MedWorm: Cardiovascular & Thoracic Surgery

Giant epidermoid cyst in the sternum region

The Thoracic and Cardiovascular Surgeon — Fri, 16 May 2008 16:46:16 +0100

Thorac cardiovasc Surg 2008; 56: 243-245DOI: 10.1055/s-2007-989459© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents | Full text (Source: The Thoracic and Cardiovascular Surgeon)

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Interposition of a thymus pedicle flap for the management of mediastinitis in a patient with a tracheostomy

The Thoracic and Cardiovascular Surgeon — Fri, 16 May 2008 16:46:16 +0100

Thorac cardiovasc Surg 2008; 56: 242-243DOI: 10.1055/s-2008-1038353© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents | Full text (Source: The Thoracic and Cardiovascular Surgeon)

Surgical approach to giant thymoma: is the hemi-clamshell incision the best option?

The Thoracic and Cardiovascular Surgeon — Fri, 16 May 2008 16:46:16 +0100

Thorac cardiovasc Surg 2008; 56: 241-241DOI: 10.1055/s-2008-1038379© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents | Full text (Source: The Thoracic and Cardiovascular Surgeon)

Chest wall mass caused by salmonella enteritidis - a pitfall of pet imaging interpretation

The Thoracic and Cardiovascular Surgeon — Fri, 16 May 2008 16:46:16 +0100

Thorac cardiovasc Surg 2008; 56: 239-240DOI: 10.1055/s-2007-965376© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents | Full text (Source: The Thoracic and Cardiovascular Surgeon)

Ulnar artery as a graft for coronary artery bypass grafting

The Thoracic and Cardiovascular Surgeon — Fri, 16 May 2008 16:46:16 +0100

Thorac cardiovasc Surg 2008; 56: 236-238DOI: 10.1055/s-2007-989333© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents | Full text (Source: The Thoracic and Cardiovascular Surgeon)

Aortic-left ventricular tunnel with late incompetence after 18-year follow-up

The Thoracic and Cardiovascular Surgeon — Fri, 16 May 2008 16:46:16 +0100

Thorac cardiovasc Surg 2008; 56: 234-236DOI: 10.1055/s-2007-965175© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents | Full text (Source: The Thoracic and Cardiovascular Surgeon)

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Endovascular repair in chronic aortic transection: a report of three cases

The Thoracic and Cardiovascular Surgeon — Fri, 16 May 2008 16:46:16 +0100

Thorac cardiovasc Surg 2008; 56: 232-234DOI: 10.1055/s-2008-1038384© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents | Full text (Source: The Thoracic and Cardiovascular Surgeon)

Nonlethal penetrating cardiac injury from a hammer splinter

The Thoracic and Cardiovascular Surgeon — Fri, 16 May 2008 16:46:16 +0100

Thorac cardiovasc Surg 2008; 56: 231-232DOI: 10.1055/s-2007-989282© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents | Full text (Source: The Thoracic and Cardiovascular Surgeon)

Mediastinal lymph node dissection affects survival in patients with stage i non-small cell lung cancer

The Thoracic and Cardiovascular Surgeon — Fri, 16 May 2008 16:46:16 +0100

Thorac cardiovasc Surg 2008; 56: 226-230DOI: 10.1055/s-2007-989494Abstract The therapeutic value of mediastinal lymph node dissection (LND) for early-stage non-small cell lung cancer (NSCLC) remains controversial. We conducted a retrospective study to investigate the impact of mediastinal LND on survival in patients with stage I NSCLC. Clinical data of patients with stage I NSCLC who were treated with surgical resection during a period of ten years were reviewed. The patients were categorized into lobectomy (or pneumonectomy) combined with mediastinal LND or lymph node sampling (LNS) according to the record of their operative procedures. The Kaplan-Meier method was used for survival analysis. Cox proportional hazards model was used for multivariate analysis. Of the 319 patients who were included in the study, 139 patients received mediastinal LND, while 180 underwent LNS. There was a significant difference in overall survival (OS) between the group with LND and the group with LNS (5-year survival rate: 76.4 % vs. 65.9 %, = 0.015 by log rank test). Multivariate analysis showed that lymph node dissection (RR = 0.548, 95 %CI: 0.350 - 0.858, = 0.009), together with the stage, significantly influenced overall survival. Lobectomy combined with mediastinal LND can improve survival in patients with stage I NSCLC. It should be performed in all patients with clinical stage I NSCLC.[...]© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents | Abstract | Full text (Source: The Thoracic and Cardiovascular Surgeon)

Completion pneumonectomy for bronchiectasis: morbidity, mortality and management

The Thoracic and Cardiovascular Surgeon — Fri, 16 May 2008 16:46:16 +0100

Thorac cardiovasc Surg 2008; 56: 221-225DOI: 10.1055/s-2008-1038349Abstract Completion pneumonectomy performed for benign causes is associated with a high morbidity and mortality. We analyzed the patients who underwent completion pneumonectomy procedure for bronchiectasis, which constitutes a specific benign condition, together with the indications for surgery, the difficulties encountered during operations and the postoperative results. Records of all patients who underwent completion pneumonectomy for the diagnosis of brochiectasis between January 1991 and April 2006 at the thoracic surgery clinic of a training and research hospital specializing in chest diseases and chest surgery were retrospectively evaluated. The age and the gender of the patients, etiologic factors, symptoms, characteristics of the first operation, the time between the first operation and completion pneumonectomy, and postoperative follow-up are examined. During the evaluation period of more than 15 years, 23 patients underwent completion pneumonectomy. The median age of these 23 patients was 28 (range: 9 - 53); 17 of the patients were male and 6 were female. The most common indication for surgery was recurrent lung infections (n = 15). The most common symptoms were cough (n = 21), expectoration (n = 19), and hemoptysis (n = 15). The mean time between the first operation and the completion pneumonectomy was 4.9 years (range: 5 months - 11 years). Left completion pneumonectomy was performed in 14 and right completion pneumonectomy was performed in 9 cases. The mean duration of hospital stay was 16.7 days (range: 12 - 42 days). The course after surgery was uneventful in all patients. The mortality rate was 0 % and morbidity was 43.5 %. Although completion pneumonectomy for benign causes is a high risk procedure, it can be performed in selected patients with an acceptable morbidity and mortality after an effective preoperative medical therapy for inflammation of the lungs and with careful dissection at the operation.[...]© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents | Abstract | Full text (Source: The Thoracic and Cardiovascular Surgeon)

Staple line covering procedure after thoracoscopic bullectomy for the management of primary spontaneous pneumothorax

The Thoracic and Cardiovascular Surgeon — Fri, 16 May 2008 16:46:16 +0100

Thorac cardiovasc Surg 2008; 56: 217-220DOI: 10.1055/s-2007-989366Abstract Thoracoscopic bullectomy together with a pleural adhesive procedure is generally accepted as the standard for the definitive treatment of primary spontaneous pneumothorax (PSP). The purpose of this study was to evaluate whether the results of a thoracoscopic bullectomy followed by coverage of the staple line with cellulose mesh and fibrin glue could be comparable with those of adhesive procedures described in the literature. Between May 2000 and February 2003, we performed 227 thoracoscopic surgeries on 219 patients with PSP using a single technique. After the bullectomy, the staple line was covered with cellulose mesh and fibrin glue. The postoperative status was evaluated with a mean follow-up of 46 months. The mean patient age was 24.3 years and 90.9 % of the 219 patients were male. Recurrent pneumothorax (37.4 %) was the most common operative indication, followed by persistent air leakage of more than 5 days (28.2 %). The mean duration of postoperative chest tube drainage was 1.6 days and the mean postoperative hospital stay was 3.8 days. Six patients experienced surgical complications (2.2 %); there was air leakage of more than 3 days in two cases, a small apical dead space in one case, a fever-associated wound problem in one case, and a reoperation due to air leakage of more than 7 days in two cases. Eleven patients (4.8 %) suffered a recurrence of pneumothorax during the follow-up period. Of these, nine cases required readmission and three (1.3 %) of these cases required a reoperation. Given the nature of a meticulous thoracoscopic bullectomy followed by coverage with cellulose mesh and fibrin glue, good surgical results can be expected without the need for a pleural adhesive procedure.[...]© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents | Abstract | Full text (Source: The Thoracic and Cardiovascular Surgeon)

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Surgical outcome of inflammatory pseudotumor in the lung

The Thoracic and Cardiovascular Surgeon — Fri, 16 May 2008 16:46:16 +0100

Thorac cardiovasc Surg 2008; 56: 214-216DOI: 10.1055/s-2007-989340Abstract Pulmonary inflammatory pseudotumors are rare, and little is known about their clinical behavior and surgical outcome. Between 1993 and 2003, 19 patients with inflammatory pseudotumor were managed in our hospital. We retrospectively reviewed the clinical and radiographic features, as well as the surgical outcomes. Of the 19 patients (15 men, 4 women; mean age 53.9 years), 6 underwent lobectomy, 11 had wedge resections, and 2 had biopsy alone. There was no recurrence of the lesion in the 17 patients who underwent resection or lobectomy of the pseudotumor. There was no disease progression in the 2 patients who had only had a biopsy. Inflammatory pseudotumor of the lung is relatively benign. Complete resection leads to an excellent outcome.[...]© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents | Abstract | Full text (Source: The Thoracic and Cardiovascular Surgeon)

Thoracic endoscopic surgery for hyperhidrosis: comparison of different techniques

The Thoracic and Cardiovascular Surgeon — Fri, 16 May 2008 16:46:16 +0100

Thorac cardiovasc Surg 2008; 56: 210-213DOI: 10.1055/s-2007-989327Abstract Hyperhidrosis is pathological perspiration in palmar, plantar or axillary surfaces. Video-assisted thoracic surgery (VATS) is currently the most commonly used therapy for hyperhidrosis. Blockage of sympathetic ganglia is achieved by segmental resection, transection and/or cauterization, and clipping of the chain. We aimed to compare the efficacy of these methods with respect to patient satisfaction, recurrence of symptoms and complications. Eighty male patients with a mean age of 22.02 ± 2.61 years undergoing bilateral thoracoscopic sympathectomy or sympathetic blockage to treat primary hyperhidrosis were included in this randomized study. The patients were divided into four groups depending on the technique used for sympathetic blockage; techniques included resection (n = 20), transection (n = 20), ablation (n = 20), and clipping (n = 20). The primary success rate for isolated palmar hyperhidrosis was 96.3 %; for palmar and axillary hydrosis it was 95.7 % and for palmar and face/scalp hyperhidrosis it was 66.7 %. No recurrence was observed. The overall success rate of the operation was 95 % and the differences between the four groups were not statistically significant. In the clipping group, the duration of the surgical procedure was significantly shorter than in the other groups. Complication rates were similar among the groups. The postoperative chest roentgenogram revealed pneumothorax in nine patients, but none of them required intervention. Thoracic endoscopic sympathetic blockage yields similar results irrespective of the surgical technique adopted.[...]© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents | Abstract | Full text (Source: The Thoracic and Cardiovascular Surgeon)

Ten years after the initiation of congenital heart surgery in guatemala: observations after a one year fellowship in the pediatric cardiac unit in a low income country

The Thoracic and Cardiovascular Surgeon — Fri, 16 May 2008 16:46:16 +0100

Thorac cardiovasc Surg 2008; 56: 205-209DOI: 10.1055/s-2008-1038350AbstractHigh-tech medicine in a low income country remains a controversial issue. In September 1997, a congenital heart surgery program was initiated in Guatemala by Aldo Castañeda, emeritus Harvard Professor of Surgery and surgeon-in-chief at the Children's Hospital Boston. He trained 3 young pediatric cardiac surgeons and in addition assembled a team of pediatric cardiologists, intensivists, anesthesiologists, nurses and the necessary technical staff to develop a pediatric cardiac program in Guatemala. Faced with limited governmental financial support, he set up the Aldo Castañeda Foundation to ensure sustainability of the program. Now, 10 years after the initiation of this program, the pediatric cardiovascular unit (UNICARP) offers diagnosis as well as medical and surgical therapy to children born with a congenital heart malformation in Guatemala and neighboring countries. In addition, UNICARP offers training opportunities for young surgeons from abroad. The experience of one such trainee from Switzerland is highlighted in this report.[...]© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents | Abstract | Full text (Source: The Thoracic and Cardiovascular Surgeon)

Management of poststernotomy mediastinitis: experience and results of different therapy modalities

The Thoracic and Cardiovascular Surgeon — Fri, 16 May 2008 16:46:16 +0100

Thorac cardiovasc Surg 2008; 56: 200-204DOI: 10.1055/s-2008-1038386Abstract Different primary treatment modalities have been utilized to treat poststernotomy mediastinitis (PM) following cardiac surgery. A literature survey using the key phrases “treatment of deep sternal wound infection” and “poststernotomy-mediastinitis” was performed. Furthermore, a questionnaire regarding the primary treatment of PM was distributed to all 79 German heart surgery centers. The review of the literature shows that the current understanding is based purely on retrospective studies, not on evidence-based medicine. All 79 German heart centers replied to the questionnaire. Vacuum-assisted closure therapy (V. A. C.®) is used in 28/79 (35 %) heart centers as the “first-line” treatment, 22/79 (28 %) perform primary reclosure in conjunction with a double-tube irrigation/suction system, and in 29/79 (37 %) German heart centers both treatment options were used according to the intraoperative conditions. As a primary treatment for PM two treatment modalities are currently in use: primary reclosure coupled with a double-tube suction/irrigation system versus V. A. C.® therapy. Since prospective randomized studies have not yet been performed, controlled clinical trials comparing both treatment modalities are pivotal to define the evidence for patients presenting with PM.[...]© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents | Abstract | Full text (Source: The Thoracic and Cardiovascular Surgeon)

Carbomedics mitroflow pericardial aortic bioprosthesis - performance in patients aged 60 years and older after 15 years

The Thoracic and Cardiovascular Surgeon — Fri, 16 May 2008 16:46:16 +0100

Thorac cardiovasc Surg 2008; 56: 195-199DOI: 10.1055/s-2008-1038385Abstract The purpose of this study was to carry out a current assessment of the Mitroflow pericardial bioprosthesis (model 11) according to the durability of the prosthesis after 15 years in patients aged 60 years or older. This bioprosthesis was implanted in 161 patients (mean age 69.5 ± 6.3 years; range 60 - 94 years) undergoing aortic valve replacement (AVR) between 1982 and 1992. There were 84 patients aged 60 - 69 years (mean 64.5 ± 3.1years) and 77 patients aged 70 years or older (mean 74.8 ± 4.3 years). Of the total population, concomitant procedures were performed in 63 patients (39.1 %); of these, coronary artery bypass grafting was performed in 39 (24.2 %). Early mortality was 4.8 % (4 patients) in the 60 - 69 year age group and 10.4 % (8) in patients aged 70 years or older ( = 0.290). Late mortality was 4.5 %/patient-year (35) for those aged 60 - 69 years and 8.1 %/patient-year (49) for those aged 70 years or older ( = 0.007). Patient survival at 15 years of patients aged 60 - 69 years was 47.6 ± 6.3 % and of patients aged 70 years or older was 20.9 ± 5.4 % ( = 0.003) (). Freedom from valve-related mortality for patients in the 60 - 69 year age group was 92.1 ± 3.5 % at 15 years (0.6 %/patient-year [5]), and in the patient group aged 70 years or older it was 84.4 ± 5.3 % (1.3 %/patient-year [8]; = 0.194). Freedom from reoperation for patients in the 60 - 69 year age group was 73.9 ± 5.0 % (2.6 %/patient-year [20]), and for patients aged 70 years or older it was 91.4 ± 3.4 % (1.0 %/patient-year [6]; = 0.029). The structural valve deterioration (SVD) rate for patients in the 60 - 69 year age group was 2.4 %/patient-year (19), and for patients aged 70 years or older it was 1.0 %/patient-year (6) ( = 0.041). Actuarial freedom from structural valve deterioration at 15 years for patients aged 60 - 69 years was 62.0 ± 7.3 %, and 80.8 ± 7.9 % for patients aged 70 years and older ( = 0.049) (actual freedom 73.9 ± 5.2 % and 91.4 ± 3.4 %, respectively). The Mitroflow pericardial bioprosthesis can still be recommended for aortic valve replacement in patients 70 years and older.[...]© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents | Abstract | Full text (Source: The Thoracic and Cardiovascular Surgeon)

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Current activity guidelines for cabg patients are too restrictive: comparison of the forces exerted on the median sternotomy during a cough vs. lifting activities combined with valsalva maneuver

The Thoracic and Cardiovascular Surgeon — Fri, 16 May 2008 16:46:16 +0100

Thorac cardiovasc Surg 2008; 56: 190-194DOI: 10.1055/s-2008-1038470Abstract The current activity guidelines for coronary artery bypass graft surgery (CABG) patients are overly restrictive, hindering recovery. As the sternotomy repair must withstand repeated coughs during convalescence, this provides a benchmark for the force tending to separate the incision that can be tolerated. Nine volunteers performed 5 weightlifting activities (lifting 5 lbs [2.3 kg], lifting a 25-lb simulated grandchild [11.4 kg], lifting a 30-lb suitcase [13.6 kg], lifting two 20-lb weights [18.2 kg], and lifting a gallon of milk to a counter [3.7 kg]), plus coughing. Valsalva forces were detected using a mouthpiece configured with an Ashcroft Inc. expiratory pressure gauge (model N10-120CMW). Three measurements were taken for each activity to calculate the mean internal forces while external forces on the sternotomy were calculated using vector algebra. Total force exerted on the sternotomy by the cough was compared to the total force exerted by each of the 5 activities using paired -tests. The cough exerted a significantly greater force across the median sternotomy (mean 27.5 kg-mass) than any of the five weightlifting activities ( < 0.05). The greatest difference was observed was for lifting a 5-lb weight (22.5 kg-mass), and the smallest for lifting two 20-lb weights (4.4 kg-mass). Lifting even 40 lbs puts less force on the median sternotomy incision than a cough. The strength of the repair is significantly greater than is implied by the recommendation to “not lift more than 5 lbs”.[...]© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents | Abstract | Full text (Source: The Thoracic and Cardiovascular Surgeon)

Ablation surgery failure after combined permanent atrial fibrillation ablation and mitral valve surgery.

The Thoracic and Cardiovascular Surgeon — Fri, 16 May 2008 16:02:59 +0100

Ablation Surgery Failure after Combined Permanent Atrial Fibrillation Ablation and Mitral Valve Surgery.

Thorac Cardiovasc Surg. 2008 Jun;56(4):185-189

Authors: Geidel S, Lass M, Jensen F, Hassan K, Boczor S, Kuck KH, Ostermeyer J, Schneider C

OBJECTIVE: The aim of this study was to evaluate the early and late results of a permanent atrial fibrillation (pAF) ablation concept carried out concomitantly with mitral valve (MV) surgery and to identify risk factors for ablation surgery failure. METHODS: Between February 2001 and April 2006, 109 patients with pAF over a median time of 48 months (Perc25/75; range 6 - 396 months) underwent monopolar endocardial radiofrequency ablation procedures concomitantly with MV surgery. All patients were restudied to assess survival, conversion rate to stable sinus rhythm (SR) and New York Heart Association (NYHA) class early (3 +/- 1 months) and late after surgery (36 +/- 19 months). For data assessment an explorative data analysis including univariate and multivariate binary logistic regression was performed. RESULTS: Early and late survival was 95 % and 91 %, respectively; at follow-up stable SR was documented in 76 % (74 %) of patients. NYHA class improved significantly after surgery ( P = 0.009), particularly when stable SR was achieved ( P = 0.042). Among these MV patients left atrial (LA) enlargement and pAF of long-time duration prior to surgery were detected as risk factors for postoperative recurrence and persistence of atrial fibrillation ( P = 0.026 and P = 0.002); furthermore, advanced age and significant tricuspidal regurgitation at the time of surgery were also relevant. The best prediction (95 % of patients) for SR, as demonstrated in a multivariate model, was based on the factors LA size and pAF duration ( P = 0.052 and 0.005). CONCLUSION: Particularly the preoperative LA size and pAF duration seem to be useful parameters to evaluate the success rate of ablation performed concomitantly with MV surgery. It could be demonstrated that an established SR remains stable over time.

PMID: 18481234 [PubMed - as supplied by publisher]

(Source: The Thoracic and Cardiovascular Surgeon)

Current activity guidelines for cabg patients are too restrictive: comparison of the forces exerted on the median sternotomy during a cough vs. lifting activities combined with valsalva maneuver.

The Thoracic and Cardiovascular Surgeon — Fri, 16 May 2008 16:02:54 +0100

Current Activity Guidelines for CABG Patients are too Restrictive: Comparison of the Forces Exerted on the Median Sternotomy during a Cough vs. Lifting Activities Combined with Valsalva Maneuver.

Thorac Cardiovasc Surg. 2008 Jun;56(4):190-4

Authors: Parker R, Adams JL, Ogola G, McBrayer D, Hubbard JM, McCullough TL, Hartman JM, Cleveland T

BACKGROUND: The current activity guidelines for coronary artery bypass graft surgery (CABG) patients are overly restrictive, hindering recovery. As the sternotomy repair must withstand repeated coughs during convalescence, this provides a benchmark for the force tending to separate the incision that can be tolerated. METHODS: Nine volunteers performed 5 weightlifting activities (lifting 5 lbs [2.3 kg], lifting a 25-lb simulated grandchild [11.4 kg], lifting a 30-lb suitcase [13.6 kg], lifting two 20-lb weights [18.2 kg], and lifting a gallon of milk to a counter [3.7 kg]), plus coughing. Valsalva forces were detected using a mouthpiece configured with an Ashcroft Inc. expiratory pressure gauge (model N10-120CMW). Three measurements were taken for each activity to calculate the mean internal forces while external forces on the sternotomy were calculated using vector algebra. Total force exerted on the sternotomy by the cough was compared to the total force exerted by each of the 5 activities using paired T-tests. RESULTS: The cough exerted a significantly greater force across the median sternotomy (mean 27.5 kg-mass) than any of the five weightlifting activities ( P < 0.05). The greatest difference was observed was for lifting a 5-lb weight (22.5 kg-mass), and the smallest for lifting two 20-lb weights (4.4 kg-mass). CONCLUSION: Lifting even 40 lbs puts less force on the median sternotomy incision than a cough. The strength of the repair is significantly greater than is implied by the recommendation to "not lift more than 5 lbs".

PMID: 18481235 [PubMed - in process]

(Source: The Thoracic and Cardiovascular Surgeon)

Carbomedics mitroflow pericardial aortic bioprosthesis - performance in patients aged 60 years and older after 15 years.

The Thoracic and Cardiovascular Surgeon — Fri, 16 May 2008 16:02:48 +0100

CarboMedics Mitroflow Pericardial Aortic Bioprosthesis - Performance in Patients Aged 60 Years and Older after 15 Years.

Thorac Cardiovasc Surg. 2008 Jun;56(4):195-9

Authors: Benhameid O, Jamieson WR, Castella M, Carrier M, Pomar JL, Germann E, Pellerin M, Brownlee RT

BACKGROUND: The purpose of this study was to carry out a current assessment of the Mitroflow pericardial bioprosthesis (model 11) according to the durability of the prosthesis after 15 years in patients aged 60 years or older. METHODS: This bioprosthesis was implanted in 161 patients (mean age 69.5 +/- 6.3 years; range 60 - 94 years) undergoing aortic valve replacement (AVR) between 1982 and 1992. There were 84 patients aged 60 - 69 years (mean 64.5 +/- 3.1years) and 77 patients aged 70 years or older (mean 74.8 +/- 4.3 years). Of the total population, concomitant procedures were performed in 63 patients (39.1 %); of these, coronary artery bypass grafting was performed in 39 (24.2 %). RESULTS: Early mortality was 4.8 % (4 patients) in the 60 - 69 year age group and 10.4 % (8) in patients aged 70 years or older ( P = 0.290). Late mortality was 4.5 %/patient-year (35) for those aged 60 - 69 years and 8.1 %/patient-year (49) for those aged 70 years or older ( P = 0.007). Patient survival at 15 years of patients aged 60 - 69 years was 47.6 +/- 6.3 % and of patients aged 70 years or older was 20.9 +/- 5.4 % ( P = 0.003) ( ). Freedom from valve-related mortality for patients in the 60 - 69 year age group was 92.1 +/- 3.5 % at 15 years (0.6 %/patient-year [5]), and in the patient group aged 70 years or older it was 84.4 +/- 5.3 % (1.3 %/patient-year [8]; P = 0.194). Freedom from reoperation for patients in the 60 - 69 year age group was 73.9 +/- 5.0 % (2.6 %/patient-year [20]), and for patients aged 70 years or older it was 91.4 +/- 3.4 % (1.0 %/patient-year [6]; P = 0.029). The structural valve deterioration (SVD) rate for patients in the 60 - 69 year age group was 2.4 %/patient-year (19), and for patients aged 70 years or older it was 1.0 %/patient-year (6) ( P = 0.041). Actuarial freedom from structural valve deterioration at 15 years for patients aged 60 - 69 years was 62.0 +/- 7.3 %, and 80.8 +/- 7.9 % for patients aged 70 years and older ( P = 0.049) (actual freedom 73.9 +/- 5.2 % and 91.4 +/- 3.4 %, respectively). CONCLUSIONS: The Mitroflow pericardial bioprosthesis can still be recommended for aortic valve replacement in patients 70 years and older.

PMID: 18481236 [PubMed - in process]

(Source: The Thoracic and Cardiovascular Surgeon)

Management of poststernotomy mediastinitis: experience and results of different therapy modalities.

The Thoracic and Cardiovascular Surgeon — Fri, 16 May 2008 16:02:45 +0100

Management of poststernotomy mediastinitis: experience and results of different therapy modalities.

Thorac Cardiovasc Surg. 2008 Jun;56(4):200-4

Authors: Schimmer C, Sommer SP, Bensch M, Elert O, Leyh R

BACKGROUND: Different primary treatment modalities have been utilized to treat poststernotomy mediastinitis (PM) following cardiac surgery. METHODS: A literature survey using the key phrases "treatment of deep sternal wound infection" and "poststernotomy-mediastinitis" was performed. Furthermore, a questionnaire regarding the primary treatment of PM was distributed to all 79 German heart surgery centers. RESULTS: The review of the literature shows that the current understanding is based purely on retrospective studies, not on evidence-based medicine. All 79 German heart centers replied to the questionnaire. Vacuum-assisted closure therapy (V. A. C.(R)) is used in 28/79 (35 %) heart centers as the "first-line" treatment, 22/79 (28 %) perform primary reclosure in conjunction with a double-tube irrigation/suction system, and in 29/79 (37 %) German heart centers both treatment options were used according to the intraoperative conditions. CONCLUSIONS: As a primary treatment for PM two treatment modalities are currently in use: primary reclosure coupled with a double-tube suction/irrigation system versus V. A. C.(R) therapy. Since prospective randomized studies have not yet been performed, controlled clinical trials comparing both treatment modalities are pivotal to define the evidence for patients presenting with PM.

PMID: 18481237 [PubMed - in process]

(Source: The Thoracic and Cardiovascular Surgeon)

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Ten years after the initiation of congenital heart surgery in guatemala: observations after a one year fellowship in the pediatric cardiac unit in a low income country.

The Thoracic and Cardiovascular Surgeon — Fri, 16 May 2008 16:02:40 +0100

Ten years after the initiation of congenital heart surgery in guatemala: observations after a one year fellowship in the pediatric cardiac unit in a low income country.

Thorac Cardiovasc Surg. 2008 Jun;56(4):205-9

Authors: Wattenwyl R

High-tech medicine in a low income country remains a controversial issue. In September 1997, a congenital heart surgery program was initiated in Guatemala by Aldo Castañeda, emeritus Harvard Professor of Surgery and surgeon-in-chief at the Children's Hospital Boston. He trained 3 young pediatric cardiac surgeons and in addition assembled a team of pediatric cardiologists, intensivists, anesthesiologists, nurses and the necessary technical staff to develop a pediatric cardiac program in Guatemala. Faced with limited governmental financial support, he set up the Aldo Castañeda Foundation to ensure sustainability of the program. Now, 10 years after the initiation of this program, the pediatric cardiovascular unit (UNICARP) offers diagnosis as well as medical and surgical therapy to children born with a congenital heart malformation in Guatemala and neighboring countries. In addition, UNICARP offers training opportunities for young surgeons from abroad. The experience of one such trainee from Switzerland is highlighted in this report.

PMID: 18481238 [PubMed - in process]

(Source: The Thoracic and Cardiovascular Surgeon)

Thoracic endoscopic surgery for hyperhidrosis: comparison of different techniques.

The Thoracic and Cardiovascular Surgeon — Fri, 16 May 2008 16:02:37 +0100

Thoracic Endoscopic Surgery for Hyperhidrosis: Comparison of Different Techniques.

Thorac Cardiovasc Surg. 2008 Jun;56(4):210-213

Authors: Inan K, Goksel OS, Uçak A, Temizkan V, Karaca K, Ugur M, Arslan G, Us M, Yılmaz AT

BACKGROUND: Hyperhidrosis is pathological perspiration in palmar, plantar or axillary surfaces. Video-assisted thoracic surgery (VATS) is currently the most commonly used therapy for hyperhidrosis. Blockage of sympathetic ganglia is achieved by segmental resection, transection and/or cauterization, and clipping of the chain. We aimed to compare the efficacy of these methods with respect to patient satisfaction, recurrence of symptoms and complications. METHODS: Eighty male patients with a mean age of 22.02 +/- 2.61 years undergoing bilateral thoracoscopic sympathectomy or sympathetic blockage to treat primary hyperhidrosis were included in this randomized study. The patients were divided into four groups depending on the technique used for sympathetic blockage; techniques included resection (n = 20), transection (n = 20), ablation (n = 20), and clipping (n = 20). RESULTS: The primary success rate for isolated palmar hyperhidrosis was 96.3 %; for palmar and axillary hydrosis it was 95.7 % and for palmar and face/scalp hyperhidrosis it was 66.7 %. No recurrence was observed. The overall success rate of the operation was 95 % and the differences between the four groups were not statistically significant. In the clipping group, the duration of the surgical procedure was significantly shorter than in the other groups. Complication rates were similar among the groups. The postoperative chest roentgenogram revealed pneumothorax in nine patients, but none of them required intervention. CONCLUSION: Thoracic endoscopic sympathetic blockage yields similar results irrespective of the surgical technique adopted.

PMID: 18481239 [PubMed - as supplied by publisher]

(Source: The Thoracic and Cardiovascular Surgeon)

Surgical outcome of inflammatory pseudotumor in the lung.

The Thoracic and Cardiovascular Surgeon — Fri, 16 May 2008 16:02:34 +0100

Surgical outcome of inflammatory pseudotumor in the lung.

Thorac Cardiovasc Surg. 2008 Jun;56(4):214-6

Authors: Chen CH, Huang WC, Liu HC, Chen CH, Chen TY

BACKGROUND: Pulmonary inflammatory pseudotumors are rare, and little is known about their clinical behavior and surgical outcome. MATERIALS AND METHODS: Between 1993 and 2003, 19 patients with inflammatory pseudotumor were managed in our hospital. We retrospectively reviewed the clinical and radiographic features, as well as the surgical outcomes. RESULTS: Of the 19 patients (15 men, 4 women; mean age 53.9 years), 6 underwent lobectomy, 11 had wedge resections, and 2 had biopsy alone. There was no recurrence of the lesion in the 17 patients who underwent resection or lobectomy of the pseudotumor. There was no disease progression in the 2 patients who had only had a biopsy. CONCLUSION: Inflammatory pseudotumor of the lung is relatively benign. Complete resection leads to an excellent outcome.

PMID: 18481240 [PubMed - in process]

(Source: The Thoracic and Cardiovascular Surgeon)

Staple line covering procedure after thoracoscopic bullectomy for the management of primary spontaneous pneumothorax.

The Thoracic and Cardiovascular Surgeon — Fri, 16 May 2008 16:02:29 +0100

Staple line covering procedure after thoracoscopic bullectomy for the management of primary spontaneous pneumothorax.

Thorac Cardiovasc Surg. 2008 Jun;56(4):217-20

Authors: Cho S, Huh DM, Kim BH, Lee S, Kwon OC, Ahn WS, Jheon S

BACKGROUND: Thoracoscopic bullectomy together with a pleural adhesive procedure is generally accepted as the standard for the definitive treatment of primary spontaneous pneumothorax (PSP). The purpose of this study was to evaluate whether the results of a thoracoscopic bullectomy followed by coverage of the staple line with cellulose mesh and fibrin glue could be comparable with those of adhesive procedures described in the literature. METHODS: Between May 2000 and February 2003, we performed 227 thoracoscopic surgeries on 219 patients with PSP using a single technique. After the bullectomy, the staple line was covered with cellulose mesh and fibrin glue. The postoperative status was evaluated with a mean follow-up of 46 months. RESULTS: The mean patient age was 24.3 years and 90.9 % of the 219 patients were male. Recurrent pneumothorax (37.4 %) was the most common operative indication, followed by persistent air leakage of more than 5 days (28.2 %). The mean duration of postoperative chest tube drainage was 1.6 days and the mean postoperative hospital stay was 3.8 days. Six patients experienced surgical complications (2.2 %); there was air leakage of more than 3 days in two cases, a small apical dead space in one case, a fever-associated wound problem in one case, and a reoperation due to air leakage of more than 7 days in two cases. Eleven patients (4.8 %) suffered a recurrence of pneumothorax during the follow-up period. Of these, nine cases required readmission and three (1.3 %) of these cases required a reoperation. CONCLUSIONS: Given the nature of a meticulous thoracoscopic bullectomy followed by coverage with cellulose mesh and fibrin glue, good surgical results can be expected without the need for a pleural adhesive procedure.

PMID: 18481241 [PubMed - in process]

(Source: The Thoracic and Cardiovascular Surgeon)

Completion pneumonectomy for bronchiectasis: morbidity, mortality and management.

The Thoracic and Cardiovascular Surgeon — Fri, 16 May 2008 16:02:27 +0100

Completion pneumonectomy for bronchiectasis: morbidity, mortality and management.

Thorac Cardiovasc Surg. 2008 Jun;56(4):221-5

Authors: Sirmali M, Karasu S, Gezer S, Türüt H, Findik G, Oz G, Aydogdu K, Kaya S, Tastepe AI, Karaoglanoglu N

BACKGROUND: Completion pneumonectomy performed for benign causes is associated with a high morbidity and mortality. We analyzed the patients who underwent completion pneumonectomy procedure for bronchiectasis, which constitutes a specific benign condition, together with the indications for surgery, the difficulties encountered during operations and the postoperative results. METHODS: Records of all patients who underwent completion pneumonectomy for the diagnosis of brochiectasis between January 1991 and April 2006 at the thoracic surgery clinic of a training and research hospital specializing in chest diseases and chest surgery were retrospectively evaluated. The age and the gender of the patients, etiologic factors, symptoms, characteristics of the first operation, the time between the first operation and completion pneumonectomy, and postoperative follow-up are examined. RESULTS: During the evaluation period of more than 15 years, 23 patients underwent completion pneumonectomy. The median age of these 23 patients was 28 (range: 9 - 53); 17 of the patients were male and 6 were female. The most common indication for surgery was recurrent lung infections (n = 15). The most common symptoms were cough (n = 21), expectoration (n = 19), and hemoptysis (n = 15). The mean time between the first operation and the completion pneumonectomy was 4.9 years (range: 5 months - 11 years). Left completion pneumonectomy was performed in 14 and right completion pneumonectomy was performed in 9 cases. The mean duration of hospital stay was 16.7 days (range: 12 - 42 days). The course after surgery was uneventful in all patients. The mortality rate was 0 % and morbidity was 43.5 %. CONCLUSION: Although completion pneumonectomy for benign causes is a high risk procedure, it can be performed in selected patients with an acceptable morbidity and mortality after an effective preoperative medical therapy for inflammation of the lungs and with careful dissection at the operation.

PMID: 18481242 [PubMed - in process]

(Source: The Thoracic and Cardiovascular Surgeon)

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Mediastinal lymph node dissection affects survival in patients with stage i non-small cell lung cancer.

The Thoracic and Cardiovascular Surgeon — Fri, 16 May 2008 16:02:24 +0100

Mediastinal lymph node dissection affects survival in patients with stage I non-small cell lung cancer.

Thorac Cardiovasc Surg. 2008 Jun;56(4):226-30

Authors: Su X, Wang X, Long H, Fu J, Lin P, Zhang L, Wang S, Rong T

BACKGROUND: The therapeutic value of mediastinal lymph node dissection (LND) for early-stage non-small cell lung cancer (NSCLC) remains controversial. We conducted a retrospective study to investigate the impact of mediastinal LND on survival in patients with stage I NSCLC. METHODS: Clinical data of patients with stage I NSCLC who were treated with surgical resection during a period of ten years were reviewed. The patients were categorized into lobectomy (or pneumonectomy) combined with mediastinal LND or lymph node sampling (LNS) according to the record of their operative procedures. The Kaplan-Meier method was used for survival analysis. Cox proportional hazards model was used for multivariate analysis. RESULTS: Of the 319 patients who were included in the study, 139 patients received mediastinal LND, while 180 underwent LNS. There was a significant difference in overall survival (OS) between the group with LND and the group with LNS (5-year survival rate: 76.4 % vs. 65.9 %, P = 0.015 by log rank test). Multivariate analysis showed that lymph node dissection (RR = 0.548, 95 %CI: 0.350 - 0.858, P = 0.009), together with the stage, significantly influenced overall survival. CONCLUSIONS: Lobectomy combined with mediastinal LND can improve survival in patients with stage I NSCLC. It should be performed in all patients with clinical stage I NSCLC.

PMID: 18481243 [PubMed - in process]

(Source: The Thoracic and Cardiovascular Surgeon)

Nonlethal penetrating cardiac injury from a hammer splinter.

The Thoracic and Cardiovascular Surgeon — Fri, 16 May 2008 16:02:21 +0100

Nonlethal penetrating cardiac injury from a hammer splinter.

Thorac Cardiovasc Surg. 2008 Jun;56(4):231-2

Authors: Santini F, Barozzi L, Faggian G, Mazzucco A

PMID: 18481244 [PubMed - in process]

(Source: The Thoracic and Cardiovascular Surgeon)

Endovascular repair in chronic aortic transection: a report of three cases.

The Thoracic and Cardiovascular Surgeon — Fri, 16 May 2008 16:02:18 +0100

Endovascular repair in chronic aortic transection: a report of three cases.

Thorac Cardiovasc Surg. 2008 Jun;56(4):232-4

Authors: Sanioglu S, Sokullu O, Sahin S, Ozay B, Sargin M, Bilgen F

PMID: 18481245 [PubMed - in process]

(Source: The Thoracic and Cardiovascular Surgeon)

Aortic-left ventricular tunnel with late incompetence after 18-year follow-up.

The Thoracic and Cardiovascular Surgeon — Fri, 16 May 2008 16:02:15 +0100

Aortic-Left Ventricular Tunnel with Late Incompetence after 18-year Follow-Up.

Thorac Cardiovasc Surg. 2008 Jun;56(4):234-6

Authors: Chen HM, Chang PC, Chen YF

PMID: 18481246 [PubMed - in process]

(Source: The Thoracic and Cardiovascular Surgeon)

Ulnar artery as a graft for coronary artery bypass grafting.

The Thoracic and Cardiovascular Surgeon — Fri, 16 May 2008 16:02:12 +0100

Ulnar artery as a graft for coronary artery bypass grafting.

Thorac Cardiovasc Surg. 2008 Jun;56(4):236-8

Authors: Simek M, Nemec P, Marcian P

PMID: 18481247 [PubMed - in process]

(Source: The Thoracic and Cardiovascular Surgeon)

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Chest wall mass caused by salmonella enteritidis - a pitfall of pet imaging interpretation.

The Thoracic and Cardiovascular Surgeon — Fri, 16 May 2008 16:02:09 +0100

Chest Wall Mass Caused by Salmonella Enteritidis - A Pitfall of PET Imaging Interpretation.

Thorac Cardiovasc Surg. 2008 Jun;56(4):239-40

Authors: Hsu PK, Hsu WH

PMID: 18481248 [PubMed - in process]

(Source: The Thoracic and Cardiovascular Surgeon)

Surgical approach to giant thymoma: is the hemi-clamshell incision the best option?

The Thoracic and Cardiovascular Surgeon — Fri, 16 May 2008 16:02:07 +0100

Surgical approach to giant thymoma: is the hemi-clamshell incision the best option?

Thorac Cardiovasc Surg. 2008 Jun;56(4):241

Authors: Incarbone M, Voulaz E, Alloisio M

PMID: 18481249 [PubMed - in process]

(Source: The Thoracic and Cardiovascular Surgeon)

Interposition of a thymus pedicle flap for the management of mediastinitis in a patient with a tracheostomy.

The Thoracic and Cardiovascular Surgeon — Fri, 16 May 2008 16:02:01 +0100

Interposition of a thymus pedicle flap for the management of mediastinitis in a patient with a tracheostomy.

Thorac Cardiovasc Surg. 2008 Jun;56(4):242-3

Authors: Huang SC, Hsu HH, Chen KY, Wang SS, Lee YC

PMID: 18481250 [PubMed - in process]

(Source: The Thoracic and Cardiovascular Surgeon)

Giant epidermoid cyst in the sternum region.

The Thoracic and Cardiovascular Surgeon — Fri, 16 May 2008 16:01:58 +0100

Giant epidermoid cyst in the sternum region.

Thorac Cardiovasc Surg. 2008 Jun;56(4):243-5

Authors: Solak O, Tunay K, Haktanir NT, Ocalan K, Esme H, Tokyol C

PMID: 18481251 [PubMed - in process]

(Source: The Thoracic and Cardiovascular Surgeon)

Ablation surgery failure after combined permanent atrial fibrillation ablation and mitral valve surgery

The Thoracic and Cardiovascular Surgeon — Thu, 15 May 2008 23:03:37 +0100

Thorac cardiovasc Surg 2008; 56: 185-189DOI: 10.1055/s-2008-1038373Abstract The aim of this study was to evaluate the early and late results of a permanent atrial fibrillation (pAF) ablation concept carried out concomitantly with mitral valve (MV) surgery and to identify risk factors for ablation surgery failure. Between February 2001 and April 2006, 109 patients with pAF over a median time of 48 months (Perc25/75; range 6 - 396 months) underwent monopolar endocardial radiofrequency ablation procedures concomitantly with MV surgery. All patients were restudied to assess survival, conversion rate to stable sinus rhythm (SR) and New York Heart Association (NYHA) class early (3 ± 1 months) and late after surgery (36 ± 19 months). For data assessment an explorative data analysis including univariate and multivariate binary logistic regression was performed. Early and late survival was 95 % and 91 %, respectively; at follow-up stable SR was documented in 76 % (74 %) of patients. NYHA class improved significantly after surgery ( = 0.009), particularly when stable SR was achieved ( = 0.042). Among these MV patients left atrial (LA) enlargement and pAF of long-time duration prior to surgery were detected as risk factors for postoperative recurrence and persistence of atrial fibrillation ( = 0.026 and = 0.002); furthermore, advanced age and significant tricuspidal regurgitation at the time of surgery were also relevant. The best prediction (95 % of patients) for SR, as demonstrated in a multivariate model, was based on the factors LA size and pAF duration ( = 0.052 and 0.005). Particularly the preoperative LA size and pAF duration seem to be useful parameters to evaluate the success rate of ablation performed concomitantly with MV surgery. It could be demonstrated that an established SR remains stable over time.[...]© Georg Thieme Verlag KG Stuttgart · New YorkGet connected:Table of contents | Abstract | Full text (Source: The Thoracic and Cardiovascular Surgeon)

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Ismics 2008 annual scientific meeting abstracts.

Innovations: Technology & Techniques in Cardiothoracic & Vascular Surgery — Mon, 12 May 2008 23:46:09 +0100

Page: 59DOI: 10.1097/IMI.0b013e318177557d (Source: Innovations: Technology & Techniques in Cardiothoracic & Vascular Surgery)

Robotically assisted beating heart totally endoscopic coronary artery bypass (tecab). is there a future?

Innovations: Technology & Techniques in Cardiothoracic & Vascular Surgery — Mon, 12 May 2008 23:46:09 +0100

Page: 52DOI: 10.1097/IMI.0b013e318176778aAuthors: Srivastava, Sudhir *+; Gadasalli, Suresh *; Agusala, Madhava *; Kolluru, Ram *; Barrera, Reyna +++; Quismundo, Shaune +++; Srivastava, Vishwa ++; Seshadri-Kreaden, Usha [S] (Source: Innovations: Technology & Techniques in Cardiothoracic & Vascular Surgery)

Histopathological evaluation of a novel radiofrequency surgical ablation system.

Innovations: Technology & Techniques in Cardiothoracic & Vascular Surgery — Mon, 12 May 2008 23:46:09 +0100

Page: 47DOI: 10.1097/IMI.0b013e31817677a4Authors: Saltman, Adam E. *; Raju, Narayan R. +; Block, Jon E. ++ (Source: Innovations: Technology & Techniques in Cardiothoracic & Vascular Surgery)

Successfully completed total cavopulmonary connection with a right-sided maze procedure after a modified starnes’ operation in a neonate with ebstein’s anomaly

General Thoracic and Cardiovascular Surgery — Sun, 11 May 2008 06:00:03 +0100

Abstract The symptomatic newborn infant with Ebstein’s anomaly is in critical condition and is difficult to treat successfully. Furthermore, supraventricular tachyarrhythmia in patients with Ebstein’s anomaly may determine the early and late results. We report a successfully treated case of extracardiac total cavopulmonary connection with a right-sided maze procedure after a modified Starnes’ operation during the neonatal period. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s11748-008-0224-0Authors Shunji Uchita, Nagano Children’s Hospital Department of Cardiovascular Surgery 3100 Toyoshina Azumino, Nagano 399-8288 JapanYorikazu Harada, Nagano Children’s Hospital Department of Cardiovascular Surgery 3100 Toyoshina Azumino, Nagano 399-8288 JapanSatoshi Yasukochi, Nagano Children’s Hospital Department of Cardiology Nagano JapanGengi Satomi, Nagano Children’s Hospital Department of Cardiology Nagano Japan Journal General Thoracic and Cardiovascular SurgeryOnline ISSN 1863-6713Print ISSN 1863-6705 Journal Volume Volume 56 Journal Issue Volume 56, Number 5 / May, 2008 (Source: General Thoracic and Cardiovascular Surgery)

Diaphragmatic repair of two cases of hepatic hydrothorax using video-assisted thoracoscopic surgery

General Thoracic and Cardiovascular Surgery — Sun, 11 May 2008 06:00:00 +0100

Abstract Hepatic hydrothorax is defined as the presence of a significant pleural effusion that develops in a patient with cirrhosis of the liver who does not have underlying cardiac or pulmonary disease. There are few published case reports dealing with hepatic hydrothorax treated surgically because patients with hepatic hydrothorax have end-stage liver disease. Recently, we treated two patients with refractory hepatic hydrothorax by directly suturing the diaphragmatic defects during video-assisted thoracoscopic surgery (VATS). During surgery, the diaphragmatic defects were identified using abdominal insufflation of saline with indocyanine green or carbon dioxide. After suture closure using fibrin glue, both right pleural effusions were improved. The patients’ postoperative courses were uneventful, and they did not require a drainage tube when they were discharged. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s11748-007-0221-8Authors Takayuki Ibi, Nippon Medical School Hospital Department of Thoracic Surgery 1-1-5 Sendagi, Bunkyo-ku Tokyo 113-8602 JapanKiyoshi Koizumi, Nippon Medical School Hospital Department of Thoracic Surgery 1-1-5 Sendagi, Bunkyo-ku Tokyo 113-8602 JapanTomomi Hirata, Nippon Medical School Hospital Department of Thoracic Surgery 1-1-5 Sendagi, Bunkyo-ku Tokyo 113-8602 JapanIwao Mikami, Nippon Medical School Hospital Department of Thoracic Surgery 1-1-5 Sendagi, Bunkyo-ku Tokyo 113-8602 JapanTakao Hisayoshi, Mitaka Chuo Hospital Department of Surgery Tokyo JapanKazuo Shimizu, Nippon Medical School Hospital Department of Thoracic Surgery 1-1-5 Sendagi, Bunkyo-ku Tokyo 113-8602 Japan Journal General Thoracic and Cardiovascular SurgeryOnline ISSN 1863-6713Print ISSN 1863-6705 Journal Volume Volume 56 Journal Issue Volume 56, Number 5 / May, 2008 (Source: General Thoracic and Cardiovascular Surgery)

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The utility of an autologous blood salvage system in emergency thoracotomy for a hemothorax after chest trauma

General Thoracic and Cardiovascular Surgery — Sun, 11 May 2008 05:59:59 +0100

Abstract In Japan, little is known about using the Cell Saver in treating blunt or penetrating chest trauma. We therefore report the utility of this autologous blood salvage device. Two patients underwent emergency thoracotomies with the Cell Saver to treat massive hemothorax and made full recoveries. The first was a 29-year-old man who suffered a stab injury to his chest; 5000 ml blood was collected from the thorax, of which about 3000 ml was reinfused. The second was a 51-year-old man involved in a car crash; 1600 ml blood was collected from the thorax, of which about 500 ml was reinfused. When no banked blood is available for an emergency thoracotomy, the Cell Saver is an extremely useful machine. This device is also effective in treating progressive hemorrhagic shock and helpful when the rate of blood loss exceeds the supply available from the blood bank. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s11748-007-0219-2Authors Mitsuhiro Kamiyoshihara, Maebashi Red Cross Hospital Department of General Thoracic Surgery 3-21-36 Asahi-Cho Maebashi, Gunma 371-0014 JapanTakashi Ibe, Maebashi Red Cross Hospital Department of General Thoracic Surgery 3-21-36 Asahi-Cho Maebashi, Gunma 371-0014 JapanIzumi Takeyoshi, Gunma Graduate University School of Medicine Division of Thoracic and Visceral Organ Surgery Maebashi, Gunma Japan Journal General Thoracic and Cardiovascular SurgeryOnline ISSN 1863-6713Print ISSN 1863-6705 Journal Volume Volume 56 Journal Issue Volume 56, Number 5 / May, 2008 (Source: General Thoracic and Cardiovascular Surgery)

Beating heart mitral valve replacement in a patient with a previous bentall operation

General Thoracic and Cardiovascular Surgery — Sun, 11 May 2008 05:59:59 +0100

Abstract Today, mitral valve replacement is performed under cardioplegic arrest with cross-clamping of the ascending aorta. In the case reported here, mitral valve replacement was performed with an on-pump beating heart technique without cross-clamping the aorta because of diffuse adhesion around the tube graft. A 36-year-old man had undergone a Bentall operation (aortic root replacement + coronary reimplantation) via median sternotomy because of type I aortic dissection 4 years previously in our cardiac center. He was admitted to the hospital complaining of palpitation and dyspnea on mild exertion. Transthoracic echocardiography study revealed third-degree mitral insufficiency. Mitral valve replacement was carried out through re-median sternotomy with an on-pump beating heart technique without crossclamping the aorta. On-pump beating heart mitral valve replacement without a cross-clamp offers a safe approach when excessive dissection is required to place a crossclamp on the ascending aorta. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s11748-007-0225-4Authors Ferit Cicekcioglu, Turkiye Yuksek Ihtisas Hospital Cardiovascular Surgery Clinic 06100 Sihhiye, Ankara TurkeyAli Ihsan Parlar, Turkiye Yuksek Ihtisas Hospital Cardiovascular Surgery Clinic 06100 Sihhiye, Ankara TurkeyLevent Altinay, Turkiye Yuksek Ihtisas Hospital Cardiovascular Surgery Clinic 06100 Sihhiye, Ankara TurkeyAlaa Hijazi, Turkiye Yuksek Ihtisas Hospital Cardiovascular Surgery Clinic 06100 Sihhiye, Ankara TurkeyAhmet Kuddusi Irdem, Turkiye Yuksek Ihtisas Hospital Cardiovascular Surgery Clinic 06100 Sihhiye, Ankara TurkeySalih Fehmi Katircioglu, Turkiye Yuksek Ihtisas Hospital Cardiovascular Surgery Clinic 06100 Sihhiye, Ankara Turkey Journal General Thoracic and Cardiovascular SurgeryOnline ISSN 1863-6713Print ISSN 1863-6705 Journal Volume Volume 56 Journal Issue Volume 56, Number 5 / May, 2008 (Source: General Thoracic and Cardiovascular Surgery)

Primary aortic intimal sarcoma

General Thoracic and Cardiovascular Surgery — Sun, 11 May 2008 05:59:58 +0100

Abstract Aortic intimal angiosarcoma is extremely rare, and the prognosis of patients with a tumor is unfavorable even if they have undergone surgery. We treated a patient with primary intimal angiosarcoma of the aortic arch who underwent an operation. The tumor originated from the inner wall of the aortic arch on the lesser curve. In order to remove the tumor completely, the entire aortic arch from the ascending to the middle of descending aorta was resected through an L-shape skin incision. On histologic examination, an undifferentiated intimal sarcoma was diagnosed. It grew into the aortic lumen while spreading along the aortic intima, focally infiltrating the media. The postoperative course was uneventful. Postoperative CT performed at 6, 12 and 18 months after surgery showed no local recurrence or metastasis. According to some reports endoarterectomy has been performed to treat this type of tumor, since the malignant cells are thought to be limited to the luminal surface. However, we favor aortic resections and graft interpositions rather than an endoarterectomy because the tumor could have invaded the media. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s11748-008-0231-1Authors Wataru Kato, Nagoya University Graduate School of Medicine Department of Cardiac Surgery 65 Tsurumai-cho, Showa-ku Nagoya, Aichi 466-8550 JapanAkihiko Usui, Nagoya University Graduate School of Medicine Department of Cardiac Surgery 65 Tsurumai-cho, Showa-ku Nagoya, Aichi 466-8550 JapanHideki Oshima, Nagoya University Graduate School of Medicine Department of Cardiac Surgery 65 Tsurumai-cho, Showa-ku Nagoya, Aichi 466-8550 JapanChikage Suzuki, Nagoya University Graduate School of Medicine Department of Pathology Aichi JapanKatsuhiko Kato, Nagoya University Graduate School of Medicine Department of Pathology Aichi JapanYuichi Ueda, Nagoya University Graduate School of Medicine Department of Cardiac Surgery 65 Tsurumai-cho, Showa-ku Nagoya, Aichi 466-8550 Japan Journal General Thoracic and Cardiovascular SurgeryOnline ISSN 1863-6713Print ISSN 1863-6705 Journal Volume Volume 56 Journal Issue Volume 56, Number 5 / May, 2008 (Source: General Thoracic and Cardiovascular Surgery)

Hydrodynamic evaluation of axillary artery perfusion for normal and diseased aorta

General Thoracic and Cardiovascular Surgery — Sun, 11 May 2008 05:59:58 +0100

Abstract Axillary artery perfusion is an attractive alternative to reduce the frequency of atheroembolism in extensive atherosclerotic aorta and aortic aneurysms. This study was conducted to evaluate the flow dynamics of axillary artery perfusion. Transparent glass models of a normal aortic arch and an aortic arch aneurysm were used to evaluate hydrodynamic properties. Streamline analysis and distribution of the shear stress was evaluated using a particle image velocity method. In the normal aortic arch model, rapid flow of 80 cm/s from the right axillary artery ran out from the brachiocephalic artery and grazed the lesser curvature of the aortic arch. There was secondary reversed flow in the ascending aorta. Flow from left axillary perfusion went straight to the descending aorta. In the aortic arch aneurysm model, flow from both axillary arteries hit the lesser curvature of the aortic arch and went into the ascending aorta with vortical flow. Distribution of shear stress was high along the jet from the ostium of the brachiocephalic artery and left subclavian artery. Flow in the aortic arch and the ascending aorta was unexpectedly rapid. Special care must be taken when the patient has frail atheroma around arch vessels or the lesser curvature of the aortic arch during axillary artery perfusion. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s11748-008-0234-yAuthors Masahito Minakawa, Hirosaki University School of Medicine Department of Thoracic and Cardiovascular Surgery 5 Zaifu-cho Hirosaki, Aomori 036-8562 JapanIkuo Fukuda, Hirosaki University School of Medicine Department of Thoracic and Cardiovascular Surgery 5 Zaifu-cho Hirosaki, Aomori 036-8562 JapanTakao Inamura, Hirosaki University Department of Intelligent Machines and System Engineering, Faculty of Science and Technology Aomori JapanHideki Yanaoka, Hirosaki University Department of Intelligent Machines and System Engineering, Faculty of Science and Technology Aomori JapanKozo Fukui, Hirosaki University School of Medicine Department of Thoracic and Cardiovascular Surgery 5 Zaifu-cho Hirosaki, Aomori 036-8562 JapanKazuyuki Daitoku, Hirosaki University School of Medicine Department of Thoracic and Cardiovascular Surgery 5 Zaifu-cho Hirosaki, Aomori 036-8562 JapanYasuyuki Suzuki, Hirosaki University School of Medicine Department of Thoracic and Cardiovascular Surgery 5 Zaifu-cho Hirosaki, Aomori 036-8562 JapanHiroshi Hashimoto, Hirosaki University School of Medicine Department of Anesthesiology Aomori Japan Journal General Thoracic and Cardiovascular SurgeryOnline ISSN 1863-6713Print ISSN 1863-6705 Journal Volume Volume 56 Journal Issue Volume 56, Number 5 / May, 2008 (Source: General Thoracic and Cardiovascular Surgery)

Fully supported open stent grafting applied with a matsui-kitamura (mk) stent in treatment of distal arch aneurysm

General Thoracic and Cardiovascular Surgery — Sun, 11 May 2008 05:59:58 +0100

Abstract Objective Our purpose was to examine the use of fully supported open stent grafting (OSG) with a Matsui-Kitamura (MK) stent for treatment of distal arch aneurysm (DAA). Methods Surgery was performed using a newly developed device in seven DAA patients (six men and one woman) from 58 to 86 years of age (mean, 73 years old) from August 2005 to June 2007. The aorta was transected at the arch between bracheocephalic artery and left subclavian artery under circulatory arrest with total cardiopulmonary bypass and selective cerebral perfusion; then the stent grafting (SG) system was inserted and positioned with a 14 Fr. pusher. The SG and a transected edge were then sutured and anastomosed with the arch graft. The surgery was completed by constructing three cerebral branches. Results The mean SG diameter and length were 34.6 mm (range, 32–38 mm) and 150 mm (120–200 mm), respectively. The mean time of circulatory arrest time and surgery were 41 min (35–55 min) and 358 min (269–450 min), respectively. Simultaneous mitral valve replacement was performed in one patient. All surgeries were completed successfully, and complete thrombosis of the aneurysm was obtained. Paraparesis and respiratory failure occurred in one patient each, and one patient died of brainstem infarction 1 month after surgery. Conclusion These initial results suggest that the OSG method is a useful surgical procedure for the treatment of DAA. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s11748-007-0223-6Authors Hirofumi Midorikawa, Southern Tohoku General Hospital Department of Cardiovascular Surgery 7-115 Yatsuyamada Koriyama Fukushima 963-8563 JapanMegumu Kanno, Southern Tohoku General Hospital Department of Cardiovascular Surgery 7-115 Yatsuyamada Koriyama Fukushima 963-8563 JapanKazunori Ishikawa, Southern Tohoku General Hospital Department of Cardiovascular Surgery 7-115 Yatsuyamada Koriyama Fukushima 963-8563 Japan Journal General Thoracic and Cardiovascular SurgeryOnline ISSN 1863-6713Print ISSN 1863-6705 Journal Volume Volume 56 Journal Issue Volume 56, Number 5 / May, 2008 (Source: General Thoracic and Cardiovascular Surgery)

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Video-assisted thoracic surgery for left lung cancer in a patient with a right aortic arch

General Thoracic and Cardiovascular Surgery — Sun, 11 May 2008 05:59:56 +0100

Abstract We report a rare case of left lung cancer in a patient with a right aortic arch. A 65-year-old woman was diagnosed to have an adenocarcinoma in the left upper lobe (S3) in addition to a right aortic arch (type II), with the left subclavian artery originating from the descending aorta. Left upper lobectomy and lymph node dissection was performed by video-assisted thoracic surgery (VATS). For the mediastinal dissection, the upper mediastinal lymph nodes were easily resected after verifying the location of the arterial ligament and the recurrent laryngeal nerve (RLN). This is the first report of using VATS to remove a lung cancer from a patient with a right aortic arch. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s11748-008-0229-8Authors Hiroshige Nakamura, Tottori University Hospital Division of General Thoracic Surgery 36-1 Nishi-cho Yonago, Tottori 683-8504 JapanKen Miwa, Tottori University Hospital Division of General Thoracic Surgery 36-1 Nishi-cho Yonago, Tottori 683-8504 JapanYoshin Adachi, Tottori University Hospital Division of General Thoracic Surgery 36-1 Nishi-cho Yonago, Tottori 683-8504 JapanShinji Fujioka, Tottori University Hospital Division of General Thoracic Surgery 36-1 Nishi-cho Yonago, Tottori 683-8504 JapanTomohiro Haruki, Tottori University Hospital Division of General Thoracic Surgery 36-1 Nishi-cho Yonago, Tottori 683-8504 JapanYuji Taniguchi, Tottori University Hospital Division of General Thoracic Surgery 36-1 Nishi-cho Yonago, Tottori 683-8504 Japan Journal General Thoracic and Cardiovascular SurgeryOnline ISSN 1863-6713Print ISSN 1863-6705 Journal Volume Volume 56 Journal Issue Volume 56, Number 5 / May, 2008 (Source: General Thoracic and Cardiovascular Surgery)

Airway stenosis associated with a mycotic pseudoaneurysm of the common carotid artery

General Thoracic and Cardiovascular Surgery — Sun, 11 May 2008 05:59:56 +0100

Abstract A 56-year-old woman was seen who had been under hemodialysis treatment. In September 2003, the patient was sent to our hospital with fever and dyspnea, and artificial respiration was initiated. Bronchoscopy detected stenosis due to compression of the bronchus. Contrast computed tomography and angiography detected a pseudoaneurysm of the right common carotid artery. We performed emergency excision of the mycotic pseudoaneurysm, which was closed with an autologous pericardial patch. We also performed median sternotomy to obtain an adequate surgical view. A perfusion tube was inserted into the internal carotid artery. The inflammatory findings and dyspnea resolved postoperatively. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s11748-008-0230-2Authors Hidetoshi Masumoto, Shizuoka City Hospital Department of Cardiovascular Surgery 10-93 Ote-machi Shizuoka 420-8630 JapanMitsuomi Shimamoto, Shizuoka City Hospital Department of Cardiovascular Surgery 10-93 Ote-machi Shizuoka 420-8630 JapanFumio Yamazaki, Shizuoka City Hospital Department of Cardiovascular Surgery 10-93 Ote-machi Shizuoka 420-8630 JapanMasanao Nakai, Shizuoka City Hospital Department of Cardiovascular Surgery 10-93 Ote-machi Shizuoka 420-8630 JapanShoji Fujita, Shizuoka City Hospital Department of Cardiovascular Surgery 10-93 Ote-machi Shizuoka 420-8630 JapanYujiro Miura, Shizuoka City Hospital Department of Cardiovascular Surgery 10-93 Ote-machi Shizuoka 420-8630 Japan Journal General Thoracic and Cardiovascular SurgeryOnline ISSN 1863-6713Print ISSN 1863-6705 Journal Volume Volume 56 Journal Issue Volume 56, Number 5 / May, 2008 (Source: General Thoracic and Cardiovascular Surgery)

Mucosa-associated lymphoid tissue lymphoma involving lung and conjunctiva

General Thoracic and Cardiovascular Surgery — Sun, 11 May 2008 05:59:53 +0100

Abstract A 68-year-old man was found to have tumors of the left lung and left conjunctiva. Thoracoscopic partial lung resection was performed. Histological examination revealed diffuse proliferations of centrocyte-like cells with lymphoepithelial lesions, and a diagnosis of mucosa-associated lymphoid tissue (MALT) lymphoma was made. Immunohistochemical study and flow cytometric analysis were also compatible with MALT lymphoma. Conjunctival tumor biopsy was performed and the diagnosis was confirmed. The postoperative course of the patient was uneventful, and he is currently being followed without further treatment. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s11748-008-0232-0Authors Makoto Motoishi, Rakuwakai Otowa Hospital Department of Respiratory Division 2 Otowachinzi-cho, Yamashina-ku Kyoto 607-8062 JapanToru Enokibori, Rakuwakai Otowa Hospital Department of Respiratory Division 2 Otowachinzi-cho, Yamashina-ku Kyoto 607-8062 JapanYuko Katsuki, Rakuwakai Otowa Hospital Department of Respiratory Division 2 Otowachinzi-cho, Yamashina-ku Kyoto 607-8062 JapanMichiko Tsuchiya, Rakuwakai Otowa Hospital Department of Respiratory Division 2 Otowachinzi-cho, Yamashina-ku Kyoto 607-8062 JapanRikuro Hatakenaka, Rakuwakai Otowa Hospital Department of Respiratory Division 2 Otowachinzi-cho, Yamashina-ku Kyoto 607-8062 Japan Journal General Thoracic and Cardiovascular SurgeryOnline ISSN 1863-6713Print ISSN 1863-6705 Journal Volume Volume 56 Journal Issue Volume 56, Number 5 / May, 2008 (Source: General Thoracic and Cardiovascular Surgery)

Solitary fibrous tumor of the lung

General Thoracic and Cardiovascular Surgery — Sun, 11 May 2008 05:59:52 +0100

Abstract Solitary fibrous tumors are mesenchymal entities integrated in a mixed group of hemangiopericytoma-like neoplasms. Although classically presented as a pleura-based mass, there are extrapleural sites including the lung. We present the clinical, imaging, and histological features of a solitary fibrous tumor of the lung. Content Type Journal ArticleCategory Case PeportDOI 10.1007/s11748-008-0233-zAuthors Helen Stamou Kouki, University of Patras Cardiothoracic Surgery Department Patras 26500 GreeceEfstratios N. Koletsis, University of Patras Cardiothoracic Surgery Department Patras 26500 GreeceVasiliki Zolota, University of Patras Department of Pathology Patras GreeceChristos Prokakis, University of Patras Cardiothoracic Surgery Department Patras 26500 GreeceEfstratios Apostolakis, University of Patras Cardiothoracic Surgery Department Patras 26500 GreeceDimitrios Dougenis, University of Patras Cardiothoracic Surgery Department Patras 26500 Greece Journal General Thoracic and Cardiovascular SurgeryOnline ISSN 1863-6713Print ISSN 1863-6705 Journal Volume Volume 56 Journal Issue Volume 56, Number 5 / May, 2008 (Source: General Thoracic and Cardiovascular Surgery)