Indian Journal of Thoracic and Cardiovascular Surgery (Indian J Thorac Cardiovasc Surg)

Publisher: Springer Verlag

Journal description

This Publication is the official organ of the Indian Association of Cardiovscular- Thoracic Surgeons. Edited, printed and published quarterly.

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Website Indian Journal of Thoracic and Cardiovascular Surgery website
Other titles Indian journal of thoracic and cardiovascular surgery (Online)
ISSN 0970-9134
OCLC 56974461
Material type Document, Periodical, Internet resource
Document type Internet Resource, Computer File, Journal / Magazine / Newspaper

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Springer Verlag

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Publications in this journal


  • No preview · Article · Feb 2016 · Indian Journal of Thoracic and Cardiovascular Surgery
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    ABSTRACT: Background Peripheral arterial disease is associated with high cardiovascular morbidity and mortality. The objective of this study was to identify unrecognized patients with peripheral arterial disease using ankle-brachial index in patients with established cardiovascular disease or at least one risk factor for atherosclerosis. Material and methods One hundred fifty-four patients with 94 males and 60 females underwent assessment of peripheral arterial disease using ankle-brachial index by pulse Doppler. Correlation between peripheral arterial disease and various variables (history of cardiovascular disease or various risk factors for atherosclerosis) was established using Pearson coefficient correlation test and linear-by-linear association. Results Peripheral arterial disease was present in 24.03 % (n = 37) of patients in the study population. A total of 22.08 % (n = 34) patients in study population had ankle-brachial index between 0.41 and 0.90, i.e., mild to moderate peripheral arterial disease, and 1.95 % (n = 3) had ankle-brachial index between 0.00 and 0.40, indicating severe peripheral arterial disease. Advancing age (p < 0.001; linear-by-linear association = 24.448), smoking (p < 0.001), diabetes (p = 0.005), hypertension (p = 0.008), hyperlipidemia (p < 0.001), cardiovascular disease (p = 0.003), and number of risk factors (p < 0.001; linear-by-linear association = 50.099) showed a statistically significant correlation with peripheral arterial disease. No significant difference was found between men and women (59.46 vs. 40.54 %, respectively, p = 0.051) in terms of peripheral arterial disease. Conclusion Peripheral arterial disease is highly prevalent in patients with established cardiovascular disease or who have at least one risk factor for atherosclerosis. Screening of patients for peripheral arterial disease by pulse Doppler (which is cheap, rapid, and precise method to detect peripheral arterial disease) would allow identification of high-risk patients who could benefit from an appropriate treatment strategy.
    No preview · Article · Jan 2016 · Indian Journal of Thoracic and Cardiovascular Surgery
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    ABSTRACT: Ischemic colitis in cardiac surgical patients is a rare entity. The presence of multiple comorbidities and potential complications related to surgery can put patients at high risk of gastrointestinal complications. The clinical presentation of ischemic colitis often can be confused with pseudo-membraneous colitis and the more ominous mesenteric infarction. The potentially morbid nature of the differential diagnoses calls for a precise and early diagnosis of this condition. Also, the relative difficulty in reliably coming to a diagnosis makes this condition particularly challenging in paralyzed patients on ventilator or with altered sensorium. Although, ischemic colitis has a relatively benign clinical course in majority of the cases, the economic and psychosocial impact of this pathology can be substantial. The potential for longstanding complications like chronic intestinal strictures warrant a long-term follow-up plan for those afflicted. Here, we present a cardiac surgical patient with multiple comorbidities whose clinical recovery was complicated by an episode of ischemic colitis following off pump coronary artery bypass surgery.
    No preview · Article · Jan 2016 · Indian Journal of Thoracic and Cardiovascular Surgery
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    ABSTRACT: Thymic cysts are divided into two groups as unilocular and multilocular cysts. Cystic wall is generally lined with squamous, transitional, cuboidal, or columnar epithelium. Unilocular cysts that are lined with ciliated respiratory epithelium are extremely rare, and there are only two reports in the literature. In this paper, we present a case, which had concurrent unilocular thymic cyst lined with ciliated respiratory epithelium and pericardial diverticulum.
    No preview · Article · Jan 2016 · Indian Journal of Thoracic and Cardiovascular Surgery
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    ABSTRACT: Objective There are different surgical techniques employed in re-routing of supracardiac total anomalous pulmonary venous connection (TAPVC) with varying degrees of outcome. This study was designed to analyse the clinical data of patients who underwent Tucker’s repair and to demonstrate potential advantages of this technique. Methods The clinical records of patients who underwent Tucker’s repair from September 2012 to November 2014 were reviewed retrospectively. The Tucker’s Repair involves anastomosis between the roof of the left atrial appendage and the common pulmonary venous chamber on cardiopulmonary bypass without cardiac displacement. Results Out of 54 patients who presented with TAPVC, 34 (63.0 %) had supracardiac type, 8 (14.8 %) cardiac type, 3 (5.6 %) infracacardic type, and 9 (13.4 %) mixed type. Out of these, 40 underwent Tucker’s repair. There were 24 males and 16 females. The patients aged from 2 days to 23 months (modal age group 0–3 months). The median weight was 3.7 kg (range 2.3–9.0 kg). The median aortic cross-clamp time (AXC) and cardiopulmonary bypass time (CPB) were 49 min (range 27–86 min) and 91 min (range 57–146 min), respectively. The median duration of intensive care unit (ICU) stay was 7 days (range 1–30 days). The immediate postoperative complications were refractory ventricular fibrillation (1), anastomotic site haemorrhage (1) and left diaphragmatic palsy (2). Other complications were chylothorax (1) and pulmonary venous obstruction at the anastomotic site (1). There were 3 deaths (7.5 %) resulting from pulmonary hypertensive crisis and sepsis. At a median follow up of 8 months (range 5–12 months), we did not find arrhythmias or pulmonary venous obstruction in any patient. Conclusion Our results have demonstrated that Tucker’s repair has a low morbidity and mortality. We therefore recommend this as an alternative for the repair of some variants of TAPVC.
    No preview · Article · Dec 2015 · Indian Journal of Thoracic and Cardiovascular Surgery
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    ABSTRACT: Background: Primary spontaneous pneumothorax (PSP) is a critical clinical problem, and its incidence is increasing. The risk of recurrence is high. Factors which may or may not predispose to recurrence have not yet been established. Methods: Over a period of 4 years, 78 cases with a diagnosis of PSP were reviewed, and the following variables were analysed: age, sex, history of smoking and the type of treatment. Results: The majority of the patients (79.48 %) were below the age of 40 years, with a male gender predominance (91 %). Three quarters of the males were smokers while the females were not smokers. The left side pneumothorax was more common than the right (55.12 vs 44.88 %), and chest pain was the commonest complaint—57.7%. Most of the patients (92.3 %) were treated with insertion of intercostal thoracostomy tube only (6.42 %). Those who showed failure of thoracostomy tube were treated by open thoracotomy. A total of 1.3 % of the patients were unfit for surgery and were treated with chemical pleurodesis. The recurrence rate after thoracostomy tube only was 15.5 %, while there was no recurrence after surgery and chemical pleurodesis. The indications of surgery were continuous air leak more than 10 days (5 cases), recurrence in the contralateral side (one case) and frequent recurrences (one case). Conclusion: PSP is a disease of young males, with chest pain as the most common presenting symptom. Intercostal thoracostomy tube and thoracotomy are effective treatment with low rate of recurrence in areas of lack of facility. © 2015, Indian Association of Cardiovascular-Thoracic Surgeons.
    No preview · Article · Dec 2015 · Indian Journal of Thoracic and Cardiovascular Surgery
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    ABSTRACT: Angiosarcoma, despite being the most common primary malignant tumour of the heart and pericardium, is itself an extremely rare tumour with a 0.001 to 0.003 % prevalence in an autopsy series. Angiosarcoma is the most common form of malignant cardiac tumour, having a tendency to occur in the third to fifth decade of life, with a distinct male preponderance. The tumour is often silent and symptomless for a long period of time, presenting late with locoregional metastasis which hampers the operability and prognosis. Metastasis is mainly to the mediastinal lymph nodes, lungs and vertebra. We present the case of a 58-year-old normotensive diabetic male who presented with dyspnea on exertion and recurrent pericardial effusion with an impending cardiac tamponade. It was identified as a large pericardial mass on CT thorax, and partial pericardiectomy was done. Histopathology identified it as a poorly differentiated carcinoma. It was only by immunohistochemistry that the diagnosis of pericardial angiosarcoma was confirmed.
    No preview · Article · Nov 2015 · Indian Journal of Thoracic and Cardiovascular Surgery
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    ABSTRACT: A 14-day-old neonate presented with severe left ventricular outflow tract obstruction (LVOTO) and type B interrupted aortic arch. The child underwent a neonatal Ross Konno with interposition graft for arch reconstruction.
    No preview · Article · Oct 2015 · Indian Journal of Thoracic and Cardiovascular Surgery

  • No preview · Article · Oct 2015 · Indian Journal of Thoracic and Cardiovascular Surgery

  • No preview · Article · Sep 2015 · Indian Journal of Thoracic and Cardiovascular Surgery
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    ABSTRACT: Background Coronary artery bypass grafting (CABG) is one of the commonest cardiothoracic surgical procedures carried out in today’s day and age. Traditionally, the midline sternotomy approach was in vogue, and CABG would be done on cardiopulmonary bypass. With further advances and expertise, various procedural modifications have been made including off-pump CABG and minimally access procedures which include minimally invasive direct coronary artery bypass (MIDCAB) grafting and partial sternotomy techniques. Subxiphoid CABG is a sparingly used novel approach but nonetheless an excellent choice in many cases. Objective To study the feasibility of minimal access subxiphoid CABG and its outcomes in patients. Materials and methods We used the subxiphoid approach in seven cases from June 2014 to date. Patients were followed up prospectively and evaluated for various factors which included post-op pain scores, healing and graft patency. Results This technique is very useful and has various advantages. Blood loss was found to be less. Healing was found to be faster and hospital stay comparably shorter. Conclusion The subxiphoid approach for CABG is a novel advancement in this surgery and is a true minimal access procedure which includes doing the CABG through a small incision, just starting below the xiphisternum and extending below to less than 3 inches. Direct CABG is done through this approach including multivessel grafting and gastroepiploic artery harvesting. We hereby would like to describe this advancement in the field of cardiac surgery.
    No preview · Article · Sep 2015 · Indian Journal of Thoracic and Cardiovascular Surgery
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    ABSTRACT: Neurofibroma is a benign nerve sheath tumor of the peripheral nervous system. A young male presented with complaints of gradually increasing breathlessness and heaviness on the right side of the chest, and percussion notes over the chest were impaired all over the right lung fields except the basal zone. Contrast-enhanced computed tomography scan of the thorax revealed a large heterogeneous mass occupying most of the right hemithorax. Intraoperatively, the huge mass measuring about 18 cm × 13 cm × 12 cm was seemed to arise from the right fourth intercostal space. Histopathology revealed a neurofibroma. Giant intrathoracic neurofibroma is very uncommon and its malignant potential should be evaluated.
    No preview · Article · Sep 2015 · Indian Journal of Thoracic and Cardiovascular Surgery
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    ABSTRACT: A 20-year-old male presented to the hospital with discharging pus from anterior chest wall region for 15 days. He had a past history of left-sided pleural effusion for which he was put on ATT by a private practitioner on an empirical basis. In view of an excessive bleeding from the chest wall abscess, the patient was taken up for emergency exploratory thoracotomy. Intra-operatively, it was found that the abscess had ruptured in the thorax eroding the left internal mammary artery which was ligated at its origin, and hemothorax was drained. Post-operatively, the patient had an uneventful recovery.
    No preview · Article · Sep 2015 · Indian Journal of Thoracic and Cardiovascular Surgery
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    ABSTRACT: Right atrial fungal mycetoma with extensive bilateral pulmonary dissemination is infrequent and lethal in children. The treatment approach in this situation are extensive fungal mass resection and perioperative antifungal therapy. We present a 9-year-old immunocompetent child who presented with a large right atrial fungal mass with bilateral pulmonary infiltration. Empirical oral voriconazole was given for 2 weeks, during preparation for fungal mass resection because of rapidly deteriorating general condition. However, the outcome was fatal. Histopathology and fungal culture diagnosed the fungus to be Neoscytalidium dimidiatum. To the best of our knowledge, this is the first report from the Indian subcontinent describing a right atrial fungal mass with extensive pulmonary dissemination caused by N. dimidiatum.
    No preview · Article · Sep 2015 · Indian Journal of Thoracic and Cardiovascular Surgery
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    ABSTRACT: IntroductionElectromagnetic navigational bronchoscopy (ENB) is a promising novel technique, which enables physicians to access pulmonary lesions, previously inaccessible, for both biopsy and fiducial placement. The use of ENB has also not been limited to the realm of the interventional pulmonologist, and success has been had in large academic centers with its performance by thoracic surgeons. The flexibility of ENB is without added risk, and may even decrease risks, as ENB has been documented to have a more favorable safety profile than other forms of biopsy and placement of fiducials. With ENB’s increasing ability for diagnosis via biopsy, this may have an influence on prognosis and treatment, and the following case is representative of that impact.CaseA 69-year-old male was previously diagnosed with adenocarcinoma of the right upper lobe of the lung in August 2011. At that time, he presented with stage IIIA multifocal disease in the right lung. He had a 1-cm lesion in the right apex, ...
    No preview · Article · Sep 2015 · Indian Journal of Thoracic and Cardiovascular Surgery
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    ABSTRACT: Background: Rheumatic heart disease remains a major health problem in developing countries in which mitral stenosis (MS) is the most common sequela of it. Its consequences are pulmonary hypertension, atrial fibrillation, thromboembolism (TE), heart failure, and if untreated death ensues. The management of MS varies depending on severity of disease, availability of expertise, and resource; however, in a facility-deprived country with low economic status, closed mitral valvotomy remains the standard palliative treatment. Closed mitral valvotomy (CMV) is indicated in patients with pure, non-calcific isolated MS with normal sinus rhythm. We believe that although the procedure seems identical, CMV is a more controlled method than percutaneous mitral balloon valvuloplasty (PMBV), which is proven by more successful results and less incidence of complications related to embolization and mitral valve regurgitation. The aim of this study was to evaluate the clinical status of patients with mitral stenosis following closed mitral valvotomy. About 96 % of the patients were in good health. These results suggest that there is still a good place for closed mitral valvotomy in carefully selected cases. Materials and methods: Data obtained over a 20-year period from August 1995 to August 2014, from 4341 patients who underwent CMV were analyzed. The analysis was carried out retrospectively and prospectively from hospital records, with follow-up examinations being conducted mainly at the outpatient clinic. The suitable patients were selected according to echocardiography criteria: (1) pliable anterior mitral leaflet, (2) absence of significant mitral subvalvular disease, (3) absence of significant calcification, and (4) the mitral valve orifice area less than (1.1 cm2). The indications also include asymptomatic women of child-bearing age with mitral valve areas of ∼1.2 cm2. The presence of left atrial thrombus, moderate-to-severe mitral regurgitation (MR), leaflet calcification >2, and severe subvalvular fibrosis >2 constitute an absolute contraindication for the procedure. Results: In-hospital mortality (≤30 days after surgery) was 0.5 % (n = 22, all closed procedures). Cardiac failure with significant MR was the main cause of early death, and no postoperative peripheral embolism occurred in cases done after transesophageal echocardiography (TEE) and occurred in 0.5 % cases done without TEE. We performed TEE in all cases after the year 2000. Freedom from thromboembolism was 99.0 ± 0.5 % at 20 years. Operative results were satisfactory in most patients, and severe mitral incompetence was seen only in hundred cases in which 15 cases converted to open heart and remaining treated with medical treatment in which we lost 12 patients. Postvalvotomy moderate mitral regurgitation occurred in 720 patients (16.58 %) during the first year after CMV. Reoperation was performed in 1110 patients (25.57 %). The mean interval between CMV and reoperation was 141.1 ± 60.8 months (range 1–240 months). Hundred patients were reoperated for moderate or severe mitral regurgitation, 990 for mitral restenosis, and 20 for mixed mitral valve disease (stenosis and regurgitation). Freedom from reoperation after CMV was 81.4 ± 1.3 % at 10 years and 74.42 ± 2.1 % at 20 years. Cox regression analysis indicated that impaired functional capacity, reduced mitral valve area, gradual increase in left atrial diameter, and postoperative mitral insufficiency increased the reoperation rate after CMV. Conclusion: There was an overall highly significant improvement in clinical stage of the disease: reduction in mean pressure gradient across the mitral valve and reduction in pulmonary hypertension and mean left atrial size. Similarly, there was improvement in ventricular function in terms of ejection fraction and increase in mean mitral valve area. When compared with percutaneous balloon or surgical open valvotomy, CMV represents a satisfactory technique in terms of lower cost, high efficacy, simplicity, and reproducibility. © 2015, Indian Association of Cardiovascular-Thoracic Surgeons.
    No preview · Article · Sep 2015 · Indian Journal of Thoracic and Cardiovascular Surgery
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    ABSTRACT: Endobronchial metastasis from extrapulmonary malignant tumors is rare. The clinical and radiological features of endobronchial metastases and primary bronchogenic carcinoma are indistinguishable. Here, we report a case of isolated endobronchial metastasis of renal cell carcinoma almost a decade after initial presentation. The importance of histopathology and immunohistochemistry has been emphasized in this case. It is thereby worthwhile to consider endobronchial metastases as a differential diagnosis in patients with persistent pulmonary symptoms having a previous history of non-pulmonary malignancy.
    No preview · Article · Sep 2015 · Indian Journal of Thoracic and Cardiovascular Surgery
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    ABSTRACT: Internal thoracic artery aneurysms are extremely rare vascular anomalies with very few cases reported so far. Relevant sources of the literature show only a few reported cases. Here we present a case of incidentally diagnosed case of right internal thoracic/mammary artery (RIMA) aneurysm.
    No preview · Article · Sep 2015 · Indian Journal of Thoracic and Cardiovascular Surgery
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    ABSTRACT: Background N-terminal pro-beta-type natriuretic peptide (NT-proBNP) is now used in the diagnosis of heart failure; nevertheless, there is still no expert consensus regarding its value in detecting rejection. This paper therefore aims to examine the role of NT-proBNP in detecting rejection at earlier asymptomatic stages. Methods This study was designed as a single-center prospective trial on 70 heart recipients, all 50 years old or younger between March 2012 and June 2014 at the Imam Khomeini Hospital Complex, Tehran University. In recipients showing any evidence of heart failure or even asymptomatic recipients with high serum level of NT-proBNP (≥450 pg/ml under age 50) or decreased LVEF, an endomyocardial biopsy (EMB) was carried out. Results Statistically significant correlation was found between rise in serum level of NT-proBNP and biopsy results (p = 0.024). Correlation was found also between serum level of NT-proBNP before and after treatment of rejection (p = 0.03). Even with an obvious rise in the serum level of NT-proBNP, there was no evidence of any simultaneous significant change in LVEF. Conclusions We showed that NT-proBNP can be used as a valuable biomarker to detect rejection in earlier asymptomatic stages to prevent further rejection progression and its bad consequences; however, it needs further multicenter studies.
    No preview · Article · Sep 2015 · Indian Journal of Thoracic and Cardiovascular Surgery