Pub Date : 2020-02-12DOI: 10.4236/wjcs.2020.102004
A. Maheshwari, Ravi Gupta, Debmalya Saha, S. Naqvi, H. Minhas, M. Geelani
Background: Small aortic annulus during aortic valve replacement can lead to implanting a smaller sized valve compared to the body surface area thereby causing patient prosthesis mismatch. Various aortic root enlargement techniques have been described depending on anterior or posterior approach. Konno procedure uses anterior approach for aortic root enlargement. In this study, we reviewed results of Konno procedure done from 2011 to 2019 by a single surgeon. Methods: 12 adult patients who underwent aortic valve replacement along with Konno procedure for small aortic root by a single surgeon at a single center between 2011 and 2019 were reviewed. Echocardiographic and demographic data and post-operative data were obtained from medical records. Symptomatic profile was assessed as per New York Heart Association Classification. Intraoperative findings and post-operative period findings were noted. Follow up symptom profile was assessed for these patients. Results: 12 patients underwent Konno procedure between 2011 and 2019 for small aortic root along with valve replacement. The main indication for surgery was aortic stenosis with small aortic annulus, with or without involvement of the mitral valve. Preoperatively, 3 patients had NYHA class II and 9 patients had NYHA class III symptoms. Mean age at operation was 26.42 years, minimum age 10 years, and maximum age 39 years. 3 were females and 9 were males. Mean bypass time was 106.4 minutes and aortic cross clamp time was 80.67 minutes. Mechanical aortic valves were implanted in all patients. Mean post-operative blood loss was 134.2 ml and duration of ventilation before extubation was 14.5 hours. Mean duration of intensive care unit (ICU) stay was 2.83 days and hospital stay was 9.1 days. Mean gradient in the post-operative period was 10.75 mm Hg. There was no mortality in these 12 patients and no reoperation was needed in the follow up period. Follow up in the outpatient department suggested all patients had NYHA class I symptoms and anticoagulation with warfarin adjusted to prothrombin time— International normalised ratio. Conclusion: Konno procedure is effective for managing small aortic root as bigger outflow orifice area through the larger valve prosthesis improves ventricular outflow and hence, improves the outcomes.
背景:主动脉瓣置换术中主动脉环小可能导致植入的瓣膜尺寸小于体表面积，从而导致患者假体不匹配。根据前路或后路的不同，已经描述了各种主动脉根部扩大技术。Konno手术采用前路手术治疗主动脉根部肿大。在这项研究中，我们回顾了2011年至2019年由一名外科医生进行的Konno手术的结果。方法:回顾了2011年至2019年在单一中心由同一名外科医生接受主动脉瓣置换术和Konno手术治疗小主动脉根的12例成年患者。超声心动图和人口统计资料及术后资料均来自医疗记录。根据纽约心脏协会分类对症状进行评估。记录术中及术后表现。对这些患者的随访症状进行评估。结果:2011年至2019年期间，12名患者接受了Konno手术治疗小主动脉根并进行了瓣膜置换术。手术的主要指征是主动脉狭窄伴小主动脉环，伴或不伴二尖瓣受累。术前3例出现NYHA II级症状，9例出现NYHA III级症状。平均手术年龄26.42岁，最小年龄10岁，最大年龄39岁。女性3例，男性9例。平均旁路时间106.4分钟，主动脉交叉夹持时间80.67分钟。所有患者均植入机械主动脉瓣。术后平均失血量134.2 ml，拔管前通气时间14.5小时。重症监护病房(ICU)平均住院时间2.83天，住院时间9.1天。术后平均梯度为10.75 mm Hg, 12例患者无死亡，随访期间无再次手术。门诊随访提示所有患者均有NYHA I级症状，并使用华法林调整至凝血酶原时间-国际正常化比率抗凝。结论:Konno手术是治疗小主动脉根的有效方法，通过较大的瓣膜假体扩大流出口面积，改善心室流出，从而改善预后。
{"title":"Konno Procedure for Managing Small Aortic Root during Aortic Valve Replacement Surgery: An Experience of 12 Cases","authors":"A. Maheshwari, Ravi Gupta, Debmalya Saha, S. Naqvi, H. Minhas, M. Geelani","doi":"10.4236/wjcs.2020.102004","DOIUrl":"https://doi.org/10.4236/wjcs.2020.102004","url":null,"abstract":"Background: Small aortic annulus during aortic valve replacement can lead to implanting a smaller sized valve compared to the body surface area thereby causing patient prosthesis mismatch. Various aortic root enlargement techniques have been described depending on anterior or posterior approach. Konno procedure uses anterior approach for aortic root enlargement. In this study, we reviewed results of Konno procedure done from 2011 to 2019 by a single surgeon. Methods: 12 adult patients who underwent aortic valve replacement along with Konno procedure for small aortic root by a single surgeon at a single center between 2011 and 2019 were reviewed. Echocardiographic and demographic data and post-operative data were obtained from medical records. Symptomatic profile was assessed as per New York Heart Association Classification. Intraoperative findings and post-operative period findings were noted. Follow up symptom profile was assessed for these patients. Results: 12 patients underwent Konno procedure between 2011 and 2019 for small aortic root along with valve replacement. The main indication for surgery was aortic stenosis with small aortic annulus, with or without involvement of the mitral valve. Preoperatively, 3 patients had NYHA class II and 9 patients had NYHA class III symptoms. Mean age at operation was 26.42 years, minimum age 10 years, and maximum age 39 years. 3 were females and 9 were males. Mean bypass time was 106.4 minutes and aortic cross clamp time was 80.67 minutes. Mechanical aortic valves were implanted in all patients. Mean post-operative blood loss was 134.2 ml and duration of ventilation before extubation was 14.5 hours. Mean duration of intensive care unit (ICU) stay was 2.83 days and hospital stay was 9.1 days. Mean gradient in the post-operative period was 10.75 mm Hg. There was no mortality in these 12 patients and no reoperation was needed in the follow up period. Follow up in the outpatient department suggested all patients had NYHA class I symptoms and anticoagulation with warfarin adjusted to prothrombin time— International normalised ratio. Conclusion: Konno procedure is effective for managing small aortic root as bigger outflow orifice area through the larger valve prosthesis improves ventricular outflow and hence, improves the outcomes.","PeriodicalId":23646,"journal":{"name":"World Journal of Cardiovascular Surgery","volume":"123 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83954507","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}
Pub Date : 2020-02-12DOI: 10.4236/wjcs.2020.102003
P. A. Dieng, M. Gaye, N. F. Sow, M. Doumbia, S. Diatta, M. Diop, Papa Amath Diagne, A. G. Ciss
Summary: The diagnosis of venous insufficiency is increasing. Multiple techniques are available for its treatment. Chemical sclerotherapy has been performed for over 70 years. The technique improves lately. Objective: This study was conducted to assess early results of foam sclerotherapy in Senegal. Patients and Methods: This is a prospective and descriptive study conducted from January 1st, 2012 to December 31st, 2015 at cardiovascular center of Fann University hospital in Dakar, Senegal. Foam sclerotherapy was done in 76 patients. Polidocanol was used in concentration of 2%. Sclerotherapy was done several times in patients, every week, as much as needed to occlude varicose veins. We used venous compression in all patients. Results: Foam sclerotherapy sessions permitted to get globally good results. In fact, tight feeling and painful leg disappear in 97% of patients. Decreases of edema were gotten in 97% of patients. For leg ulcer, 64% of complete healing was obtained. The main ulcer healing time was 47 days (18; 72). Some minor complications occurred. No major events, such as deep venous thrombosis or pulmonary embolism, were observed. Conclusion: Foam sclerotherapy is an efficient technique for the treatment of varicose veins of the limbs. Also, it opens good perspectives for vein care.
摘要:静脉功能不全的诊断越来越多。有多种治疗方法。化学硬化疗法已有70多年的历史。这项技术最近有所改进。目的:本研究旨在评估塞内加尔泡沫硬化疗法的早期效果。患者和方法:2012年1月1日至2015年12月31日在塞内加尔达喀尔范恩大学医院心血管中心进行的前瞻性描述性研究。76例患者采用泡沫硬化疗法。聚醚醇浓度为2%。每周对患者进行多次硬化治疗，尽可能多地闭塞静脉曲张。我们对所有患者进行静脉压迫。结果:泡沫硬化疗法可获得全面良好的效果。事实上，97%的患者的紧绷感和腿痛消失。97%的患者水肿减轻。腿部溃疡的完全愈合率为64%。主要溃疡愈合时间为47 d (18;72)。发生了一些小并发症。未观察到深静脉血栓形成或肺栓塞等重大事件。结论:泡沫硬化疗法是治疗四肢静脉曲张的有效方法。同时，它也为静脉护理开辟了良好的前景。
{"title":"Sclerotherapy for Varicose Veins of the Lower Limbs","authors":"P. A. Dieng, M. Gaye, N. F. Sow, M. Doumbia, S. Diatta, M. Diop, Papa Amath Diagne, A. G. Ciss","doi":"10.4236/wjcs.2020.102003","DOIUrl":"https://doi.org/10.4236/wjcs.2020.102003","url":null,"abstract":"Summary: The diagnosis of venous insufficiency is increasing. Multiple techniques are available for its treatment. Chemical sclerotherapy has been performed for over 70 years. The technique improves lately. Objective: This study was conducted to assess early results of foam sclerotherapy in Senegal. Patients and Methods: This is a prospective and descriptive study conducted from January 1st, 2012 to December 31st, 2015 at cardiovascular center of Fann University hospital in Dakar, Senegal. Foam sclerotherapy was done in 76 patients. Polidocanol was used in concentration of 2%. Sclerotherapy was done several times in patients, every week, as much as needed to occlude varicose veins. We used venous compression in all patients. Results: Foam sclerotherapy sessions permitted to get globally good results. In fact, tight feeling and painful leg disappear in 97% of patients. Decreases of edema were gotten in 97% of patients. For leg ulcer, 64% of complete healing was obtained. The main ulcer healing time was 47 days (18; 72). Some minor complications occurred. No major events, such as deep venous thrombosis or pulmonary embolism, were observed. Conclusion: Foam sclerotherapy is an efficient technique for the treatment of varicose veins of the limbs. Also, it opens good perspectives for vein care.","PeriodicalId":23646,"journal":{"name":"World Journal of Cardiovascular Surgery","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75451910","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}
Pub Date : 2020-01-16DOI: 10.4236/wjcs.2020.101002
Aykut Şahin, Cengiz Ovalı
Introduction: Treatment of combined coronary artery surgery (CABG) and severe carotid artery stenosis is still controversial. The decision of surgical priority can change according to the severity of the coronary artery disease or carotid artery disease at staged surgery. The aim of the study is to compare the outcomes of simultaneous surgery (CEA + CABG) and CABG alone at our department. Materials and Methods: We retrospectively reviewed the CABG and CEA + CABG patients which were performed between 2010 and 2015. If the patients had simultaneous another operation, they were excluded from the study. A total of 294 patients (252 CABG patients and 42 combined surgery patients), were retrospectively examined. Results: Two patients in CABG group and two patients in CABG + CEA group developed stroke. There was no statistically significant difference between the two groups in terms of early stroke rate (p > 0.05). One patient in CEA + CABG group and three patients in CABG group died. The average carotid clamp time was 19.93 ± 5.06 minutes. Aortic clamp times were 42.89 ± 6.38 minutes in CABG and 42.81 ± 5.70 minutes in CEA + CABG patients. Results of the two groups were similar. Conclusion: Combined CEA and CABG can be performed successfully and safely in patients.
{"title":"Comparison of Coronary Bypass Grafting Surgery with Carotid Endarterectomy and Coronary Bypass Grafting Surgery","authors":"Aykut Şahin, Cengiz Ovalı","doi":"10.4236/wjcs.2020.101002","DOIUrl":"https://doi.org/10.4236/wjcs.2020.101002","url":null,"abstract":"Introduction: Treatment of combined coronary artery surgery (CABG) and severe carotid \u0000artery stenosis is still controversial. The decision of surgical priority can \u0000change according to the severity of the coronary artery disease or carotid \u0000artery disease at staged surgery. The aim of the study is to compare the \u0000outcomes of simultaneous surgery (CEA + CABG) and CABG alone at our department. Materials and Methods: We retrospectively reviewed the CABG and CEA + \u0000CABG patients which were performed between 2010 and 2015. If the patients had simultaneous \u0000another operation, they were excluded from the study. A total of 294 patients \u0000(252 CABG patients and 42 combined surgery patients), were retrospectively \u0000examined. Results: Two patients in CABG group and two patients in CABG + \u0000CEA group developed stroke. There was no statistically significant \u0000difference between the two groups in terms of early stroke rate (p > 0.05). \u0000One patient in CEA + CABG group and three patients in CABG group died. The average \u0000carotid clamp time was 19.93 ± 5.06 minutes. Aortic clamp times were 42.89 ± \u00006.38 minutes in CABG and 42.81 ± 5.70 minutes in CEA + CABG patients. Results \u0000of the two groups were similar. Conclusion: Combined CEA and CABG can be \u0000performed successfully and safely in patients.","PeriodicalId":23646,"journal":{"name":"World Journal of Cardiovascular Surgery","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84478742","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}
Pub Date : 2020-01-16DOI: 10.4236/wjcs.2020.101001
E. Gupta, K. Carey, L. McDermott, N. Cavarocchi, H. Hirose, M. Baram
Background: Even with the use of extracorporeal membrane oxygenation (ECMO) in acute respiratory distress syndrome (ARDS), mortality remains high. Also, prognostication of patients with ARDS and ECMO is difficult. Cytokines are thought to be markers of inflammation in both ARDS and in ECMO, however, understanding is limited. We aimed to study the association of three serum cytokine levels with mortality in these patients with ARDS on ECMO. Methods: We performed a retrospective chart review of ARDS patients on ECMO between 2011 and 2017. Patients with serum TNF-α, IL-6 and IL-2 measured while on ECMO were included, with measurements recorded weekly up to a maximum of 4 measurements. A multivariable regression analysis was performed and generalizing estimating equations were used to analyze longitudinal trend of cytokines with mortality. Results: There were 47 patients with ARDS on ECMO, of which 31 (68.9%) survived at 30 days and 2 were lost to follow up. Initial IL-2 levels were found to be significantly higher among those who were alive compared to those who died at 30 days (2720 ± 2432 pg/ml vs. 1293 ± 693 pg/ml); p = 0.0460. At any given time, an increase in IL-2 was associated with a decrease in odds of death at 30 days (adjusted odds ratio 0.98, 95% confidence interval 0.97 - 0.99, p = 0.08). There was no significant difference in average or initial levels of TNF-α and IL-6 among those who were alive vs. those who died at 30 days. There was no association between either of these cytokine levels with death while on ECMO. Conclusions: Higher levels of cytokine IL-2 were associated with lower 30-day mortality. Further studies are needed to elucidate the pathobiology of cytokines while on ECMO and their use in predicting outcomes.
{"title":"Role of Serum Cytokine Levels in Acute Respiratory Distress Syndrome Patients on Extracorporeal Membrane Oxygenation Support","authors":"E. Gupta, K. Carey, L. McDermott, N. Cavarocchi, H. Hirose, M. Baram","doi":"10.4236/wjcs.2020.101001","DOIUrl":"https://doi.org/10.4236/wjcs.2020.101001","url":null,"abstract":"Background: Even with the use of extracorporeal membrane oxygenation (ECMO) in acute respiratory distress syndrome (ARDS), mortality remains \u0000high. Also, prognostication of patients with ARDS and ECMO is difficult. \u0000Cytokines are thought to be markers of inflammation in both ARDS and in ECMO, however, understanding is limited. We aimed to study the association of three \u0000serum cytokine levels with mortality in these patients with ARDS on ECMO. Methods: We performed a retrospective chart review of ARDS patients on ECMO between 2011 and 2017. Patients with serum TNF-α, \u0000IL-6 and IL-2 measured while on ECMO were included, with measurements recorded \u0000weekly up to a maximum of 4 measurements. A multivariable regression analysis \u0000was performed and generalizing estimating equations were used to analyze longitudinal \u0000trend of cytokines with mortality. Results: There were 47 patients with \u0000ARDS on ECMO, of which 31 (68.9%) survived at 30 days and 2 were lost to follow \u0000up. Initial IL-2 levels were found to be significantly higher among those who \u0000were alive compared to those who died at 30 days (2720 ± 2432 pg/ml vs. 1293 ± \u0000693 pg/ml); p = 0.0460. At any given time, an increase in IL-2 was associated with a decrease in \u0000odds of death at 30 days (adjusted odds ratio 0.98, 95% confidence interval 0.97 \u0000- 0.99, p = 0.08). There was no significant difference in average or initial \u0000levels of TNF-α and IL-6 among those \u0000who were alive vs. those who died at 30 days. There was no association between either of \u0000these cytokine levels with death while on ECMO. Conclusions: Higher \u0000levels of cytokine IL-2 were associated with lower 30-day mortality. Further \u0000studies are needed to elucidate the pathobiology of cytokines while on ECMO and \u0000their use in predicting outcomes.","PeriodicalId":23646,"journal":{"name":"World Journal of Cardiovascular Surgery","volume":"66 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79618578","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}
Pub Date : 2020-01-01DOI: 10.4236/wjcs.2020.106009
Shilpa Suresh, S. Kalpana, H. J. Kumar, S. Selvam, K. Sreedhar
Background: The left internal mammary artery (IMA) is widely used as a conduit for coronary revascularization. The incidence of atherosclerosis is known to be lower in the IMA than in the coronary artery. The aim of this study was to evaluate the reliability of the use of the distal section of the IMA as an anastomotic site for bypass grafting and morphometric studies of IMA in patients with proven coronary artery disease and their associated risk factors. Methods: Patients who underwent Coronary Artery Bypass Graft (CABG) from June 2010 to November 2012 were chosen in this retrospective study and the discarded distal segments of the internal mammary artery were analyzed. The potential risk factors for atherosclerosis considered were age, sex, diabetes mellitus, history of cigarette smoking, hypertension and hypercholesterolemia. The samples were analyzed for the degree of intimal thickening and atherosclerosis by calculating the percentage of Luminal Narrowing, Intimal Thickness Index (ITI) and Intima-to-Media Ratio (IMR). Results: There were seven cases of intimal hyperplasia and two cases of focal medial and intimal hyperplasia
{"title":"Histopathology and Morphometric Analysis of the Internal Mammary Artery to Study the Incidence of Atherosclerosis and Its Associated Risk Factors","authors":"Shilpa Suresh, S. Kalpana, H. J. Kumar, S. Selvam, K. Sreedhar","doi":"10.4236/wjcs.2020.106009","DOIUrl":"https://doi.org/10.4236/wjcs.2020.106009","url":null,"abstract":"Background: The left internal mammary artery (IMA) is widely used as a conduit for coronary revascularization. The incidence of atherosclerosis is known to be lower in the IMA than in the coronary artery. The aim of this study was to evaluate the reliability of the use of the distal section of the IMA as an anastomotic site for bypass grafting and morphometric studies of IMA in patients with proven coronary artery disease and their associated risk factors. Methods: Patients who underwent Coronary Artery Bypass Graft (CABG) from June 2010 to November 2012 were chosen in this retrospective study and the discarded distal segments of the internal mammary artery were analyzed. The potential risk factors for atherosclerosis considered were age, sex, diabetes mellitus, history of cigarette smoking, hypertension and hypercholesterolemia. The samples were analyzed for the degree of intimal thickening and atherosclerosis by calculating the percentage of Luminal Narrowing, Intimal Thickness Index (ITI) and Intima-to-Media Ratio (IMR). Results: There were seven cases of intimal hyperplasia and two cases of focal medial and intimal hyperplasia","PeriodicalId":23646,"journal":{"name":"World Journal of Cardiovascular Surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77605245","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}
Pub Date : 2020-01-01DOI: 10.4236/wjcs.2020.107015
K. Morimoto, Y. Fujiwara, Tsuyoshi Sasami, Kunitaka Kumagai, Rikuto Nii
The infarction exclusion technique using endoventricular continuous sutures for ventricular septal rupture after acute myocardial infarction may be a difficult surgical technique and create residual shunt due to fragile myocardium. We present a patient of ventricular septal rupture (VSR) after extensive anteroseptal myocardial infarction who underwent successful repair using a modified infarction exclusion technique. In our procedure interrupted mattress sutures were placed through the ventricular wall in a way as to exclude the VSR and infarcted muscle of the left ventricle. A heterogeneous pericardial patch is sutured to healthy endocardium in the free and septal wall all around the infarcted area. We describe a procedure for repairing postinfarction VSR, by the infarction exclusion technique with total transmural sutures (TTS) method.
{"title":"Total Transmural Sutures (TTS) Method, Modified Infarction Exclusion Technique for Ventricular Septal Rupture after Extensive Myocardial Infarction","authors":"K. Morimoto, Y. Fujiwara, Tsuyoshi Sasami, Kunitaka Kumagai, Rikuto Nii","doi":"10.4236/wjcs.2020.107015","DOIUrl":"https://doi.org/10.4236/wjcs.2020.107015","url":null,"abstract":"The infarction exclusion technique using endoventricular continuous sutures for ventricular septal rupture after acute myocardial infarction may be a difficult surgical technique and create residual shunt due to fragile myocardium. We present a patient of ventricular septal rupture (VSR) after extensive anteroseptal myocardial infarction who underwent successful repair using a modified infarction exclusion technique. In our procedure interrupted mattress sutures were placed through the ventricular wall in a way as to exclude the VSR and infarcted muscle of the left ventricle. A heterogeneous pericardial patch is sutured to healthy endocardium in the free and septal wall all around the infarcted area. We describe a procedure for repairing postinfarction VSR, by the infarction exclusion technique with total transmural sutures (TTS) method.","PeriodicalId":23646,"journal":{"name":"World Journal of Cardiovascular Surgery","volume":"42 10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88167225","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}
Pub Date : 2019-12-30DOI: 10.4236/wjcs.2019.912019
M. Gaye, P. A. Dieng, N. F. Sow, M. Boufi, A. G. Ciss
The evaluation of the extension of the atheromatous lesion is essential for the planning of the endovascular technique at the level of the femoral arterial bifurcation. Therefore, we changed the classification of Azema and applied it to a series of patients who had undergone open surgery of the femoral arterial bifurcation. This evaluation made it possible to have an idea of the distribution of atheromatous lesions in this region and to compare the efficiency of this modified classification of Azema with others used in the literature. This modified classification of Azema is relevant and constitutes a decision-making tool for the endovascular therapeutic indications of femoral arterial bifurcation.
{"title":"What Classification of the Extent of Atheromatous Lesions on the Femoral Arterial Bifurcation for a Good Endovascular Therapeutic Indication?","authors":"M. Gaye, P. A. Dieng, N. F. Sow, M. Boufi, A. G. Ciss","doi":"10.4236/wjcs.2019.912019","DOIUrl":"https://doi.org/10.4236/wjcs.2019.912019","url":null,"abstract":"The evaluation of the extension of the atheromatous lesion is essential \u0000for the planning of the endovascular \u0000technique at the level of the femoral arterial bifurcation. Therefore, we \u0000changed the classification of Azema and applied it to a series of patients who \u0000had undergone open surgery of the femoral arterial bifurcation. This evaluation \u0000made it possible to have an idea of the distribution of atheromatous lesions in \u0000this region and to compare the efficiency of this modified classification of \u0000Azema with others used in the literature. This modified \u0000classification of Azema is relevant and constitutes a decision-making tool for \u0000the endovascular therapeutic indications of femoral arterial bifurcation.","PeriodicalId":23646,"journal":{"name":"World Journal of Cardiovascular Surgery","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74782227","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}
Pub Date : 2019-11-21DOI: 10.4236/wjcs.2019.911018
B. Sarkar, Pares Banerjee
Importance of thrombendarterectomy (TEA) had declined with the advent of bypass techniques and availability of prosthetic grafts, in patients with Peripheral arterial occlusive disease (PAOD). Recently, there had been a significant shift towards lower limb revascularization using endoluminal techniques. However, previously available data evaluating the long leg bypass or combined endoluminal and bypass procedures have been too anatomically heterogeneous to be easily applied to patients with infrainguinal disease and tissue loss. Clinical decision making in Complex multilevel or diffuse peripheral arterial occlusive disease with multiple co-morbidities especially associated coronary arterial disease is challenging. We describe twelve patients of iliofemoral arterial occlusive disease with tibiopopliteal arterial occlusive disease along with multiple co-morbidities like coronary arterial disease and diabetes mellitus who showed marked improvement with minimal post-operative morbidities after iliofemoral or ileopopliteal bypass grafting with endarterectomy of the tibiopopliteal segment and related review of the literature.
{"title":"Can Endarterectomy Be Useful in Peripheral Arterial Occlusive Disease with Critical Limb Ischemia?","authors":"B. Sarkar, Pares Banerjee","doi":"10.4236/wjcs.2019.911018","DOIUrl":"https://doi.org/10.4236/wjcs.2019.911018","url":null,"abstract":"Importance of thrombendarterectomy (TEA) had declined with the advent of bypass techniques and availability of prosthetic grafts, in patients with Peripheral arterial occlusive disease (PAOD). Recently, there had been a significant shift towards lower limb revascularization using endoluminal techniques. However, previously available data evaluating the long leg bypass or combined endoluminal and bypass procedures have been too anatomically heterogeneous to be easily applied to patients with infrainguinal disease and tissue loss. Clinical decision making in Complex multilevel or diffuse peripheral arterial occlusive disease with multiple co-morbidities especially associated coronary arterial disease is challenging. We describe twelve patients of iliofemoral arterial occlusive disease with tibiopopliteal arterial occlusive disease along with multiple co-morbidities like coronary arterial disease and diabetes mellitus who showed marked improvement with minimal post-operative morbidities after iliofemoral or ileopopliteal bypass grafting with endarterectomy of the tibiopopliteal segment and related review of the literature.","PeriodicalId":23646,"journal":{"name":"World Journal of Cardiovascular Surgery","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86519058","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}
Pub Date : 2019-11-21DOI: 10.4236/wjcs.2019.911017
B. Sarkar, Krishnendu Chakraborty, P. Bandyopadhayay
Thoracoplasty has been a useful procedure to control and cure recalcitrant lung lesions often as a last measure to treat pulmonary infections like post- tubercular chronic empyema with fibrocavitary lesions and residual pleural space infections after pulmonary resections. Long-standing empyemas with persistent discharge on drainage often respond poorly after decortication and debridement alone due to non-expanding underlying lung tissue due to fibrotic changes. These cases often develop recurrent empyemas with sepsis with high morbidity and mortality. Similarly chronic space-occupying lung lesions with adjacent pulmonary damage and fibrosis leave a considerable residual space after surgery of these lesions and these persistent residual space leads to pleural space infections and empyema. In the presence of a large apical abscess and destruction of the apical pulmonary tissue forming a potential space confined by the bony thoracic cage and limited inferiorly by the rigid lining of the abscess, the cure and management of the chronic empyema especially the post-tubercular ones are particularly difficult. We address these cases in our series by performing partial thoracoplasty tailored to the site of the lesions in addition to other procedures. Partial thoracoplasty was found beneficial for selective cases of chronic empyema, obliteration of residual cavity after resectional surgery and management of the apical abscess.
{"title":"Role of Partial Thoracoplasty in Lung Lesions —A Single Institute Experience","authors":"B. Sarkar, Krishnendu Chakraborty, P. Bandyopadhayay","doi":"10.4236/wjcs.2019.911017","DOIUrl":"https://doi.org/10.4236/wjcs.2019.911017","url":null,"abstract":"Thoracoplasty has been a useful procedure to control and cure recalcitrant lung lesions often as a last measure to treat pulmonary infections like post- tubercular chronic empyema with fibrocavitary lesions and residual pleural space infections after pulmonary resections. Long-standing empyemas with persistent discharge on drainage often respond poorly after decortication and debridement alone due to non-expanding underlying lung tissue due to fibrotic changes. These cases often develop recurrent empyemas with sepsis with high morbidity and mortality. Similarly chronic space-occupying lung lesions with adjacent pulmonary damage and fibrosis leave a considerable residual space after surgery of these lesions and these persistent residual space leads to pleural space infections and empyema. In the presence of a large apical abscess and destruction of the apical pulmonary tissue forming a potential space confined by the bony thoracic cage and limited inferiorly by the rigid lining of the abscess, the cure and management of the chronic empyema especially the post-tubercular ones are particularly difficult. We address these cases in our series by performing partial thoracoplasty tailored to the site of the lesions in addition to other procedures. Partial thoracoplasty was found beneficial for selective cases of chronic empyema, obliteration of residual cavity after resectional surgery and management of the apical abscess.","PeriodicalId":23646,"journal":{"name":"World Journal of Cardiovascular Surgery","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88947003","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}
Pub Date : 2019-09-30DOI: 10.4236/wjcs.2019.910016
H. Benyoussef, Said Makani, Mohammed Yassine Benzha, Amal Haoudar, Aziza Kantri, Chafik El Kettani Hamidi, S. Scadi, Amal El Ouradi, M. Sabry, M. Houssa
Background: The aim of this study was to evaluate the impact of additional coronary revascularization on the early results in patients submitted to valve surgery. Patients and Methods: A retrospective review of the cardiac surgical database between January 2000 and December 2018 was performed. A total of 1667 patients were included and divided into two groups: Group A isolated valve surgery (IVS n = 1608) and Group B with valve surgery combined to coronary artery bypass grafting (VS + CABG n = 59). Demographic, operative data and postoperative outcomes were compared between groups. Results: Patients with combined procedure were older than patients who underwent isolated valvular surgery (64.9 ± 9.2 years vs 44.4 ± 13.1 years; p = 0.0001) and there was a higher proportion of diabetics (40.7% vs 6.6%; p = 0.0001). The 30 days mortality rate in the combined procedure group was 18.6% versus 6.2% in isolated valve surgery (p = 0.001). Also post-operative complications were more frequent than for patients who underwent IVS. Additionally we noted a high prevalence of coronary artery risk factors in patients with combined procedures. Conclusion: Surgical mortality and morbidity of coexisting coronary and heart valve disease were substantially higher than IVS. More efforts in medical management may reduce the incidence of adverse outcomes.
背景:本研究的目的是评估额外冠状动脉血运重建术对接受瓣膜手术患者早期结果的影响。患者和方法:对2000年1月至2018年12月的心脏外科数据库进行回顾性分析。共纳入1667例患者，分为两组:A组单纯瓣膜手术(IVS n = 1608)和B组瓣膜手术联合冠状动脉旁路移植术(VS + CABG n = 59)。组间比较人口学、手术资料及术后结果。结果:联合手术患者比单独瓣膜手术患者年龄大(64.9±9.2岁vs 44.4±13.1岁;P = 0.0001)，糖尿病患者比例更高(40.7% vs 6.6%;P = 0.0001)。联合手术组的30天死亡率为18.6%，而单独瓣膜手术组为6.2% (p = 0.001)。此外，术后并发症比静脉注射患者更频繁。此外，我们注意到联合手术患者冠状动脉危险因素的患病率很高。结论:合并冠心病和心瓣膜病的手术死亡率和发病率明显高于静脉注射。在医疗管理方面做出更多努力可能会减少不良后果的发生率。
{"title":"Does Additional Coronary Artery Bypass Grafting Increase Hospital Mortality of Patients Requiring Valve Surgery?","authors":"H. Benyoussef, Said Makani, Mohammed Yassine Benzha, Amal Haoudar, Aziza Kantri, Chafik El Kettani Hamidi, S. Scadi, Amal El Ouradi, M. Sabry, M. Houssa","doi":"10.4236/wjcs.2019.910016","DOIUrl":"https://doi.org/10.4236/wjcs.2019.910016","url":null,"abstract":"Background: The aim of this study was to evaluate the impact of additional coronary revascularization on the early results in patients submitted to valve surgery. Patients and Methods: A retrospective review of the cardiac surgical database between January 2000 and December 2018 was performed. A total of 1667 patients were included and divided into two groups: Group A isolated valve surgery (IVS n = 1608) and Group B with valve surgery combined to coronary artery bypass grafting (VS + CABG n = 59). Demographic, operative data and postoperative outcomes were compared between groups. Results: Patients with combined procedure were older than patients who underwent isolated valvular surgery (64.9 ± 9.2 years vs 44.4 ± 13.1 years; p = 0.0001) and there was a higher proportion of diabetics (40.7% vs 6.6%; p = 0.0001). The 30 days mortality rate in the combined procedure group was 18.6% versus 6.2% in isolated valve surgery (p = 0.001). Also post-operative complications were more frequent than for patients who underwent IVS. Additionally we noted a high prevalence of coronary artery risk factors in patients with combined procedures. Conclusion: Surgical mortality and morbidity of coexisting coronary and heart valve disease were substantially higher than IVS. More efforts in medical management may reduce the incidence of adverse outcomes.","PeriodicalId":23646,"journal":{"name":"World Journal of Cardiovascular Surgery","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84154239","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}
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