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ABSTRACT: Although cardiac contusions are common, cardiac rupture is an uncommon sequela of blunt chest trauma. The mortality rate associated with cardiac rupture is very high, and patients usually do not survive long enough to reach the hospital. We report a 66-year-old man with a history of coronary artery bypass grafting 15 years previously, who was involved in a traffic accident and experienced multiple trauma, including a small contained rupture of the right ventricular outflow tract. He survived, and a false aneurysm developed at the site of the rupture within the next 6 months. The patient then underwent a cardiac operation, and the aneurysm was successfully resected. The intraoperative and postoperative courses were uneventful. In this case, the previous cardiac operation with the resulting pericardial adhesions proved to be lifesaving.
The Annals of thoracic surgery 04/2013; 95(4):1445-7. · 3.74 Impact Factor
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ABSTRACT: We report the case of a 74-year-old man with a large aneurysm (60 mm) of the descending thoracic aorta. Because of severe calcification and kinking of the iliac vessels, the expected access-related complication during the endovascular repair urged us to search for an alternative strategy. Having good experience with transcatheter aortic valve implantation, we thought that the transapical approach may be the best option in this case. The stent-graft was successfully deployed through the heart apex without any complications. The postoperative imaging showed an excellent result.
The Annals of thoracic surgery 06/2012; 93(6):2063-5. · 3.74 Impact Factor
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ABSTRACT: A 37-year-old woman who sustained blunt chest trauma as a result of a car accident was found unconscious at the accident site with signs of circulatory compromise. Computed tomographic trauma screening excluded thoracic, intracranial, and intra-abdominal bleeding, or other pathologic findings, except a small circumferential hemopericardium. Echocardiography revealed a hemopericardium that was partially clotted and the beginning of compression of the right ventricle. Because of progressive hemodynamic compromise, the decision was made for operative exploration. After a median sternotomy, the resultant excessive bleeding necessitated extracorporeal circulation. Careful inspection revealed isolated rupture of the upper right pulmonary vein, which was successfully repaired.
The Annals of thoracic surgery 04/2011; 91(4):1267-9. · 3.74 Impact Factor
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ABSTRACT: The study aim was to determine the clinical reliability of the EuroSCORE as a predictor of operative risk in aortic valve replacement (AVR).
Between 2000 and 2007, a total of 1497 patients underwent isolated elective AVR (no endocarditis, aortic procedure or re-do) at the authors' institution. A fitting of the deviation of expected mortality (EM) from observed mortality (OM) was performed and studied. To identify the cause of deviation of EM, a multivariate analysis of the EuroSCORE variables (using SAS JMP software) was conducted on the available data, and the results were re-evaluated.
An overestimation of EM was observed, and this was found to increase systematically with the rise in expected risk (0.3 +/- 1.0% at 5% OM versus 23.8 +/- 1.9% at 35% OM; p < 0.0001). A multivariate analysis of the EuroSCORE variables showed only age and preoperative neurological dysfunction as significant risk factors (p < 0.003 and < 0.04, respectively). All other EuroSCORE variables were statistically insignificant.
The EuroSCORE is a solid and practical concept, but is clinically unreliable as a predictor of operative risk for elective AVR; hence, it should no longer be used for this purpose in its present form. It is recommended that a statistical correction of the EuroSCORE deviation be used, and that an updated EuroSCORE or a new risk stratification tool be developed to predict operative risk for patients undergoing heart valve surgery.
The Journal of heart valve disease 01/2010; 19(1):16-20. · 0.81 Impact Factor
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ABSTRACT: The aim of this work was to question the necessity of repeated administration of warm blood cardioplegia in modern cardiac surgery. A consecutive series of 4014 patients underwent cardiosurgical procedures in the period from January 2001 to December 2006 in our centre, where modified Calafiore warm blood-cardioplegic solution was used. 1708 patients received a single shot of cardioplegia instead of repeated blood cardioplegia (every 20 min). A multivariate analysis was performed using logistic regression models to reveal the statistical significance of the effect of single-shot cardioplegia on the occurrence of: death, intraoperative need of inotropics, intraoperative intra-aortic balloon pump (IABP), postoperative infarction, arrhythmia, postoperative need for inotropics and postoperative IABP. The results showed statistical insignificance concerning mortality (P=0.704), intraoperative IABP (P=0.247), postoperative inotropics (P=0.273), postoperative IABP (P=0.678), postoperative arrhythmia (P=0.661). Single-shot cardioplegia showed a positive effect concerning postoperative myocardial infarction (P=0.003). However, it showed an unfavourable effect concerning intraoperative inotropics (P=0.038) and postoperative dialysis (P=0.015). The clinical safety of the first shot of warm blood cardioplegia might be exceeding 20 min. In the light of increasingly short cross-clamping time, the safety of the first shot might be long enough to cover the whole cross-clamping time.
Interactive cardiovascular and thoracic surgery 02/2009; 8(5):517-21.
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ABSTRACT: Functional tricuspid regurgitation secondary to mitral valve disease can not be attributed to the dilatation of the tricuspid annulus alone. Furthermore, geometrical changes of the right ventricle lead to tethering of the tricuspid valve leaflets and thereby to an incomplete leaflet coaptation. With this pathologic entity, conventional isolated tricuspid valve annuloplasty will presumably result in significant residual tricuspid regurgitation. The surgical goal should be the reduction of tricuspid annulus dilatation and annihilation of tethering forces on the tricuspid leaflets. In combination with conventional tricuspid valve annuloplasty, right ventricular reduction surgery, as demonstrated, may be effective in reaching these goals and hereby avoiding residual tricuspid regurgitation in this patient population.
The Annals of thoracic surgery 06/2008; 85(5):e27-9. · 3.74 Impact Factor
