Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jul 2011
Mid-term results of tricuspid annuloplasty using the MC3 ring for secondary tricuspid valve regurgitation.
We investigated mid-term outcomes after ring annuloplasty with the MC3 ring and aimed to identify factors associated with recurrent tricuspid regurgitation (TR). From October 2006 to October 2010, 136 patients (male:female 80:56, with a mean age 64.7±11.8 years) underwent tricuspid valve (TV) annuloplasty for functional TR. The indications for TV annuloplasty were (1) severe TR, or (2) mild or moderate TR with pulmonary hypertension (systolic pulmonary artery pressure >50 mmHg) or tricuspid annular (TA) dilatation, in patients undergoing mitral valve (MV) surgery. ⋯ Multivariate analysis revealed that residual TR was significantly associated with preoperative severe TR, left ventricular end-diastolic dimension >70 mm, right ventricular dimension >40 mm, dilated cardiomyopathy (DCM) and left ventriculoplasty. This MC3 ring corrects TR effectively, and provided good results. We must point out, however, that additional or alternative surgical options should still be considered for high-risk of repair failure, such as those with DCM or high pulmonary hypertension.
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Interact Cardiovasc Thorac Surg · Jul 2011
Feasibility of blood conservation strategies in pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension.
Blood transfusion requirements were reviewed for a consecutive series of 25 patients undergoing elective pulmonary endarterectomy (PEA) between August 2005 and March 2009 in our institution. Patients were divided into two groups based on the implementation of a conservative blood transfusion algorithm that combined antifibrinolytic therapy, intraoperative blood sequestration, blood salvage and lack of correction of coagulation parameters in the absence of ongoing bleeding. ⋯ The international normalized ratio normalized within six to 12 hours after discontinuation of cardiopulmonary bypass without transfusion of fresh frozen plasma or platelets in 13 of the 16 patients. In conclusion, a conservative blood transfusion strategy allows PEA to be safely performed with no or minimal blood product transfusions in a majority of patients despite deep hypothermic circulatory arrest.
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Interact Cardiovasc Thorac Surg · Jul 2011
Number of recurrent lesions is a prognostic factor in recurrent thymoma.
In advanced stage thymomas, recurrence is not uncommon but prognostic factors in recurrent thymoma have not been determined and standardized treatment for recurrence has not yet been established. A retrospective analysis was conducted on 24 thymoma patients who underwent treatment for recurrence in our institution to determine the prognostic factors for overall survival. Recurrence of thymoma appeared 11.6-109.6 months after the primary operation (34.6±25.7 months). ⋯ Patients with one or two recurrent lesions detected on CT examinations showed better prognosis. Prognosis in thymoma patients with recurrence was reviewed in the present study. Patients with a small number of recurrent lesions showed better prognosis irrespective of the treatment.
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Interact Cardiovasc Thorac Surg · Jul 2011
Case ReportsMalpositioning of the chest tube across the anterior mediastinum is risky in chronic obstructive pulmonary disease patients with pneumothorax.
Malpositioning is one of the most common complications of chest tube insertion and is associated with increased morbidity and mortality. We present two cases of patients with chronic obstructive pulmonary disorder (COPD) in whom malpositioned chest tubes penetrated through the anterior mediastinum to the contralateral pleural cavity, and were later removed without complications. Both patients had a relatively wide retrosternal airspace and received blunt dissection with a trocar for percutaneous chest tube insertion, which may have increased the risk of chest tube penetration through the anterior mediastinum during tube thoracostomy. Further, the precise location of the malpositioned chest tubes could not be confirmed by single-view anteroposterior portable chest radiography, and computed tomography (CT)-scan was more helpful in the diagnosis and management of the cases reported herein.