ASIAN CARDIOVASCULAR & THORACIC ANNALS最新文献

IntroductionInfective endocarditis (IE) is a severe infection of the endocardium, primarily affecting the heart valves, exhibiting high morbidity and mortality rates. Cardiac surgery for IE with cardiopulmonary bypass (CPB) can further exacerbate the inflammatory response and cytokine production from IE. The current meta-analysis evaluates the use of CytoSorb^® hemoadsorption in IE patients undergoing cardiac surgery to determine its efficacy in reducing inflammatory mediators and improving clinical outcomes.MethodsPubMed, Cochrane, Google Scholar, Clinical Trials, and Google Scholar were searched for articles until July 2024. After performing a risk of bias and quality assessment, data on operative times, mortality, and morbidity were extracted for meta-analysis. Statistical Software R (version 4.4.0) was used to calculate odds ratio (OR) and standardized mean differences using a random-effect model with a 95% confidence interval (CI) and p-value less than 0.05.ResultsEight studies, encompassing 1076 patients, were included in the analysis. These comprised three randomized controlled trials and five nonrandomized studies. The majority of these studies exhibited some concerns regarding bias. Hemoadsorption group showed lower discharge mortality (OR: 0.58, 95% CI: 0.33-1.00, p = 0.05) compared to controls, but no significant disparity is observed in other outcomes. In-hospital outcomes also showed higher heterogeneity, with an I² value greater than 50%.ConclusionCytoSorb use in patients undergoing cardiac surgery with CPB used for IE has no impact on operative mortality and morbidity but has a beneficial effect on discharge mortality.

IntroductionTuberculosis (TB) is a rare cause of chylopericardium. Optimal management remains unclear.Methods/ResultsA 30-year-old Filipino male presented with recurrent massive pericardial effusions, with pericardiostomy revealing chylopericardium. Microbiologic TB studies were negative, and other etiologies were excluded. Pericardial fluid adenosine deaminase was elevated; anti-TB regimen was initiated, leading to resolution.DiscussionThere is no consensus about the optimal management of TB chylopericardium. Adenosine deaminase represents a useful test to diagnose TB in inflammatory, lymphocyte-predominant effusions, especially when other tests are negative. Failed conservative management merits more invasive approaches.ConclusionWhile data remain lacking, this case suggests that TB chylopericardium responds to anti-TB therapy.

A 48-year-old female underwent emergency surgery for an undetermined mass in the right atrium associated with bilateral pulmonary artery emboli. Under deep hypothermic circulatory arrest, a large gelatinous mass was excised from the right atrium, and large embolic lumps were removed from both main pulmonary arteries. Histopathological testing of excised specimens confirmed the diagnosis of a vascularized myxoma. At 6 months of follow-up, repeated transthoracic echocardiography has not shown any signs of local recurrence or elevated pulmonary artery pressure. The potential for right atrial myxoma as a source of pulmonary embolization should be borne in mind, as this potentially fatal yet curable condition demands emergency surgical intervention.

IntroductionThromboelastography (TEG), which indicates hemostatic ability, is useful for monitoring coagulation during extracorporeal circulation (ECC). However, the extent to which TEG levels are independently affected by ECC exposure remains unclear. To determine the effects of TEG levels in blood exposed to a membrane oxygenator, we performed in vitro experiments using whole human blood with ECC circuits including a membrane oxygenator.MethodsBlood provided by healthy volunteers was heparinized and circulated in three types of experimental circuits: polymer-coating, heparin-coating (HC), or non-coating (NC) membrane oxygenators (five of each type). Thromboelastography tests using a global hemostasis assay were performed at 3, 6, 12, and 24 h of circulation in each experiment. During TEG, the sampled blood was reversed with 0.05 mg of protamine. One-way analysis of variance (ANOVA) and two-way repeated measures ANOVA were performed to evaluate trends in circulation duration and coating types, respectively.ResultsCitrated kaolin with heparinase reaction times (CKHR) were significantly shortened at 6 and 12 h but prolonged at 24 h. The maximum amplitude for citrated kaolin with heparinase (CKHMA) was magnified from 6 to 12 h. Regarding the coating type, a significant difference was observed between HC and NC in CKHR at 6 h, but significance was not noted in other comparisons of coating types in CKHR and CKHMA.ConclusionsThromboelastography data indicated that the hemostatic capability of blood exposed to membrane surfaces was maintained after 12 h of circulation. The effects on TEG data in terms of coating type remain to be determined.

We present the case of a 61-year-old male who was admitted with superior vena cava syndrome. Patient's medical history includes a coronary artery bypass surgery 5 years ago. Echocardiography and computed tomography angiography showed a giant right coronary artery aneurysm compressing the superior vena cava. Due to hemodynamic deterioration, emergent cardiac surgery was performed to alleviate the compression, and veno-arterial extracorporal membrane oxygenation (VA ECMO) was necessary during intensive care unit. Hemodynamic improvement over 6 days allowed for successful ECMO weaning and eventually patient's discharge.

The DeVega annuloplasty procedure involves a double-running suture line along the circumference of the tricuspid annulus, encircling the anterior and posterior leaflets. A rare mechanical complication of this technique is the detachment of the suturing from the annulus, which can be referred to as the "bowstring sign" or "guitar string sign."

IntroductionCoronary artery bypass graft (CABG) surgery is performed globally around 400,000 times annually. Despite its benefits, CABG can lead to complications, including chylothorax, a rare condition where chyle accumulates in the pleural cavity due to thoracic duct trauma. Currently, there are no international guidelines for traumatic chylothorax management post-CABG. This is the first systematic review to provide a comprehensive overview of the current state of management for chylothorax post-CABG.MethodsThis systematic review was conducted by searching EMBASE, Cochrane, Ovid and PubMed databases on 16 June 2024. The inclusion criteria focused on studies addressing post-CABG chylothorax management and reporting clinical outcomes. Data was extracted from 11 studies focusing on graft type, complications and management strategies.ResultsThis review included 11 case report studies with 14 cases of post-CABG chylothorax. Conservative management was attempted in all cases, with varying components such as total parenteral nutrition, nil by mouth, octreotide and low-fat diets. High-output chylothorax (>1000 mL/day) often necessitated surgical intervention after an average of 12.5 days of conservative management. Surgical approaches included thoracic duct ligation, embolisation and pleurodesis. Surgical ligation was effective in three cases, while thoracic duct embolisation was successful in one case.ConclusionsChylothorax post-CABG is managed initially with conservative strategies, but high-output cases often necessitate surgical intervention. This review highlights the need for standardised guidelines, regarding the timing of surgical escalation and the use of octreotide and somatostatin. Further research should focus on higher-powered studies to validate these findings and establish clinical guidelines for managing chylothorax post-CABG.

Cardiac tumors, whether primary (mostly benign) or secondary (metastatic), are extremely rare, and very few cases of retiniform hemangioendothelioma have been documented since its initial diagnosis in 1994. We present a 67-year-old male who presented with pericarditis, recurrent pericardial and pleural effusions. On computed axial tomography, an oval lesion located on the superior aspect of the left pulmonary pericardial recess within the transverse sinus, adjacent to the trunk of the pulmonary artery. In the operating room, after dissection and resection of the mass, the histopathological diagnosis of retiniform hemangioendothelioma was confirmed.