal space [Brief communication - Cardiac general]

eComment: Which functional tricuspid regurgitation should be surgically corrected? [eComment]

Which patient undergoing mitral valve surgery should also have the tricuspid repair? [Best evidence topic - Valves]

In patients with first-episode primary spontaneous pneumothorax is video-assisted thoracoscopic surgery superior to tube thoracostomy alone in terms of time to resolution of pneumothorax and incidence of recurrence? [Best evidence topic - Thoracic non-oncologic]

Can chronic neuropathic pain following thoracic surgery be predicted during the postoperative period? [Institutional report - Thoracic oncologic]

Early outcomes of video-assisted thoracoscopic resection of thymus in 181 patients with myasthenia gravis: who are the candidates for the next morning discharge? [Institutional report - Thoracic non-oncologic]

Long-term follow-up after minimal invasive direct coronary artery bypass grafting procedure: a multi-factorial retrospective analysis at 1000 patient-years [Institutional report - Cardiac general]

Urgent segmental resection as the primary strategy in management of benign tracheal stenosis. A single center experience in 164 consecutive cases [Institutional report - Thoracic non-oncologic]

An observational study of CoSeal(R) for the prevention of adhesions in pediatric cardiac surgery [Institutional report - Congenital]

Air-leak management after upper lobectomy in patients with fused fissure and chronic obstructive pulmonary disease: a pilot trial comparing sealant and standard treatment [Institutional report - Thoracic non-oncologic]

Effectiveness of sympathetic block by clipping in the treatment of hyperhidrosis and facial blushing [Institutional report - Thoracic non-oncologic]

The hemiclamshell approach in thoracic surgery: indications and associated morbidity in 50 patients [Institutional report - Thoracic oncologic]

Malignant pleural effusion in the presence of trapped lung. Five-year experience of PleurX tunnelled catheters [Institutional report - Thoracic oncologic]

eComment: Monitoring of atrial fibrillation burden after surgical ablation [eComment]

Monitoring of atrial fibrillation burden after surgical ablation: relevancy of end-point criteria after radiofrequency ablation treatment of patients with lone atrial fibrillation [Institutional report - Arrhythmia]

Myocyte injury along myofibers in left ventricular remodeling after myocardial infarction [Institutional report - Cardiac general]

Endovascular treatment of thoracic aortic pathology in renal transplant recipients: early and intermediate-term results [Work in progress report - Aortic and aneurysmal]

Effect of 5-azacytidine induction duration on differentiation of human first-trimester fetal mesenchymal stem cells towards cardiomyocyte-like cells [Work in progress report - Experimental]

Graft fixation with a side graft holder for sequential and composite graft anastomosis in coronary artery bypass surgery [Work in progress report - Coronary]

Influence of major pulmonary resection on postoperative daily ambulatory activity of the patients [Work in progress report - Thoracic non-oncologic]

Controlled antegrade single lung reperfusion during double lung transplant [New ideas - Pulmonary]

Lung function evaluation before surgery in lung cancer patients: how are recent advances put into practice? A survey among members of the European Society of Thoracic Surgeons (ESTS) and of the Thoracic Oncology Section of the European Respiratory Society (ERS) [Editorial - Thoracic oncologic]

Correction

Translational Research: Then and Now

Reply

The Relative Renal Safety of Iodixanol Compared With Low-Osmolar Contrast Media

European Society of Cardiology Congress 2009: Update in Interventional Cardiology

Successful Coronary Angioplasty Via the Radial Approach After Sealing a Radial Perforation

Irrelevance of the Chromosome 9p21.3 Locus for Acute Cardiovascular Events and Restenosis

No Association of Chromosome 9p21.3 Variation With Clinical and Angiographic Outcomes After Placement of Drug-Eluting Stents

Long-Term Risk of Adverse Outcomes and New Malignancies in Patients Treated With Oral Sirolimus for Prevention of Restenosis

The Efficacy of a Bilateral Approach for Treating Lesions With Chronic Total Occlusions: The CART (Controlled Antegrade and Retrograde subintimal Tracking) Registry

Evaluation of the Effect of a Concurrent Chronic Total Occlusion on Long-Term Mortality and Left Ventricular Function in Patients After Primary Percutaneous Coronary Intervention

In Search of an Algorithm to Prevent Acute Kidney Injury

Sodium Bicarbonate Plus N-Acetylcysteine Prophylaxis: A Meta-Analysis

Are Our Patients Better Off With Drug-Eluting Stents in Saphenous Vein Grafts?

Outcomes With Drug-Eluting Versus Bare-Metal Stents in Saphenous Vein Graft Intervention: Results From the STENT (Strategic Transcatheter Evaluation of New Therapies) Group

The Worry About Clopidogrel "Nonresponsiveness": Identification and Treatment in the Post-Percutaneous Coronary Intervention Patient