WTC: Spare the Steroids and Still Save the Graft
BOSTON -- Steroids are gradually being pushed aside in immunosuppressive regimens given chronically to transplant recipients, according to multiple studies presented at the World Transplant Congress here.
Source: MedPage Today Surgery ? - July 24, 2006

[Editorial] Enhanced virtual conferencing on ICVTS: introduction of DOIs makes eComments citable
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - von Segesser, L. K.

[New ideas - Vascular thoracic] New open stent-graft delivery system: the CLATE flexible metal graft holder
The surgical approach to the treatment of distal aortic arch aneurysms is still a matter of controversy. Median sternotomy is usually selected when the patient has the pulmonary emphysema, and the atherosclerotic change involves the ascending aorta or the aortic arch as well as the distal aortic arch. However, when the end of the aneurysm is deep and distant, distal anastomosis becomes more difficult. Left thoracotomy is another approach, but in the patients with impaired respiratory function or when dense lung adhesions to the chest wall are anticipated because of a history of inflammation, the risk of intraoperative ...
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Kubota, H., Endo, H., Sudo, K.

[Work in progress report - Cardiac general] Sternal closure with titanium plate fixation - a paradigm shift in preventing mediastinitis
Sternal instability predisposes to post-operative mediastinitis. Biomechanical studies have shown the superiority of rigid plate fixation over wire circlage in sternal healing. We studied rigid plate fixation for sternotomies in high-risk patients. High-risk patients were identified as those having three or more historically established risk factors for post-operative mediastinitis, such as COPD, re-operative surgery, renal failure, diabetes, steroid use, obesity, existing infection, and immunosuppression. Three hundred and twenty high-risk patients had prophylactic rigid plate fixation (Group S) between July 2000 and ...
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Raman, J., Song, D. H., Bolotin, G., Jeevanandam, V.

[Work in progress report - Vascular thoracic] Flow-sensitive 3D magnetic resonance imaging reveals complex blood flow alterations in aortic Dacron graft repair
A thorough knowledge of both vascular anatomy and hemodynamics is of high interest for the understanding of the severity of the underlying disease, the therapeutic decision-making and follow-up. In this context, flow-sensitive 3D magnetic resonance imaging (MRI) offers the possibility to simultaneously acquire detailed information about vascular hemodynamics and morphology. Recent methodological progress, extensive validation of the technique and combination with advanced 3D blood flow visualization enables nowadays for a detailed depiction of normal and altered flow characteristics in large arteries such as the thorac...
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Frydrychowicz, A., Weigang, E., Langer, M., Markl, M.

[Work in progress report - Arrhythmia] Minimal touch surgical implantable cardioverter defibrillator implantations
A growing number of patients with contraindication for transvenous implantable cardioverter defibrillator (ICD) implantation or need for system upgrade of a pre-existent pacemaker system is to be observed. Therefore, unconventional system constellation may be necessary to provide patient safety by using a minimal invasive access avoiding sternotomy. Two similar cases are presented to demonstrate configuration solutions which can be easily individually modified. Simple pacemaker and ICD implantation is nowadays mostly performed by cardiologists and/or general surgeons. As soon as partial or total thoracotomy becomes nec...
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Osswald, B. R., Tochtermann, U., Tanzeem, A., Hagl, S.

[Work in progress report - Congenital] Evaluation of valved saphenous vein homograft as right ventricle-pulmonary artery conduit in modified stage I Norwood operation
Potential drawbacks from right ventricle-pulmonary artery (RV-PA) conduit in modified Norwood procedure may be regurgitation through the conduit and incision at the systemic ventricle. In order to address the question if valved RV-PA conduit can provide hemodynamic advantages, we retrospectively reviewed the data of patients who underwent modified stage I Norwood operation with either a non-valved ePTFE RV-PA conduit (ePTFE) or a valved saphenous vein homograft (SVG). Four patients in each group, both the ePTFE and SVG, were involved in the study and 2 patients in each group eventually died. Conduit regurgitation was s...
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Takeuchi, K., Murakami, A., Takaoka, T., Takamoto, S.

[Work in progress report - Congenital] No patch technique for complete atrioventricular canal repair
We describe our initial experience with a new technique, consisting in direct closure of the ventricular septal defect component of the AV canal, by directly attaching the common bridging leaflets to the crest of the ventricular septum with interrupted sutures. After closure of the cleft, the ostium primum defect was closed with a running suture suturing the border of the septum primum to the newly created AV valve annulus. Three patients were operated upon. There was no mortality. Mean ischemic time was 39 min and mean pump time 77 min. All patients remained in sinus rhythm. At follow-up only trivial or mild...
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Aramendi, J. I., Rodriguez, M. A., Luis, T., Voces, R.

[Work in progress report - Congenital] ICVTS on-line discussion A
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Basaran, M.

[Institutional report - Coronary] Tissue perfusion in non-donor and donor forearm/hand after radial artery harvest: 1- and 5-year follow-up
Radio-labeled red cell perfusion scan of the non-donor/donor forearm/hand was undertaken, 1- and 5-years post operation, in 12 patients who had received a radial artery graft during myocardial revascularisation. Results were analysed using a Wilcoxon Signed Rank test (P-value <0.05 was taken as statistically significant). Mean tissue perfusion (in milliliters/100 ml tissue/min) declined in the non-donor (–10.06%, P=0.07) and donor (–6.65%, P=0.15) forearm, respectively, compared to 1 year post radial artery harvest. The statistically significant observed difference in tissue perfusion between the no...
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Shah, S. S., Sadaba, J. R., Batchelor, T. J.P., Coughlin, P., Burniston, M. T., Barnfield, M., Munsch, C. M.

[Institutional report - Valves] Results of mitral valve repair in rheumatic mitral regurgitation
Between January 1988 and December 2003, 898 patients with rheumatic heart disease (mean age 22.4±10.1 years) underwent mitral valve (MV) repair. Five hundred and sixty-five patients (63%) had pre-operative atrial fibrillation. Six hundred and ten (68%) patients were in NYHA class III or IV. Four hundred and twelve (45.9%) had pure mitral regurgitation (MR) and 486 (54.1%) had mixed mitral stenosis and MR. The pathology was leaflet prolapse (n=270, 30%), annular dilatation (n=717, 79.8%) and calcification (n=39, 4.3%). Reparative procedures included annuloplasty (n=793, 88%), commissurotomy (n=530, 59%), cho...
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Sampath Kumar, A., Talwar, S., Saxena, A., Singh, R., Velayoudam, D.

[Institutional report - Valves] ICVTS on-line discussion A
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Yousefnia, M. A., Roshanali, F., Mandegar, M.H.

[Institutional report - Thoracic general] Prognostic value of the histological subtype in completely resected non-small cell lung cancer
Non-small cell lung cancer (NSCLC), which includes several different histological subtypes, is usually treated by the same strategy. However, the biological behavior of each cell type appears to be different. We retrospectively reviewed the clinical records of 1119 consecutive NSCLC patients who underwent a complete resection, in order to investigate whether a histological cell type is a powerful prognostic factor. The overall 5- and 10-year survivals of the patients with adenocarcinoma (AD), squamous cell carcinoma (SQ), large cell carcinoma (LA), and adenosquamous cell carcinoma (AS) were 54.2 and 40.2%, 51.6 and 30....
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Okamoto, T., Maruyama, R., Suemitsu, R., Aoki, Y., Wataya, H., Kojo, M., Ichinose, Y.

[Institutional report - Cardiac general] Reduction in hospitalisation rates following simultaneous carotid endarterectomy and coronary artery bypass grafting; experience from a single centre
The aim of this study was to compare hospital, clinical, and health care cost among patients undergoing reversed staged procedure coronary artery bypass grafting without cardiopulmonary bypass (off-pump CABG) first and carotid endarterectomy (CEA) second (control group), compared with patients who had simultaneous CEA and off-pump CABG (study group). From January 1, 2000 to December 31, 2004, 53 consecutive patients underwent combined operations at a single institution. Reversed staged procedures were used in the first 23 patients (January 2000–September 2003), and the next 30 patients (September 2003–Septe...
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Hudorovic, N.

[Institutional report - Valves] Computational simulations of the aortic valve validated by imaging data: evaluation of valve-sparing techniques
The goal of this study has been to develop a numerical model of the aortic valve, to validate it with in-vivo data and to computationally evaluate the effect of two types of aortic valve-sparing reconstructions on valve dynamics and hemodynamics. A model of the native aortic valve and two models of the valve after surgical reconstruction (reimplantation with a straight conduit and remodeling with a shaped conduit) were created. These models were transferred to a finite element analysis software where the interaction between valve structures and blood was taken into account in a dynamic manner. Leaflet and blood dynamic...
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Ranga, A., Bouchot, O., Mongrain, R., Ugolini, P., Cartier, R.

[Institutional report - Assisted circulation] Right ventricular failure after left ventricular assist device insertion: preoperative risk factors
Right ventricular failure after left ventricular assist device placement is the major concern on weaning from cardiopulmonary bypass and it is one of the most serious complications in the postoperative period. This complication has a poor prognosis and is generally unpredictable. The identification of pre-operative risk factor for this serious complication is incomplete yet. In order to determine pre-operative risk for severe right ventricular failure after left ventricular assist device support we analyzed preoperative hemodynamics, laboratory data and characteristics of 48 patients who received Novacor (World Heart C...
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Santambrogio, L., Bianchi, T., Fuardo, M., Gazzoli, F., Veronesi, R., Braschi, A., Maurelli, M.

[Institutional report - Coronary] Brain magnetic resonance angiography-based strategy for stroke reduction in coronary artery bypass grafting
We have been using magnetic resonance angiography (MRA) preoperatively to identify patients at increased risk of stroke in coronary artery bypass grafting (CABG). Based upon the intracranial MRA findings, either the off-pump or the on-pump procedure was selected. We report the results of our MRA-based strategy of CABG in 140 consecutive patients. Intracranial arterial lesions were found in 90 patients (64%). The most affected arteries were internal carotid (48%), followed by vertebral (18%) and middle cerebral (16%). Using the MRA score describing the severity of intracranial atherosclerosis, 35 patients with a score o...
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Takami, Y., Masumoto, H.

[Institutional report - Cardiopulmonary bypass] Markers of inflammation and oxidative stress in patients undergoing CABG with CPB with and without ventilation of the lungs: a pilot study
Cardiopulmonary bypass triggers systemic inflammation and systemic oxidative stress. Recent reports suggest that continuous ventilation during cardiopulmonary bypass (CPB) can affect the outcome of patients after cardiac surgery. We investigated the influence of lung ventilation on inflammatory and oxidative stress markers during coronary artery bypass graft (CABG) with CPB in 13 patients with (Group 2) or without (Group 1) ventilation of the lungs with small tidal volume (4 ml/kg). IL-10 and elastase in blood were elevated in both groups with a peak at the end of CPB (P<0.05) and returned to the baseline at 24...
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Deblier, I., Sadowska, A. M., Janssens, A., Rodrigus, I., DeBacker, W. A.

[Institutional report - Cardiac general] Clinical outcomes of surgery of mitral valve regurgitation and coronary artery bypass grafting
The impact of etiology of associated mitral valve regurgitation and a valve procedure on operative and long-term outcomes after coronary bypass grafting surgery is yet to be clearly defined. Results of combined coronary artery bypass grafting and valve procedures for mitral valve regurgitation were retrospectively analyzed in 468 patients. The regurgitation was of ischemic in 45%, degenerative in 55% and 78% valve repairs, 22% valve replacements were performed. Severe coronary artery disease, acute myocardial infarction, low ejection fraction, ischemic mitral regurgitation, advanced heart failure symptoms, failure to u...
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Sirivella, S., Gielchinsky, I.

[Institutional report - Valves] Does the type of biological valve affect patient outcome?
Patient background mortality and excess mortality related to aortic valve disease may play a greater role than implanted valve type in explaining the observed survival differences after aortic valve replacement. This study attempts to identify the differences between the performance of selected biological valves, given similar patient characteristics and excess mortality. Four biological valve types, the Carpentier-Edwards pericardial and supra-annular valve, Medtronic Freestyle valve and allografts were used for this analysis. Primary data calculated observed patient-survival and median time to structural valvular det...
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Kappetein, A. P., Takkenberg, J. J.M., Puvimanasinghe, J. P.A., Jamieson, W.R. E., Eijkemans, M., Bogers, Ad.J.J.C.

[Institutional report - Cardiac general] Continuous retrograde blood cardioplegia ensures prolonged aortic cross-clamping time without increasing the operative risk
The aim of this study was to assess whether the continuous retrograde blood cardioplegia ensures prolonged aortic cross-clamping time without increasing the operative risk. From 1996 to 2003, 204 consecutive patients who had cardiac procedure requiring aortic cross-clamping time ≥150 min, were prospectively included in this study: low risk group (EuroSCORE ≤2) 50 patients, medium risk group (EuroSCORE 3–5) 68 patients, high risk group (EuroSCORE ≥6) 86 patients. The myocardial protection associated induction of cardiac arrest by antegrade injection of hyperkalemic warm blood, continuous retrograde i...
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Bezon, E., Choplain, J. N., Aziz Khalifa, A. A., Numa, H., Salley, N., Barra, J. A.

[Institutional report - Cardiac general] Complete myocardial revascularization and sutureless technique for left ventricular free wall rupture: clinical and echocardiographic results
Left ventricular free wall rupture (LVFWR) is one of the most dramatic complications of myocardial infarction. We present our mid-term clinical and echocardiographic results of LVFWR with patch and complete myocardial revascularization on viable tissue. From August 2000 to July 2005, 9 patients underwent surgery for LVFWR. Mean age was 68±S.D. 9.3 years. Mean interval time between AMI and LVFWR was 122.2±154.9 h. All patients presented for emergency surgery with cardiac tamponade at echocardiography. Three patients received IABP preoperatively. Eight had coronarography. Effective control of blee...
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Leva, C., Bruno, P. G., Gallorini, C., Lazzarini, I., Musazzi, G., Vittonati, L., Rizzo, L., Di Credico, G.

[Institutional report - Coronary] In situ bilateral skeletonized internal thoracic arterial grafting for left-side myocardial revascularization using an off-pump technique
The aim of this study was to review the clinical and angiographic outcomes of in situ skeletonized bilateral internal thoracic artery (ITA) grafting for left coronary arterial revascularization using an off-pump technique in 144 consecutive patients. We also assessed the difference between left and right ITA grafting to the left anterior descending coronary artery (LAD). Arrangement of the bilateral ITAs (grafting of the left/right ITA to the LAD) was decided according to the coronary anatomy and quality of the grafts. Early postoperative angiograms were evaluated in 110 patients. The average numbers of anastomoses and...
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Fukui, T., Takanashi, S., Hosoda, Y., Suehiro, S.

[Institutional report - Thoracic general] Staging of non-small cell lung cancer: clinical value of positron emission tomography and mediastinoscopy
We report about a MEDLINE research from 2000 to 2005 with the key words ‘positron emission tomography AND/OR mediastinoscopy’. The search identified 448 potential studies. Out of the published data sensitivity, specificity, positive and negative predictive value, and accuracy for mediastinal lymph node staging by FDG-PET ranged from 58%–94%, 76%–96%, 43%–95%, 56%–98% to 74%–91%, respectively. With corresponding values of 80%–96%, 100%, 100%, 92%–97%, and 94%, respectively, for mediastinoscopy. FDG-PET improved the rate of detection of local and distant metastases in...
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Schimmer, C., Neukam, K., Elert, O.

[Institutional report - Thoracic general] Video-assisted thoracic surgery for bronchopulmonary sequestration
Bronchopulmonary sequestration is a rare congenital lung anomaly for which surgical resection is the definitive treatment. Open thoracotomy is the conventional approach, yet associated with considerable morbidity. We report one of the largest series of major lung resection for bronchopulmonary sequestration using the video-assisted thoracic surgery (VATS) approach that could reduce such morbidity. Six cases of VATS anatomical lobectomy for intrapulmonary sequestration performed between January 1996 and January 2005 were reviewed. The six patients included two males and four females, with a mean age of 43.3 years (...
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Tsang, F. H.F., Chung, S.-S., Sihoe, A. D.L.

[Institutional report - Thoracic general] Percutaneous tracheostomy in patients with cervical spine fractures - feasible and safe
The aim of this study is to evaluate the short and long-term results of percutaneous tracheostomy in patients with documented cervical spine fracture. Between June 2000 and September 2005, 38 consecutive percutaneous tracheostomy procedures were performed on multi-trauma patients with cervical spine fracture. Modified Griggs technique was employed at the bedside in the general intensive care department. Staff thoracic surgeons and anesthesiologists performed all procedures. Demographics, anatomical conditions, presence of co-morbidities and complication rates were recorded. The average operative time was 10 min (6...
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Ben Nun, A., Orlovsky, M., Anson Best, L.

[Institutional report - Thoracic general] Uniportal VATS for mediastinal nodal diagnosis and staging
The objective of the present study was to assess feasibility of single port (uniportal) VATS in the diagnosis and staging of mediastinal nodal enlargements. To this purpose, between January 2002 and October 2005, 13 patients (8 males and 5 females; mean age 54 years) have undergone uniportal VATS sampling of mediastinal nodes either as part of a diagnostic pathway or as a staging procedure for primary lung cancer when either nodal stations were inaccessible to standard mediastinoscopy or in the event of redo nodal biopsy. Sampled stations were the aortopulmonary window (6), subcarinal (1), right paratracheal (5), ...
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Rocco, G., Brunelli, A., Jutley, R., Salati, M., Scognamiglio, F., La Manna, C., La Rocca, A., Martucci, N.

[ESCVS article - Experimental] Neurological damage after radial artery harvesting in coronary surgery: a direct measure
Background: The incidence of neurological complications in the forearm after radial artery harvesting varies in the literature, ranging from 2% to more than 50%. Also, the areas affected and the type of neurological complications differ a lot. Peripheral nerve injuries may be divided into three types: neuroapraxia (conduction block that recovers within 3 months), axonotmesis (recovers 1 ml/day) and neurotmesis (needs surgery for recovering). We decided to perform a neuroelectrophysiological study, before and after surgery, in peripheral nerves of the forearm to find out the real incidence and the type of lesion af...
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Reyes, G., Traba, A., Lopez, L., Pinto, A., Duarte, J., Vallejo, J. L.

[ESCVS article - Experimental] ICVTS on-line discussion A
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Ozeren, M.

[ESCVS article - Cardiac general] Brain natriuretic peptide - a reliable parameter for the effectiveness of cardiac resynchronization therapy after coronary artery bypass grafting
Objectives: Brain natriuretic peptide (BNP) is a valuable marker in heart failure and its therapy, for example cardiac resynchronization therapy (CRT). So far, one finding which is indicative for CRT is dyssynchronity of ventricular contraction obtained by echocardiography. The aim of this study was to show that BNP is also a helpful marker to help decide whether CRT is useful for patients after CABG. Methods: Forty-two patients with a poor ejection fraction (<35%) underwent elective CABG. Twenty-eight of them received permanent biventricular stimulation for seven days after surgery. Before and on the first, third, ...
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Raab, S., Oertel, F., Weimann, T., Danov, V., Beyer, M.

[Proposal for bail-out procedures - Assisted circulation] Conversion of the TandemHeart percutaneous ventricular assist device to long-term support
The TandemHeart percutaneous ventricular assist device (VAD) has been employed at our institution to support a diverse group of patients. Patients that fail to demonstrate ventricular recovery must be transitioned to more definitive ventricular assist device support. We report utilization of the TandemHeart femoral cannulae as conduits for cardiopulmonary bypass as an operative strategy to facilitate implantation of a more durable VAD system.
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Mehta, S., Pae, W.

[Negative results - Thoracic general] The false assumption of lung cancer based upon a positive positron emission tomographic scan
Objective: To show that positron emission tomography (PET) can have false positive results from inflammatory lesions. Methods: We present a complicated, elderly patient who underwent an extensive work-up that failed to provide a diagnosis for a radiographic abnormality. Results: A PET scan was positive and the patient was believed to have lung carcinoma until eventual surgical excision was performed. Final pathology revealed that the patient had exogenous lipoid pneumonia. Conclusions: PET scans that are positive cannot be assumed to show a malignancy. Inflammatory lesions will also be positive with PET scanning.
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Carr, J. A., Silver, J. M.

[Negative results - Cardiopulmonary bypass] Severe hypotension and overflowing of venous reservoir at the initiation of cardiopulmonary bypass in a patient undergoing repair of ruptured sinus of Valsalva aneurysm: management issues
Aneurysm of sinus of Valsalva is a rare cardiac lesion that may be acquired or congenital. The presentations of RSOV range from incidental detection to frank heart failure. Right sinus of Valsalva aneurysm usually ruptures into the right ventricle. If non-coronary sinus is involved, most aneurysms erode into the right atrium. The problems described with surgical repair of RSOV include – distension of the communicating chamber at initiation of cardiopulmonary bypass (CPB), limited ability to achieve cardiac arrest if RSOV is misdiagnosed as ventricular septal defect, and air entrainment in venous drainage line on ...
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Neema, P. K., Sethuraman, M., Krishnamanohar, S. R., Rathod, R. C.

[Negative results - Vascular thoracic] Underestimated abdominal vascular pathology in a patient with Takayasu arteritis
Objective: To describe a 31-year-old female with symptomatic Takayasu disease who was operated for aortic valve replacement. Although she had no preoperative abdominal vascular symptoms, she died on the first postoperative day due to extensive ischemia bowel syndrome. Methods: Echocardiography and computed tomography revealed progressive dilatation and thickening of the ascending aorta, severe aortic regurgitation and diminished left ventricular function from 1998 onwards. In 2000 she was operated and a prosthesis was placed end-to-end distally of the sinutubular junction with combined reduction plasty of this junction...
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Hartman, J. M., Bekkers, J. A., Roos-Hesselink, J. W., Bogers, A. J. J. C.

[Negative results - Vascular thoracic] ICVTS on-line discussion A
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Ibrahim, M. F., Refaat, A.

[Negative results - Cardiac general] Non-anastomotic avulsion of a left internal mammary artery graft - a rare complication of minimally invasive direct coronary artery bypass surgery
Objective: To describe a rare complication of minimally invasive coronary artery bypass surgery. Method: Case report. Results: We present a 72-year-old patient with a left anterior descending artery stenosis who underwent elective minimally invasive direct coronary artery bypass (MIDCAB) surgery. Three months post-operatively he developed an anterior chest wall haematoma with electrocardiographic and enzyme evidence of myocardial ischaemia, though without haemodynamic embarrassment. Surgical exploration revealed non-anastomotic avulsion of the LIMA graft, which was bleeding freely into the left hemithorax. Conclusions:...
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Asherson, A. P., Vohra, H. A., Mason, M. J., Gaer, J. A.

[Negative results - Vascular] Open stent-grafting: aborted procedure in a patient with mega aorta syndrome
Objective: Open stent-grafting is a recent technical modification of endoluminal stent-grafting, in which a stent-graft is inserted into the descending thoracic aorta through an opening in the aortic arch, to treat distal arch aneurysms or aortic dissection. Controversy remains as to whether patients with mega aorta syndrome, or those with very wide aneurysm necks, could be candidates for stent-graft treatment – open or endoluminal. Methods: We recently attempted open stent-grafting in a patient with mega aorta syndrome who had a distal aortic arch aneurysm. A previous attempt at surgical resection of the aneurys...
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Bashar, A. H. M., Kazui, T., Suzuki, K., Terada, H., Yamashita, K., Washiyama, N.

[Negative results - Vascular] ICVTS on-line discussion A
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Ates, M.

[Negative results - Valves] Fatal early acute thrombosis of mechanical mitral prosthesis
Objective: To report a rare case of fatal early acute thrombosis of mechanical mitral prosthesis. Methods: A 62-year-old lady, who underwent closed mitral valvotomy for rheumatic heart disease 19 years ago, presented with Canadian Cardiovascular Society Class II angina and New York Heart Association Class III dyspnoea. Investigations including echocardiogram and cardiac catheterisation revealed mixed mitral valve disease. She had severe pulmonary artery hypertension with pulmonary artery wedge pressure of 35 mm of mercury. Significant stenosis in the midportion of dominant right coronary artery was also demon...
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Dandekar, U., Kalkat, M., Smallpeice, C.

[Negative results - Coronary] Rapid formation of the left ventricular pseudoaneurysm after sutureless repair of a subacute left ventricular free wall rupture
Objective: We report a rare, rapid, huge formation of the left ventricular pseudoaneurysm after sutureless repair with GRF glue. Methods: The case was a 70-year-old male, who received an emergency operation for a subacute left ventricular free wall rupture (LVFWR) complicated by acute myocardial infarction. At that time the left ventricle was wrapped with equine pericardium by using gelatin resorcin formaldehyde (GRF) glue (sutureless repair). The patient had been stable for 13 months but suffered acute heart failure. The left ventricular angiogram (LVG) revealed a huge left ventricular aneurysm and 75% stenosis i...
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Yamaguchi, S., Watanabe, G., Yamamoto, S.

[Follow-up paper - Thoracic general] Endoscopic thoracic sympathectomy - its effect in the treatment of refractory angina pectoris
Objective: To document an improvement in the quality of life in a group of patients with refractory angina and videothoracoscopic sympathectomy (VTSY) during the early postoperative period and a six-month follow-up. Methods: Ten patients with angina CCS IV refractory to a conventional therapy underwent VTSY between the years 1998 and 2002 at our institution. All patients underwent a complex preoperative evaluation, including pain assessment using a visual analog scale (VAS). Proximal thoracic sympathetic blockage was performed in all patients as a diagnostic test. The resection of bilateral Th2-Th4 ganglions was perfor...
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Stritesky, M., Dobias, M., Demes, R., Semrad, M., Poliachova, E., Cermak, T., Charvat, J., Malek, I.

[Best evidence topic - Cardiopulmonary bypass] Does use of the Hepcon(R) point-of-care coagulation monitor to optimise heparin and protamine dosage for cardiopulmonary bypass decrease bleeding and blood and blood product requirements in adult patients undergoing cardiac surgery?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether use of the Hepcon® point-of-care coagulation monitor (Medtronic, Minneapolis, MN) to optimise and monitor heparin and protamine dosage for cardiopulmonary bypass could decrease bleeding and blood and blood product requirements in adult patients undergoing cardiac surgery. Altogether 680 papers were identified on Medline, and 879 on Embase using the reported search strategy. Two further relevant papers were found by hand-searching of reference lists. Fourteen papers represented the best evidenc...
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Aziz, K. A. A., Masood, O., Hoschtitzky, J. A., Ronald, A.

[Best evidence topic - Thoracic general] Does lung cancer screening with chest X-ray improve disease-free survival?
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether screening an asymptomatic person with a routine chest X-ray would detect lung cancer early and, most importantly, improve that person's disease-free survival from lung cancer. Altogether 136 papers were identified using the search below. Ten papers presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of the papers are tabulated. We conclude that despite...
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Hunt, I., Siva, M., Southon, R., Treasure, T.

[Best evidence topic - Thoracic general] Chemotherapy following complete resection of non-small-cell lung cancer is of small but significant benefit in terms of survival
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether patients benefit in terms of survival from chemotherapy following complete resection of non-small-cell lung cancer. Altogether 681 papers were found using the reported search, of which 14 represented the best evidence on this topic. The authour, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses were tabulated. We conclude that post-operative adjuvant chemotherapy carries a small survival benefit in those patients with comp...
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - West, D., Kirk, A. J.B., Dunning, J.

[Best evidence topic - Cardiac general] Is recombinant activated factor VII useful for intractable bleeding after cardiac surgery?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether use of Recombinant Activated Factor VII could help haemostasis for intractable bleeding, and decrease blood or blood product requirements in patients undergoing cardiac surgery without excessive risk from thrombosis. Altogether 129 papers were identified using the reported search strategy of which 13 represented the best evidence on the topic. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses were tabulated. We ...
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Tanos, M., Dunning, J.

[Brief communication - Assisted circulation] Initial experience of enoxaparine as anticoagulant during mechanical circulatory support in children
Unfractioned heparin–infusion is traditionally used for anticoagulation during mechanical circulatory support. We evaluated initial experience of subcutaneous enoxaparine during mechanical circulatory support in children. Nine consecutive children treated with Berlin Heart mechanical support were enrolled in this retrospective analysis. Of these, 3/9 were anticoagulated with enoxaparine, 6/9 anticoagulated with unfractioned heparin served as historical controls. Unfractioned heparin-group was divided in two (early/late) according to patients chronological order. All enoxaparine-treated children survived and had n...
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Mildh, L., Tynkkynen, P., Mattila, I., Rautiainen, P.

[Case report - Transplantation] Stenting of unprotected left main stem stenosis in cardiogenic shock after orthotopic heart transplantation
We report the spectacular case of a young patient who developed cardiogenic shock caused by significant stenosis of the left main stem 8 years after orthotopic cardiac transplantation. Immediate percutaneous coronary intervention was a life saving procedure. The report illustrates the importance of early coronary angiography for the clinical management of heart transplant patients in cardiogenic shock as a relevant differential diagnosis to acute rejection. Allograft vasculopathy can develop unexpectedly even after years of uncomplicated follow-up.
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - van de Loo, A., Beyersdorf, F.

[Case report - Coronary] Off-pump myocardial revascularizaton in a Jehovah's Witness patient with pheochromocytoma
We present a female Jehovah's Witness patient with concomitant severe left main and left anterior descending coronary artery disease and pheochromocytoma who underwent successful off-pump myocardial revascularization. Perioperative management of this patient included alpha-blockade with Doxazosin followed by beta-blockade with Metoprolol. A short-acting Phentolamine was used for alpha-blockade before surgery. Because she refused transfusion of blood and blood products, erythropoietin and iron was used to increase her hemoglobin in both the preoperative and postoperative periods. Intraoperative stategy included off-pump...
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Baciewicz, F. A., Williams, M.

[Case report - Cardiac general] Successful salvage of post-traumatic metallic foreign body partially retained in the posterior papillary muscle of the left ventricle
We report a rare case of a 40-year-old man who had suffered from a metallic foreign body which had punctured from the anterior chest wall into the left ventricle caused by trauma without cardiac tamponade. Surgery was performed. Based on the operation findings, the foreign body was diagnosed as a metallic rusted object partially retained in the posterior papillary muscle. It is very rare particularly for its location, penetrating route of injury and without any symptoms.
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Zhang, C., Hu, J., Ni, Y., Xu, H.

[Case report - Thoracic general] Triple reconstruction of pulmonary artery, superior vena cava and bronchus for lung cancer
We report on a case of a complete resection for bronchogenic carcinoma necessitating right upper sleeve lobectomy with prosthetic replacement of right pulmonary artery (PA) and superior vena cava (SVC). A 74-year-old male with squamous cell carcinoma had a tumor which extended to the right main bronchus, right PA and SVC. After reconstruction of the SVC with a ringed polytetrafluoroethylene (PTFE) graft between the left brachiocephalic vein (BCV) and right atrial auricle, the tumor was completely resected en bloc. Bronchial anastomosis followed by the prosthetic reconstructions of PA and SVC between the right BCV and t...
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Sekine, Y., Yasufuku, K., Motohashi, S., Fujisawa, T.

[Case report - Thoracic general] ICVTS on-line discussion A
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Bayrak, Y.

[Case report - Pulmonary] Pulmonary Langerhans' cell histiocytosis presented with recurrent pneumothorax
Pulmonary Langerhans' cell histiocytosis is a relatively unusual, interstitial lung disease. Several organ systems may be involved, including the lung, bone, liver, lymph nodes and brain. It is known to occur preferentially in heavy smokers, and the cases such as ours presenting pneumothorax as the major clinical manifestation are rare.
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Kim, C. K., Park, C. B., Jin, U., Seo, E. J.

[Case report - Pulmonary] Pulmonary inflammatory myofibroblastic tumor associated with histoplasmosis
Inflammatory myofibroblastic tumors of the lung in children are a non-neoplastic process characterized by an unregulated proliferation of inflammatory cells. The etiology of these ‘tumors’ is not certain and often difficult to ascertain. The current understanding of the pathophysiology of this lesion is based on an abnormal response by the myofibroblast to tissue injury. The vigorous immunologic response observed is commonly ascribed to a viral or foreign antigen–antibody interaction. We describe the case of an 8-year-old boy with inflammatory myofibroblastic tumor of the lung clearly associated with ...
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Cassivi, S. D., Wylam, M. E.

[Case report - Thoracic general] Right postpneumonectomy gained dextrocardia
The negative pressure realized into the hemi thorax with lung pneumonectomy has consequences upon the mediastinum organ statics. This aspect results in expansion of the other lung. These changes are usual but limited in the adult lung pneumonectomy. In the right lung pneumonectomy, the mediastinum moves to the operated part and disturbs the function of the vessels and cavities with thin wall or low pressure (vena cava, right atrium). These aspects are not described in the left lung pneumonectomy. Taking into consideration the previous factors, we present a particular case of a young woman with right lung pneumonectomy;...
Source: Interactive CardioVascular and Thoracic Surgery recent issues ? - July 24, 2006 - Parvulescu, V. N., Camen, D., Ioncica, L., Traistaru, R.