ResearchPad - cardiac-thoracic-vascular-surgery Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Hughes Stovin Syndrome, a Rare Form of Behcet's Disease Presenting as Recurrent Intracardiac Thrombus]]> Hughes Stovin syndrome (HSS) is a particularly rare disease characterized by multiple pulmonary artery and/or bronchial artery aneurysms with concomitant peripheral venous thrombosis and is believed to be a cardiovascular variant of Behcet’s disease. Intracardiac thrombus occurring as a thrombotic manifestation of HSS is an unusual presentation and represents a challenge in diagnosis and treatment. Here we report a 25-year-old male presenting with recurrent right-sided intracardiac thrombi, in whom pulmonary artery aneurysm was later detected in the clinical course corroborating the diagnosis of HSS and leading to appropriate initiation of immunosuppressive agents. The patient required multiple cardiac surgeries during the clinical course for cardiovascular complications associated with recurrent cardiac thrombus. Unfortunately, the patient was readmitted a year later for massive hemoptysis secondary to pulmonary arterial aneurysm rupture requiring left lower lobectomy. Our case highlights also the significant morbidity, complications, and treatment challenges associated with this potentially life-threatening syndrome, which is intensified in the presence of cardiac involvement.

<![CDATA[Thoracolaparoscopic-Assisted Esophagectomy for Corrosive-Induced Esophageal Stricture]]> Corrosive-induced stricture of the digestive tract is a dreaded complication following corrosive ingestion. When surgical reconstruction is needed, esophagectomy helps to avoid the long-term complications related to leaving behind the scarred native esophagus. We tried to ascertain the feasibility and safety of a thoracolaparoscopic-assisted esophagectomy in such a setting.

A 32-year-old male presented with corrosive-induced esophageal stricture that lead to progressive dysphagia not amenable for endoscopic dilatation. Thoracoscopic approach was used for mobilization of the scarred esophagus under vision. Laparoscopic approach was used in mobilizing the stomach and creating a conduit. Esophagogastric anastomosis was performed in the neck. The patient had an uneventful recovery postoperatively and was discharged after six days on a semisolid diet.

Thoracolaparoscopic-assisted esophagectomy can be safely performed for corrosive strictures of the esophagus. Besides improving the ease of performing the procedure, it also helps mitigate the morbidity associated with conventional open surgery in such cases.

<![CDATA[Heyde Syndrome: A Case Report and Literature Review]]> Heyde syndrome is characterized by an association between gastrointestinal (GI) bleeding and calcific aortic stenosis (AS). Although the course of disease progression that links AS and GI bleeding has not been determined, overlaps among AS, intestinal dysplasia, and acquired von Willebrand's syndrome are thought to result in GI bleeding. Aortic valve repair in some patients has been reported to result in marked improvement or the complete resolution of signs and symptoms of Heyde syndrome. The prevalence of Heyde syndrome is higher among elderly persons than among other age groups, suggesting that a degenerative process may be a significant factor in the disease progression. This report describes a patient with Heyde syndrome, as well as a review of the current literature. 

<![CDATA[Right Ventricular Perforation Presenting as Tingling of the Left Breast]]> Pacemaker lead-associated cardiac perforation is a rare phenomenon. Lead perforations can be acute, subacute, or chronic following lead placement. Symptoms are typically nonspecific and depend on the location of the displaced lead. Diagnostic workup requires interrogation of the pacemaker and imaging studies. Management of lead displacement is dependent on multiple risk factors such as age, gender, corticosteroid use, and anticoagulation therapy.

A 74-year-old female with a history of myosin light chain kinase (MYLK) 2 hypertrophic cardiomyopathy, Sjogren’s syndrome, Raynaud’s disease, and sick sinus syndrome was evaluated for an abnormal finding on pacemaker interrogation. The patient’s only symptom was tingling of her left breast. Imaging studies confirmed pacemaker lead perforation. Right ventricle perforation due to a pacemaker lead displacement can cause severe complications. Early identification and treatment by physicians can reduce the risk of mortality.

<![CDATA[The Effect of Preoperative Hematocrit Level on Early Outcomes After Coronary Artery Bypass Surgery]]> Introduction: Low hematocrit level is a hematological problem that is frequently encountered in the preoperative evaluation of patients undergoing coronary artery bypass grafting (CABG) surgery. The aim of this study was to investigate the effect of preoperative hematocrit level on the first 30-day outcomes in patients undergoing CABG surgery.

Methods: Ninety-four patients undergoing isolated CABG were included in the study. The patients were divided into two groups as patients with preoperative low hematocrit levels (<36%) in Group 1 and patients with preoperative normal hematocrit levels (≥36%) in Group 2.

Results: Forty-six patients in Group 1 (mean age: 63.6 ± 7.9 years) and 48 patients in Group 2 (mean age: 56.5 ± 8.8 years) were enrolled. European System for Cardiac Operative Risk Evaluation (EuroSCORE) scoring was statistically significantly higher in Group 1 (p = 0.011). In the postoperative period, the amount of drainage, transfusion of blood, and blood products were significantly higher in Group 1 (p < 0.001). The mortality rate of Group 1 was statistically higher in the first 30 days postoperatively (p = 0.020).

Conclusion: Low preoperative hematocrit levels are associated with increased mortality after CABG surgery. We suggest that patients’ preoperative hematocrit levels must be added to the risk scoring systems as an assessment parameter.

<![CDATA[The Effectiveness of Endovenous Radiofrequency Ablation Application in Varicose Vein Diseases of the Lower Extremity]]> We aimed to determine the outcome, complications, and quality of life effects of radiofrequency ablation (RFA) in the treatment of superficial venous insufficiency.

A total of 134 extremities from 100 patients were evaluated in this retrospective study performed at the Cardiovascular Surgery Department of Atatürk University Faculty of Medicine. Treatment success was determined by occlusion. The clinical, etiologic, anatomic, and pathophysiologic (CEAP) and venous clinical severity score (VCSS) scores of patients were assessed pre- and postoperatively to evaluate clinical outcome and quality of life. The pain was assessed with the Wong-Baker score. Complications and their frequency were assessed and recorded.

Treatment success, as measured by occlusion rate, was 99% percent. Prior to treatment, the CEAP clinical score was C2 (81.0%), while after treatment, it was C0 (54.0%) (p<0.001). The pretreatment median VCSS score was 5 (min-max: 1-9) while the post-treatment median was 1 (min-max: 1-3) (p<0.001). The mean pain score was 1.34; only one patient reported a score of 6 while the minimum score was 1. A total of 15 complications occurred; only one was a major complication (deep vein thrombosis or DVT) while the remaining 14 were minor complications.

While longstanding surgical treatments still provide significant success, the RFA technique not only surpasses them in success rate but also in terms of pain, complications, and better patient satisfaction. The results of our study indicate that RFA is an effective and safe option for the treatment of superficial venous insufficiency.

<![CDATA[Trends, Outcomes, and Predictors of Sepsis and Severe Sepsis in Patients with Left Ventricular Assist Devices]]> Left ventricular assist device (LVAD) is used in end-stage heart failure that is refractory to medical treatment. However, there is a paucity of data looking at the rates of sepsis and severe sepsis (SSS). Therefore, this study was conceived with the purpose of analyzing the SSS burden and outcomes associated with LVAD implantation. The national inpatient sample database was queried from 2010 to 2014 using ICD-9 procedure code for LVAD use among patients 18 years or older and 2359 patients were identified. During the five-year study period, the average incidence of SSS was 11.8% and it was noted that cases with SSS were associated with an increased likelihood of mortality, greater length of hospital stay (LOS), and higher hospital-related charges (p < .001) compared to controls. Controlling for age, sex, and LOS, hierarchical multivariate logistic regression revealed that significant predictors of SSS were acute kidney injury [Adjusted odd’s ratio (AOR) = 2.75, 95% CI = 1.87, 4.14)], mechanical ventilation (AOR = 2.34, 95% CI = 1.70, 3.23), venous thromboembolism (AOR = 1.76, 95% CI = 1.12, 2.75), gastrointestinal bleed (AOR = 1.77, 95% CI = 1.12, 2.76), chronic obstructive pulmonary disease (COPD) (AOR = 0.55, 95% CI = 0.40, 0.77), acute myocardial infarction (AOR = 0.54, 95% CI = 0.36, 0.80) and mild liver disease (AOR = 2.18, 95% CI = 1.55, 3.06). The rate of incidence of sepsis has remained constant and is often associated with a worse clinical outcome. This provides a basis to identify high-risk groups and helps argue for earlier detection of such patients and better patient selection so as to reduce infectious complications.

<![CDATA[The Management Dilemma: Concomitant Acute Hip Fracture and Severe Asymptomatic Aortic Stenosis]]> Acute hip fractures (AHF) are common in elderly patients. A combination of age-related osteoporosis and increased fall risk makes this population group most susceptible to different fractures including acute fracture of the hip. AHF is a disabling condition that warrants immediate attention. It has a huge impact on the already compromised baseline functional status of elderly patients rendering them more susceptible to different morbidities and even mortality. Similarly, age-related degeneration of the aortic valve with resulting calcification also makes elderly patients prone to aortic stenosis (AS). Severe asymptomatic AS when diagnosed in these patients with AHF in the perioperative period makes the management options very challenging. Severity of AS usually translates into worse postoperative outcomes. The management rationale of concomitant presence of these two conditions is unclear. There is a lack of clear-cut recommendations and societal guidelines in such scenario. 

<![CDATA[Successful Treatment of Cardiac Tamponade due to Rupture of the Heart Performing an Open-chest Pericardiotomy]]>

A 78-year-old woman with mild dementia was found unconscious by her family. She was transported by an ambulance to our emergency room (ER). Initially, she was comatose and in a state of shock. The echocardiographic findings suggested cardiac tamponade by hematoma. Computed tomography also showed tamponade without aortic dissection. After imaging, she went into cardiac arrest, was returned to the ER, and tracheal intubation and left thoracotomy for pericardiotomy were performed. A return of spontaneous circulation was obtained by following this procedure. Bleeding from a rupture of the left cardiac free wall was confirmed, and the rupture was closed with TachoSil®. After closing the thoracotomy, electrocardiography revealed ST elevation in the precordial leads. Subsequently, placement of an indwelling intra-aortic balloon pump and coronary angiography (CAG) were performed. CAG showed an occlusion of the anterior interventricular branch and circumflex branch of the left coronary artery. She underwent conservative therapy in a coronary care unit. Finally, after obtaining hemodynamic stability and baseline mental status, she was transferred to another medical facility.

We herein report a rare case involving the successful treatment of cardiac tamponade due to rupture of the heart performing an open-chest pericardiotomy and additionally discuss the key points for obtaining a favorable outcome.

<![CDATA[Damage Control Management for Thoracic Trauma with Cardiac Arrest Complicated by Emphysematous Gastritis and Cystitis]]>

A 78-year-old man was found unconscious after sliding from a rock. His history included hypertension, atrial fibrillation and cerebral infarction requiring warfarin. On arrival, he received six units of blood type O transfusion and vitamin K in an emergency room (ER) due to hemorrhagic shock. His systolic blood pressure temporarily increased to 100 mmHg, and he underwent traumatic pan scan revealing occipital fracture, cerebral contusion, and cervical and multiple left rib fractures with left-dominant bilateral hemothorax. He re-entered a shock state after the examination and underwent transfusion again, but he then entered cardiac arrest. He underwent damage control surgery in the ER and obtained spontaneous circulation. The postoperative course was eventful, but he eventually obtained a survival outcome. Damage control surgery may be beneficial, even in cases of severe thoracic blunt trauma; however, postoperative infections may cause severe problems.

<![CDATA[The Right Anterior Thoracotomy Approach to Resect a Cardiac Papillary Fibroelastoma of the Aortic Valve]]>

A cardiac papillary fibroelastoma (CPFE) is reported to be the second most common cardiac neoplasm after myxoma cordis. CPFEs are histologically benign, frequently asymptomatic, but highly thrombogenic, which could lead to systemic and peripheral embolization. We present a case of a 68-year-old-patient, with a history of angioosteohypertrophy syndrome, who presented at our emergency department (ED) with symptoms of transient ischemic attacks. A thorough investigation, including echocardiography, revealed a neoplasm on the left coronary cusp (LCC) of the aortic valve. The neoplasm was resected via a valve-sparing shave via the right anterior thoracotomy (RAT). The pathological assessment confirmed it to be CPFE. CPFE is a rare but treatable cause of thromboembolism. The removal of CPFEs has classically been performed through a full median sternotomy. We like to present the first case of a valve-sparing removal of a CPFE on the aortic valve through a RAT approach.

<![CDATA[Laparoscopic Hiatal Hernia Repair in Patients with an Intrathoracic Pancreas: Case Series and a Review of Literature]]>

Transhiatal herniation of the pancreas is rare with only 17 cases reported in 25 years. Presentation of pancreatic herniation is diverse. In the majority of cases, the pancreatic herniation is found incidentally on CT-scans made for evaluating complaints related to a large or giant hiatal hernia. We present a literature review and case series of three patients with symptomatic type IV hiatal hernia with incidental, asymptomatic pancreatic herniation. All cases were managed laparoscopically with robotic assistance.

<![CDATA[Hemorrhagic Shock Secondary to Aortoesophageal Fistula as a Complication of Esophageal Cancer]]>

Although aortoesophageal fistulas are rare, they can present as life-threatening emergencies. This condition can develop secondary to an aneurysm, foreign bodies, infiltrating tumors, and radiotherapy. We report a patient with hemorrhagic shock secondary to an aortoesophageal fistula. A 69-year-old male with squamous cell carcinoma of the esophagus treated with chemoradiation and metallic stent placement was admitted to the intensive care unit (ICU) after an episode of hematemesis. The patient was hemodynamically unstable, requiring fluid resuscitation, blood transfusions, and respiratory and vasopressor support. The patient developed electric pulseless activity, and cardiopulmonary resuscitation was performed for 40 minutes. An upper endoscopy showed the esophageal tumor infiltrating into the stent, and computed tomography (CT) angiogram showed leakage of contrast from the thoracic aorta to the esophagus. The diagnosis of aortoesophageal fistula was made. The patient underwent endovascular management for the fistula. However, his critical condition did not improve, and the patient perished.

<![CDATA[Two Intriguing Cases of Stanford Type A Acute Aortic Dissection]]>

Stanford type A acute aortic dissection (AAD) is a life-threatening illness that presents with chest pain and hemodynamic instability. Prompt and accurate evaluation and management are critical for survival as it is a cardiac surgical emergency. We aim to highlight the physicians about this potentially fatal condition, by reporting two cases of Stanford type A AAD, with atypical presentations that were initially misdiagnosed.

<![CDATA[Morgagni-Larrey Hernia: A Possible Cause of Recurrent Lower Respiratory Tract Infections]]>

Morgagni-Larrey hernia is an exceedingly rare presentation of congenital diaphragmatic hernia. Despite its rarity, it is associated with significant risk of morbidity and mortality. Herein, we describe a unique case report of an elderly woman who presented with left-sided chest pain, dyspnea, and chronic history of recurrent respiratory tract infections. On the basis of her medical history, general physical examination and imaging studies, she was operated for a presumptive diagnosis of thymolipoma. However, the intra-operative findings revealed that it was an unusual variant of a diaphragmatic hernia and the hernia sac appeared through the retrosternal foramen of Morgagni. Hence we concluded that it was a Morgagni-Larrey hernia compressing the lungs and heart. Consequently, the hernia was reduced and the defect was repaired. During the postoperative period, the patient had an uneventful recovery. To conclude, the possibility of a Morgagni-Larrey hernia should be strongly considered while evaluating a patient with recurrent chest infections, dyspnea, and vague chest pain.

<![CDATA[An Unusual Variational Anatomy of the Medial Circumflex Femoral Artery: A Case Report of a Post-catheterization Femoral Arteriovenous Fistula]]>

The medial circumflex femoral artery (MCFA) typically presents as a major branch of the profunda femoris artery or it can also directly originate from the common femoral artery. Many anatomical variations of the MCFA have been described due to their clinical significance. We herein report a case of an unusual anatomical variation of the MCFA crossing anterior to the femoral vein that led to iatrogenic arteriovenous fistula formation after cardiac catheterization. The identification of such rare vascular anatomical variations is of great importance when attempting femoral arterial or venous puncture in order to minimize unnecessary complications.

<![CDATA[Mediastinal Hibernoma: A Rare Cause of Chronic Cough]]>

A hibernoma is an uncommon benign soft tissue tumor composed of brown adipose cells; the mediastinal location as presentation is scarce, with only six cases previously reported. The diagnosis of hibernoma is challenging and must be made based on the clinical, radiographic, and cytologic features. Here we present a 33-year-old woman without any relevant medical history presented for outpatient evaluation of a dry cough persisting for three months, and the X-rays revealed a dense well-defined mass with smooth borders in the left upper posterior mediastinum.  Posterior mediastinal lesions represent a relatively small proportion of patient loads in thoracic surgery and account for a total of 25% of the cases, with neurogenic tumors among the most frequently seen in adults. Of these, the nerve sheath tumors (schwannoma, neurofibroma, paraspinal ganglioneuroma) are the most seen. Other differential diagnoses of paravertebral masses are the paraspinal abscess, metastases, hematoma, descending aortic aneurysm, among others. The patient underwent surgical resection via left posterolateral thoracotomy, without complications.

<![CDATA[Prevalence of Sensorineural Hearing Loss in Children with Palliated or Repaired Congenital Heart Disease]]>


Children with congenital heart disease (CHD) are at increased risk of neurodevelopmental deficits, and the presence of sensorineural hearing loss (SNHL) may further lead to poor language skills acquisition and speech delays. Prevalence of SNHL in the general pediatric population is estimated to be 0.2% at birth to 0.35% during adolescence. Very few studies have attempted to estimate SNHL prevalence in children who have undergone congenital heart surgery.


This retrospective study aimed to estimate SNHL prevalence in children who underwent congenital heart surgery in our institution and were followed up in our high-risk pediatric cardiology clinics for four years from 2009 to 2013. Data were collected on demographics, preoperative variables, surgical variables, and post-operative variables.


SNHL prevalence in asymptomatic, palliated/repaired CHD patients followed in our high-risk clinics and undergoing routine surveillance was 11.6% (20 of 172 patients with hearing impairment). SNHL prevalence was not statistically higher in single-ventricle patients (17.2%) compared to biventricular patients (14.7%). Inotropic score in the first 24 hours of postoperative period (p=0.05), lowest arterial PaO2 (p=0.003), duration of Lasix drip (p=0), and bolus dose in days (p=0.03) were all found to be statistically significant in the hearing-impaired group. However, using logistic regression, we identified no statistically significant predictors for hearing loss.


The results suggest the need for routine audiology screening of all patients with complex CHD, especially those who have undergone neonatal cardiac repair/palliation at less than one year of age, irrespective of risk factors.

<![CDATA[Management of Takotsubo Syndrome: A Comprehensive Review]]>

Takotsubo syndrome (TTS), also known as Takotsubo cardiomyopathy, is a transient left ventricular wall dysfunction that is often triggered by physical or emotional stressors. Although TTS is a rare disease with a prevalence of only 0.5% to 0.9% in the general population, it is often misdiagnosed as acute coronary syndrome. A diagnosis of TTS can be made using Mayo diagnostic criteria. The initial management of TTS includes dual antiplatelet therapy, anticoagulants, beta-blockers, angiotensin-converting enzyme inhibitors or aldosterone receptor blockers, and statins. Treatment is usually provided for up to three months and has a good safety profile. For TTS with complications such as cardiogenic shock, management depends on left ventricular outflow tract obstruction (LVOTO). In patients without LVOTO, inotropic agents can be used to maintain pressure, while inotropic agents are contraindicated in patients with LVOTO. In TTS with thromboembolism, heparin should be started, and patients should be bridged to warfarin for up to three months to prevent systemic emboli. Our comprehensive review discussed the management in detail, derived from the most recent literature from observational studies, systematic review, and meta-analyses.

<![CDATA[Novel Single-Staged Posterior Retropleural Approach with Thoracoscopic Guidance for Resection of a Thoracic Dumbbell Schwannoma]]>

Dumbbell spinal cord tumors are infrequent pathologic entities. The optimal approach to safe surgical resection is ill-defined and must often be individualized. This is assisted with multiple tumor classification systems. Here, we describe a novel technique used to safely and successfully resect a large thoracic dumbbell schwannoma originating from the left T3 spinal nerve root with extension into the posterior mediastinum adjacent to the parietal pleura and thoracic aorta. A review of the literature was performed to study described surgical approaches to primary spinal dumbbell tumors. The decision-making process and preoperative imaging for operative planning are included. A detailed description of the procedure follows with intraoperative images. Gross total resection with no neurologic sequelae was achieved. Previously described operative techniques for resection of primary spinal dumbbell tumors with advantages and limitations of each are then reviewed. Gross total resection was safely achieved utilizing a single-staged posterior retropleural approach with anterior thoracoscopic guidance. The tumor was removed en bloc through a large posterior window. The prone position was utilized for the entire case with no intraoperative repositioning required. No intraoperative or immediate postoperative complications occurred. We report a novel approach to resecting a large primary spinal dumbbell tumor. A single-stage retropleural approach with anterior thoracoscopic guidance facilitated safe and successful gross total resection. Maintenance of the prone position throughout surgery allowed for reduced operative time, excellent anterior, and posterior visualization and no added patient morbidity. Repositioning to the lateral decubitus position may not be required in select cases.