The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Aug 2014
Interpapillary muscle distance independently affects severity of functional mitral regurgitation in patients with systolic left ventricular dysfunction.
Surgical papillary muscle (PM) imbrication has been reported to be effective to relieve leaflet tethering in patients with functional mitral regurgitation (FMR). However, the mechanism that contributes to improvement of FMR by shortening the interpapillary muscle distance (IPMD) has not been well investigated. The purpose of the present study was to investigate whether IPMD can affect MR severity independently of PM tethering distance in patients with left ventricular dysfunction (LVD) using multislice computed tomography. ⋯ IPMD, which affects leaflet tethering independently of PM tethering distance, was the major determinant of mitral tenting volume and FMR severity in patients with LVD.
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J. Thorac. Cardiovasc. Surg. · Aug 2014
First nationwide survey of US integrated 6-year cardiothoracic surgical residency program directors.
The recently implemented integrated 6-year (I-6) format represents a significant change in cardiothoracic surgical residency training. We report the results of the first nationwide survey assessing I-6 program directors' impressions of this new format. ⋯ High satisfaction rates with the I-6 format were prevalent among I-6 program directors. However, concerns with respect to training relatively less experienced, mature trainees were evident.
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J. Thorac. Cardiovasc. Surg. · Aug 2014
Laryngopharyngeal dysfunction independent of vocal fold palsy in infants after aortic arch interventions.
Laryngopharyngeal dysfunction contributes significantly to morbidity, length of stay, and increased resource utilization after aortic arch interventions in infants. Previous studies have focused on postoperative evaluation of selected symptomatic patients with vocal fold palsy (VFP). A prospective evaluation of laryngopharyngeal function was undertaken to assess and determine its importance in perioperative management. ⋯ Postoperative laryngopharyngeal dysfunction is common among infants undergoing aortic arch interventions, and is largely independent of vocal fold function. Preoperative evaluation demonstrates significant intrinsic abnormalities in sensory and motor function. Routine, comprehensive, multimodality preoperative and postoperative evaluation is required to identify at-risk children and reduce morbidity and resource utilization.
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J. Thorac. Cardiovasc. Surg. · Aug 2014
Clinical, biochemical, and genetic predictors of coronary artery bypass graft failure.
To identify novel predictors for coronary artery bypass grafting failure, we probed for associations with known clinical and biochemical risk factors for atherosclerosis. We also used microarray analysis to identify novel single nucleotide polymorphisms to better understand the genetics and pathogenesis of graft occlusion. ⋯ We identified diabetes as a potential clinical predictor and plasma fibrinogen, creatinine, and high-density lipoprotein as potential novel biomarkers. These might help risk stratify patients for the development of graft failure. We also demonstrated a novel association between glutathione-S-transferase α3 and graft failure.
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J. Thorac. Cardiovasc. Surg. · Aug 2014
Surgery of massive hemoptysis in pulmonary tuberculosis: immediate and long-term outcomes.
To determine the current role of surgery and the risks and operative outcomes in patients with massive hemoptysis caused by pulmonary tuberculosis. ⋯ In the present study, the immediate and long-term outcomes after surgery for patients with massive hemoptysis caused by pulmonary tuberculosis were fairly satisfactory. The morbidity and mortality were also acceptable. However, delayed elective surgery is preferred and emergency surgery should be reserved for patients with persistent life-threatening hemoptysis despite a multidisciplinary intervention.