Abstract: Retrospective analysis revealed that 24 of 4401 adult patients (0.5%) developed severe gastrointestinal complications after open heart surgery during a 3-year period from January 1995. There were 4...

Abstract: All patients who received a Carbomedics heart valve prosthesis were assessed retrospectively by interview regarding thromboembolic, hemorrhagic, or other valve-related events. In cases of such even...

Abstract: An internal carotid artery-to-internal jugular vein fistula was observed at angiography in a 35-year-old man who had sustained a gunshot injury 6 months earlier. Successful repair required institution of cardiopulmonary bypass.

Abstract: Cardiac myxoma was detected by transthoracic echocardiography in 8 patients (aged 11 to 64 years) who were admitted between 1991 and 1999 with stroke or transient ischemic attacks, representing 80% of the total myxoma cases treated in this period. All patients underwent surgery and the myxomas were successfully removed. There were no recurrences during a mean follow-up of 3.1 years. In the presence of unexplained transient ischemic attack, cerebral infarction, or syncope, this relatively rare cardiac lesion should be suspected and investigated by transthoracic echocardiography.

Abstract: Empyema is a serious complication of bacterial pneumonia in children. Between July 1992 and July 1998, 53 children aged 7 months to 12 years (mean age, 5.5 years) were treated for empyema complicating pneumonia. After diagnostic thoracentesis, closed tube drainage was carried out with appropriate antibiotic therapy and other treatment strategies such as pleural lavage, intrapleural enzymatic debridement, decortication, or pulmonary resection, according to the effectiveness of drainage and clinical status. There was one death from toxic shock. It was concluded that early decortication in the chronic stage of the disease is a safe and effective treatment modality.

Abstract: From 1993 to 1998, 19 patients with mediastinal tuberculosis underwent mediastinoscopy without any demonstrable parenchymal lesion and with negative diagnostic bronchoscopy. The mean age was 34.4 years (range, 15 to 67 years) and 10 were male. The most common symptom was cough in 12 patients, 4 were asymptomatic. Computed tomography showed involvement of the right paratracheal nodal station in 8 cases. Multiple biopsies of 3 to 5 mediastinal nodal stations diagnosed tuberculous lymphadenitis in 16 patients; in 5 of these, nonspecific inflammatory nodes were also sampled. In 3 patients who had biopsies of 1 mediastinal nodal station, the diagnosis could not be established. It was concluded that when used effectively, mediastinoscopy was acceptable as a final diagnostic step in patients with mediastinal tuberculous lymphadenitis.

Abstract: Diabetic renal transplant candidates have a high prevalence of obstructive coronary artery disease that is a major cause of morbidity and mortality. This study sought to stratify the risk for renal transplantation by correlating noninvasive tests with arteriographic findings. Fifty-two diabetics (46 males, 6 females) with end-stage renal disease were evaluated noninvasively and by coronary arteriography. The mean age was 46 ± 6 years. Twenty-five patients (48%) had noninvasive evidence of coronary artery disease (angina in 10, old myocardial infarction on electrocardiogram in 6, ST-T changes in 8, regional wall motion abnormality on echocardiography in 8, positive dobutamine echocardiogram in 4, and positive dipyridamole thallium tests in 13). Obstructive coronary artery disease was demonstrated by arteriography in 27 (51.9%). Concordance between noninvasive findings and arteriography was 65.3%. Obstructive coronary disease was present in 66.7% of those with 2 noninvasive indications, in all with more tha...

Abstract: Records of 103 patients with constrictive pericarditis who underwent subtotal pericardiectomy from January 1990 to December 1997 were retrospectively analyzed. The etiology of pericardial constrict...

Abstract: Postoperative blood loss, blood and blood-product requirements, and complications were compared for 3 commonly used doses of epsilon-aminocaproic acid in 150 patients undergoing first-time coronary artery bypass surgery. The patients were randomly assigned to one of 4 groups. Group 1 (n = 30) served as a control, group 2 (n = 30) received a single dose of 150 mg·kg−1 of epsilon-aminocaproic acid after anesthetic induction, group 3 (n = 30) received a loading dose of 150 mg·kg−1 followed by infusion of 1 g·h−1 for 6 hours, and group 4 (n = 60) received doses of 150 mg·kg−1 at induction, on bypass, and after protamine. No patients, including those who had endarterectomies, experienced any complications attributable to epsilon-aminocaproic acid administration. All patients who received epsilon-aminocaproic acid had significantly less bleeding compared to controls. Groups 3 and 4 had the least blood loss and packed-cell requirements.

Abstract: A retrospective analysis was performed to determine the surgeon's impact on the selection of the size of prosthesis in aortic valve replacement. From January 1993 through December 1997, 748 patients underwent either isolated aortic valve replacement (530) or double valve replacement (218) with bileaflet valves. Depending on the operating surgeon, patients were divided into group A (367) or group B (381). Preoperative, intraoperative, and postoperative variables in both groups were compared. Groups A and B were identical in demographic and clinical profiles. Cardiopulmonary bypass time, ischemic time, and early and late results in both groups were similar. Significantly more patients undergoing isolated aortic valve replacement in group A (169; 67.9%) received a large (≥25 mm) prosthesis compared with group B (69; 24.5%). Compared with group B, a large prosthesis was used in a significantly greater proportion of all patients in group A, irrespective of etiology, predominant aortic valve lesion, and age of ...

Abstract: A 68-year-old man underwent coronary angiography for postinfarction angina, which revealed right coronary artery stenosis and a mass in the left ventricle. Transesophageal echocardiography showed a large blood cyst originating from the anterior papillary muscle of the mitral valve. Coronary artery bypass grafting was performed and the cyst was successfully excised.

Abstract: Aortocaval fistula is a rare complication of rupture of an aortic aneurysm into the inferior vena cava. Prompt surgical repair is mandatory for salvage. Emergency surgery was performed in 2 cases of aortocaval fistula. The underlying etiology was polyarteritis nodosa in one patient and atherosclerosis in the other. Polyarteritis nodosa leading to abdominal aortic aneurysm with aortocaval fistula is reported for the first time.

Abstract: A 14-year-old boy was investigated for unexplained tachycardia and multiple pulmonary emboli demonstrated by computed tomography. A right ventricular hydatid cyst was diagnosed by echocardiography and successfully excised under cardiopulmonary bypass.

Abstract: Between 1988 and 1998, 7 patients with coronary arteriovenous fistulas were treated surgically. Indications for surgery were congestive heart failure and marked left-to-right shunt in association with ischemic heart disease. Long-term follow-up (mean, 99 ± 37 months) was complete and mainly uneventful. Coronary arterio-venous fistulas can be successfully managed by surgery and patients should be treated without delay because complications of an untreated fistula may increase the complexity of the operation.

Abstract: Right thoracotomy provides an alternative approach for commissurotomy in selected cases of mitral valve disease. From 1970 through 1985, over 300 patients underwent closed mitral commissurotomy by this approach, with satisfactory early results.

Abstract: To evaluate serum troponin T as a marker of perioperative myocardial infarction, 50 patients undergoing coronary artery bypass grafting were divided into 2 groups. Group A (14 patients) had serum c...

Abstract: A retrograde coronary sinus cardioplegia catheter was used for administration of retrograde cardioplegic solution in 620 of 942 coronary bypass procedures performed over a 3-year period. Coronary sinus injuries were encountered in 4 patients (0.65%).

Abstract: To evaluate myocardial impairment induced by uncontrolled reoxygenation, the effects of hypoxia-reoxygenation were compared with ischemia-reperfusion in isolated rat hearts. After stabilization, 2 groups (n = 8) of Langendorff-perfused rat hearts were exposed to 40 minutes of ischemia (10% of baseline flow) or hypoxia (10% of baseline oxygen content) followed by a sudden return to baseline conditions (reperfusion or reoxygenation). The O2 content was identical for the two groups during baseline conditions, O2 shortage, and O2 readmission. Metabolic (lactate production) and functional parameters (heart rate, peak systolic pressure, left ventricular developed pressure, maximal contraction and relaxation rates, end-diastolic pressure, coronary perfusion pressure) were recorded at the end of stabilization, after O2 deficiency, and after 2 minutes of reoxygenation. Systolic function was significantly depressed after ischemia (p < 0.0001) but completely recovered to baseline values after 2 minutes of reperfusio...

Abstract: Thromboembolic complications and valve thrombosis in pericardial xenografts are rare. A case of early postoperative thrombosis of a pericardial xenograft is described.

Abstract: Between April 1996 through March 1999, 15 patients with severe (> 60%) left main coronary artery stenosis became hemodynamically unstable on induction of anesthesia, in spite of optimal pharmacological management. Retrograde coronary sinus perfusion was instituted soon after the median sternotomy to improve hemodynamics until the establishment of cardiopulmonary bypass after harvesting internal mammary artery and saphenous vein grafts.

Abstract: From January 1986 to December 1997, 17 patients (12 males and 5 females) aged 13 to 70 years were treated for primary neoplasms of the chest wall. There were 4 cases of fibrous dysplasia, 3 each of chondrosarcoma and Askin's tumor, 2 of plasmacytoma, and 1 each of fibrosarcoma, Ewing's sarcoma, synovial sarcoma, osteosarcoma, and enchondroma. All patients, except the case of Ewing's sarcoma, underwent wide excision or debulking for unresectable tumor, and reconstruction of the chest wall. Preoperative neoadjuvant chemotherapy was given to 1 patient with osteosarcoma, radiotherapy and chemotherapy were given to 2 others. In 8 patients, the skeletal defect was reconstructed with prosthetic material. Soft tissue reconstructive procedures with various myocutaneous flaps were performed in 6 patients. None of the patients required mechanical ventilation postoperatively. There were 2 early deaths. During follow-up of 3 months to 10 years, all patients with benign tumors were free of recurrence, 2 with Askin's tu...

Abstract: From September 1994 to September 1999, 50 patients underwent successful aortic valve reconstruction. Four were lost to follow-up, there were 2 early and 2 late deaths. The remaining 35 males and 11 females (mean age, 39.1 years) were followed up for 1 to 61 months (mean, 30.75 months). Most had rheumatic disease (27), the others had infective endocarditis (16) or degenerative disease (3). There was isolated aortic valve disease in 22 cases, double-valve disease in 16, triple-valve disease in 7, and 1 other. Preoperative aortic regurgitation was severe in most cases and the mean ejection fraction was 55.3%. Surgical procedures included subcommissural annuloplasty (14), cusp thinning (13), commissurotomy (10), and free-edge unrolling (10). Cusp extension with autologous pericardium was performed in 9 patients and aortic valve replacement with autologous pericardium in 22. Nine patients needed aortic valve replacement at a mean of 15.8 months postoperatively. The other 33 patients experienced marked improvem...

Abstract: Between 1996 and 1998, surgery was carried out in 4 patients with myocardial bridging who had angina refractory to medical therapy. Two patients were treated by supraarterial myotomy and 2 underwent coronary artery bypass grafting. One patient suffered a right ventricular perforation that was successfully repaired. Surgery is recommended for a grade-III myocardial bridge.

Abstract: Spontaneous dissection of a coronary artery is a rare cause of obstructive coronary artery disease and sudden death. We report a case of spontaneous dissection of the left main coronary artery, whi...

Abstract: Angiography is the usual means of assessing the patency of grafted internal mammary artery. The feasibility of assessing patency by Doppler echocardiography was studied prospectively in 49 patients undergoing left internal mammary artery-to-left anterior descending coronary artery anastomosis. Postoperative angiographic findings were normal in 45 patients (92%), 2 had > 70% and 2 had 70% narrowing of the graft in the other). Thallium scanning in patients with suboptimal angiographic results but unobstructed Doppler flow patterns showed no evidence of myocardial ischemia in the left anterior descending artery territory. Echocardiography is a sensitive noninvasive screening...

Abstract: Between January 1989 and December 1998, 13 patients (7 males) aged 3 months to 32 years, underwent surgery for anomalous left coronary artery from the pulmonary artery. Eight presented with congestive cardiac failure and all had evidence of left ventricular dysfunction. One patient had associated tetralogy of Fallot. Preoperative diagnosis was established by echocardiography and cineangiography. Nine patients underwent Takeuchi repair and 4 had direct implantation of the anomalous artery into the aorta. There were 2 postoperative deaths due to low cardiac output. In survivors, serial echocardiograms demonstrated significant improvement in left ventricular function 3 months to 10 years after surgery. Postoperative angiograms in 4 patients showed a patent aortocoronary tunnel in 3 who underwent Takeuchi repair and a patent aortocoronary anastomosis in one who had direct implantation of the anomalous artery into the aorta. It was concluded that early establishment of a two-coronary system gave gratifying sho...

Abstract: An asymptomatic 24-year-old man underwent surgical correction of an aorto-left ventricular tunnel. A 1-cm opening was found 1 cm above the commissure of the left and right coronary cusps, which communicated with the left ventricle. It was successfully closed by direct suture.

Abstract: Multiple anastomotic suture lines in aortic aneurysm surgery are prone to bleeding. To improve hemostasis, a 15-mm-wide strip of native pericardium was used to reinforce all anastomotic suture lines. This technique was used in 4 consecutive patients who underwent modified Bentall and elephant trunk procedures for extensive aortic aneurysm. The mean cardiopulmonary bypass time was 230 minutes and the mean aortic crossclamp time was 92 minutes. Mean blood loss through the mediastinal drainage tubes was 193 mL in the first 12 hours postoperatively and the mean blood requirement was 3 units. It was concluded that this technique markedly improved hemostasis in extensive aortic aneurysm surgery.

Abstract: Successful beating heart multiple bypass grafting to the left anterior descending and circumflex artery for a left main trunk lesion was performed in 5 patients through a left thoracotomy using the “MIDCAB doughnut” for immobilization and hemostasis. After completion of left internal thoracic artery-to-left anterior descending artery grafting, a radial artery or saphenous vein graft was anastomosed safely to the obtuse marginal branch, without hemodynamic deterioration. Extending the left anterior small thoracotomy 3 or 4 cm laterally, the obtuse marginal branch could be approached easily without rotating the beating heart. The device achieved a still and stable operative field even for circumflex grafting. An inflow of the graft to the circumflex was placed at the left axillary artery to prevent blood flow shortage to the left coronary system. Mean perioperative blood flow was 29.5 ± 7.1 mL·min−1 in the internal thoracic artery grafts and 43 ± 8 mL·min−1 in the circumflex grafts. Postoperative angiograph...