The Open Cardiovascular and Thoracic Surgery Journal最新文献

{"title":"Rapid Ventricular Transvenous Pacing via Pulmonary Artery Catheter:Deliberate Hypotension Technique for Precise Proximal Thoracic AorticStent Graft Deployment","authors":"E. Wittwer, W. Mauermann, N. Torres, G. Oderich, J. Pulido","doi":"10.2174/1876533501508010001","DOIUrl":"https://doi.org/10.2174/1876533501508010001","url":null,"abstract":"Deliberate hypotension facilitates precise deployment of endovascular stent grafting in the thoracic aorta. We describe a practical technique using pulmonary artery catheter (PAC) guided transvenous rapid ventricular pacing via transjugular approach and delineate pertinent anesthetic considerations. Anesthesiologists performed PAC guided rapid ventricular pacing in thirty-nine (39) patients (27 men and 12 women, mean age 74 ± 11 years) undergoing thoracic endograft deployment for aneurysm repair. Patient characteristics, hemodynamic parameters, pacing rate, and number of pacing events were recorded. Post-operative complications were evaluated. PAC guided rapid ventricular pacing successfully provided controlled hypotension without technical complications. Mean pacing rate was 177 ± 17 beats/min with an average of 2.6 ± 2 pacing events/surgical procedure. Average pacing duration was 34 ± 29 seconds (MAP of 47 ± 5 mmHg). One intraoperative death occurred in a patient with severe valvular heart disease. In all other cases, recovery time to baseline hemodynamics was short. Postoperative complications included atrial fibrillation in five patients (12%), elevated troponin levels in eight (21%), and stroke in three (8%). No patients had PAC related complications. Pulmonary artery catheter guided rapid ventricular pacing allows for accurate deployment of thoracic aorta endovascular stent-grafts. Patients with severe valvular or ischemic heart disease are likely poor candidates for this technique.","PeriodicalId":238767,"journal":{"name":"The Open Cardiovascular and Thoracic Surgery Journal","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2015-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127790453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pedunculated Pulmonary Parenchymal Leiomyoma Associated with Hypertrophic Osteoarthropathy: Case Report","authors":"L. Politi, C. Comin, D. Barale, Andrea Lopez Pegna","doi":"10.2174/1876533501407010006","DOIUrl":"https://doi.org/10.2174/1876533501407010006","url":null,"abstract":"Hypertrophic osteoarthropathy, a condition of osteitis of the long bones that manifests clinically with clubbing, is often secondary to a thoracic neoplasm, especially lung carcinoma in long-time smokers. We report an unusual case in which hypertrophic osteoarthropathy was the only manifestation of a benign pulmonary parenchymal leiomyoma. A 38- year-old non-smoking man had bilateral clubbing of the fingers. Hypertrophic osteoarthropathy was diagnosed when radiography revealed thin lamellar deposits along the metatarsals and phalanges of the hands and similar osteal changes in the feet. Respiratory tests indicated normal lung functioning, but computed tomography revealed a 5x4 cm2 lobulated mass in the lower left lung which did not take up 18F-FDG on positron emission tomography. Exploratory thoracotomy revealed a pedunculated neoplasm which was removed by standard lobectomy. Histopathological diagnosis indicated the presence of smooth muscle spindle cells but absence of mitotic activity, nuclear atypia or necrosis, leading to a diagnosis of pulmonary parenchymal leiomyoma. Four months after surgery, the patient experienced a noticeable reduction in the finger clubbing. Hypertrophic osteoarthropathy may be the presenting characteristic of benign masses such as pulmonary leiomyoma.","PeriodicalId":238767,"journal":{"name":"The Open Cardiovascular and Thoracic Surgery Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121316393","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing the Importance of Hemodynamic Obstruction with Diastolic Dysfunction in Patients with Hypertrophic Obstructive Cardiomyopathy","authors":"D. D’Alessandro, E. Skripochnik, R. Michler, Viktoria Hentschel, S. Neragi-Miandoab","doi":"10.2174/1876533501407010001","DOIUrl":"https://doi.org/10.2174/1876533501407010001","url":null,"abstract":"Objective: Myomectomy is the cornerstone of therapy for hypertrophic obstructive cardiomyopathy (HOCM) in the presence of a high gradient. The importance of mechanical gradient across the left ventricle outflow track (LVOT) vs left ventricular diastolic dysfunction (LVDD) is debatable. Methods: We retrospectively analyzed data on 14 patients with HOCM who underwent myomectomy from 2007 to 2011 at our institution. All patients in this study were symptomatic. The purpose of this study was to assess the significance of immediate reduction of the gradient across the LVOT as well as improved LVDD and its correlation with hemodynamics. Results: A total of 14 patients with a mean age of 52.5 ± 19.0 years (male-female ratio of 5/8) were evaluated. The preoperative LVOT peak gradient was 76.9 ± 63.4 mmHg, the left atrial (LA) diameter was 41.9 ± 6.1 mm, and the septal thickness was 15.4 ± 3.2 mm. The relevant preoperative risk factors included DM (23.0%; n = 3), angina pectoris (15.4%; n = 2), cerebrovascular disease (CVD) (30.8%; n = 4), stroke (15.4%; n = 2), arrhythmias (30.8%; n = 4), and COPD (15.4%; n = 2). The concurrent procedures included mitral valve repair/ replacement (MVR) (30.8%; n = 4), aortic valve replacement (AVR) (23.0%; n = 3), coronary artery bypass grafting (CABG) (15.4%; n = 2), and modified MAZE procedure/ablation (15.4%; n = 2). The perioperative mortality was 7.7% (n = 1), and the long-term survival was 85.6% at a median follow up of 30 months. The postoperative LVOT gradient improved to 32.3 ± 24.4 mmHg and the septal thickness to 12.5 ± 3.8 mm. These differences were not statistically significant, likely due to small sample size. The postoperative complications included iatrogenic small VSD in one patient (who had myomectomy for a third time), atrial fibrillation (n = 4), cardiac arrest (7.7%; n = 1), neurologic adverse event (7.7%; n = 1), and new onset renal failure (7.7%; n = 1). We did not observe any new onset AV block. The length of stay (LOS) in the surgical critical care unit was 95.5 ± 112.7 hours. The overall hospital LOS was 15 ± 11.5 days. Conclusion: The septal myomectomy results showed an immediate reduction of the LVOT gradient, which translates into clinical and echocardiographic improvement.","PeriodicalId":238767,"journal":{"name":"The Open Cardiovascular and Thoracic Surgery Journal","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2014-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121839669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Esophagobronchial Fistula Following Corrosive Injury of Esophagus: 2 Cases with Different Etiology But Similar Presentation","authors":"E. Skripochnik, R. Ashton, S. Neragi-Miandoab","doi":"10.2174/1876533501306010016","DOIUrl":"https://doi.org/10.2174/1876533501306010016","url":null,"abstract":"Acquired esophagobronchial fistula (EBF) is a rare condition and its surgical remediation is challenging. Management depends on the cause and degree of the injury. Corrosive substances can be alkaline or acidic in nature. Alkali ingestion commonly causes esophageal injury while acid ingestion most often damages the stomach. However, it is not always clear which gastrointestinal site will be injured. We present two cases of tracheoesophageal fistula with different etiology but similar complication: one due to alkaline ingestion, and one due to acidic ingestion. Both patients had successful surgical management.","PeriodicalId":238767,"journal":{"name":"The Open Cardiovascular and Thoracic Surgery Journal","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132921553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Progress in Radical Surgery for Malignant Pleural Mesothelioma","authors":"L. Politi, G. Girbino, D. Anna, S. Borgianni, D. Barale, G. Tancredi, G. Borzellino, F. Cianchi","doi":"10.2174/1876533501306010010","DOIUrl":"https://doi.org/10.2174/1876533501306010010","url":null,"abstract":"Aim: Stages I and II malignant pleural mesothelioma (MPM) can be satisfactorily treated with extended extrapleural pneumonectomy (EPP). We modified our diagnostic methods and surgical techniques to improve outcome. Methods: 74 patients were treated with EPP, 33 from 1988 to May 2000 (first group), and 41 from June 2000 to 2010 (second group) and all underwent thoracoscopy without mediastinoscopy or laparoscopy prior to EPP. We began to make changes in surgical management in group 2 (2000-2010). Staging was improved using 3D CT scan and Standard Uptake Values (SUV) provided by 2-(Fluorine-18)fluro-2-deoxy-D-glucose positron emission tomography (FDG PET) scan. Talc pleurodesis was used preoperatively in 15 cases. Double unilateral thoracotomy, performed on 24 patients, facilitated dissection of the diaphragm and made alterations in the reconstructive phase possible. Polytetrafluoroethylene (PTFE) prostheses were used instead of biological materials. In 10 cases the pericardium was not reconstructed on the left side after the previous negative experience of functional pericardial concretio that needed the prosthesis removal (Table 1). Topical thrombin was used to reduce postoperative complications whereas posterior prosthetic packing was used to prevent paraprosthetic evisceration and reduce postoperative bleeding. Results: Patients of group 2 experienced less morbidity. Fourteen of the 71 patients who survived beyond the immediate postoperative period lived at least 3 years. Potential positive prognostic factors were identified at follow-up. Conclusions: The innovations we adopted, especially the reconstruction procedures, improved the outcome for our series of patients who underwent extended EPP for MPM. Follow-up results suggest that the MIB-1 index, stage 1 disease, prosthetic diaphragmatic replacement, adjuvant radiotherapy and control are important positive prognostic factors.","PeriodicalId":238767,"journal":{"name":"The Open Cardiovascular and Thoracic Surgery Journal","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133216782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stimulation Along the Vagal Pre and Postganglionic Pathway to Selectively Enhance Vagal Tone to the Heart","authors":"S. Sayers, Donald Thomas, J. Walter, A. Scheiner, R. Dieter, A. Hsieh, Sanjay Singh","doi":"10.2174/1876533520130524001","DOIUrl":"https://doi.org/10.2174/1876533520130524001","url":null,"abstract":"Objectives: Sympathetic overactivity and vagal withdrawal are cardinal presentations in patients with heart failure that predisposes them to malignant arrhythmias and sudden cardiac death. To develop therapy to enhance vagal tone and regain autonomic balance we conducted stimulation recruitment tests at three locations along the cardiac vagal pathway. Materials and Methodology: In anesthetized canines, small electrodes were placed against the vagus nerve (n=4) or in epicardial fat containing the sinoatrial or ventricular cardiac ganglia (n=8). Results: Stimulation of the vagus nerve induced vocal cord evoked potentials at 0.5 mA and increases in heart rate at 1.3 ± 0.3 mA. Higher currents were needed to induce parasympathetic effects of decreased heart rate and blood pressure, 3.7 ± 1.0 mA. Stimulation of the sinoatrial node ganglia decreased heart rate at a threshold current of 4.4 ± 2.1 mA. Stimulation of the ventricular ganglia, produced sympathetic effects at 9.3 ± 0.7 mA of current and ventricular arrhythmias or pacing at 10.7 ± 0.7 mA; using small wire electrodes unwanted sympathetic and ventricular pacing effects occurred at even lower stimulating currents. Conclusion: Our results show that the effects of stimulation are highly dependent upon the site of stimulation and stimulation currents. Further, given the significant side effects of whole nerve stimulation an important need exists for more selective vagal and cardiac ganglia stimulation technology as offered by microelectrode arrays.","PeriodicalId":238767,"journal":{"name":"The Open Cardiovascular and Thoracic Surgery Journal","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2013-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117045769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tension Pneumothorax on Extracorporeal Membrane Oxygenation Leading to Significant Pneumoperitoneum","authors":"K. Holoyda, N. Cavarocchi, H. Hirose","doi":"10.2174/1876533501205010031","DOIUrl":"https://doi.org/10.2174/1876533501205010031","url":null,"abstract":"Veno-venous and veno-arterial extracorporeal membrane oxygenation (ECMO) therapy is used to support the cardiac and pulmonary systems in the setting of acute failure. Maintaining adequate ECMO flow is crucial for the success of the therapy. Sudden decrease in venous return on ECMO has multiple etiologies, such as intravascular hypovolemia, malposition or kink of the venous cannula, suction occlusion of a cannula, and venous or arterial thrombi. Pathology within the chest, including pneumothorax, tension hemothorax and pericardial tamponade, may also decrease the ECMO flow because of compression of the cannula and decreased atrial volume. Air from a tension pneumothorax may be transmitted from the pleural space to the pericardial and contralateral pleural spaces, as well as the peritoneal cavity if significant pressure is applied to either side of the diaphragm, even without diaphragmatic disruption. The case presented here represents a unique presentation of sudden and sustained decrease of ECMO flow secondary to tension pneumothorax, as well as pneumoperitoneum, following a central venous catheter insertion.","PeriodicalId":238767,"journal":{"name":"The Open Cardiovascular and Thoracic Surgery Journal","volume":"2016 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129113056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hydrogen Peroxide Versus Povidone Iodine as Intra-Operative Scolicidal Agents to Attack Hydatid Cysts","authors":"H. Elayouty, Ali M. Baterfy, Soliman H. Alkamash","doi":"10.2174/1876533501205010027","DOIUrl":"https://doi.org/10.2174/1876533501205010027","url":null,"abstract":"Objectives: A prospective randomized study designed to compare results of intra-operative applications of povidone-iodine with those of hydrogen peroxide during surgery for hydatid cysts. Methods: This study includes 160 patients with pulmonary and/or hepatic univesicular hydatid cysts. Group A consisted of 80 patients for whom we used hydrogen peroxide; Group B consisted of 80 patients for whom we used povidone- iodine. Each cyst was examined both macroscopically and microscopically to identify effects of the used scolicidal agent on the wall. Post-operatively, patients received Albendazole as a scolicidal drug for one year. Follow up times ranged between 48 and 84 months. Chest x-rays and abdominal ultrasound examinations were performed every six months to detect any recurrences. Results: There was no peri-operative mortality in either of the two groups. Group A: one case of postoperative prolonged air-leak and two cases of wound infection. No recurrences were reported. Mean hospital stay was 5.5 ± 1.1 days. Group B: two cases of prolonged air leak, three cases of persistent cough and hemoptysis, one developing broncho-pleural fistula that healed (air leak ceased after 19 days), two cases of wound infection, one had subphrenic abscess, nine cases of recurrences, one on the diaphragmatic pleura, two with deep chest wall cysts at sites of thoracostomy tubes, four intraperitonial recurrences, two in the same liver lobe. Recurrences occurred in 11% of the subjects (9/80; p value = 0.028). Mean hospital stay was 9.6 ± 1.5 days. On histologic examination of Group A, the cyst wall lost its integrity, luster and viability and became friable. In Group B the cyst wall maintained most of its luster, integrity, viability and did not become friable. Conclusions: Hydrogen peroxide is a more effective and safer scolicidal drug than povidone-iodine as shown by the differences in mean duration of hospital stay and postoperative recurrence rate significance.","PeriodicalId":238767,"journal":{"name":"The Open Cardiovascular and Thoracic Surgery Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131259726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Levosimendan in Congenitally Corrected Transposition of the Great Arteries: A Case Report","authors":"L. Mantziari, V. Kamperidis, G. Giannakoulas, C. Davos, H. Karvounis, V. Vassilikos, I. Styliadis","doi":"10.2174/1876533501205010024","DOIUrl":"https://doi.org/10.2174/1876533501205010024","url":null,"abstract":"We present a case of acute decompensated heart failure in a patient with congenitally corrected transposition of great arteries treated with levosimendan, an agent with positive inotropic and vasodilatory effects. Levosimendan infusion resulted in symptomatic and functional improvement, improvement of the subpulmonary left ventricular systolic function and amelioration of the diastolic but not the systolic function of the systemic right ventricle. A number of factors may account for the poor response of the systemic right ventricle to levosimendan, such as altered myofibrillar structure and coronary flow together with the particular loading conditions of the systemic right ventricle.","PeriodicalId":238767,"journal":{"name":"The Open Cardiovascular and Thoracic Surgery Journal","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130399863","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Report: Identification of a Small Valsalva Sinus Pseudoaneurysm Following Type A Aortic Dissection Using 64 Slice CT Angiography","authors":"F. Bizzarri, A. Winfield, S. Congiu","doi":"10.2174/1876533501205010021","DOIUrl":"https://doi.org/10.2174/1876533501205010021","url":null,"abstract":"Pseudoaneurysms are rare complications occurring after prosthetic ascending or aortic arch replacement for the treatment of dissections, aneurysms and aortic dilatation with or without aortic valve pathology, and are a consequence of suture line weakness and increased tissue fragility. However, in cases of thoracic aorta reconstructive surgery, the occurrence of false aneurysms or dissections originating from suture lines between grafts and the aorta varies greatly. Suture line disruption is a life threatening complication after thoracic aortic surgery that always requires reoperation. This case emphasises the potential role of CT scanning in the follow-up of patients after aortic surgery.","PeriodicalId":238767,"journal":{"name":"The Open Cardiovascular and Thoracic Surgery Journal","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2012-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126568912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}