Annals of Thoracic and Cardiovascular Surgery
Online ISSN : 2186-1005
Print ISSN : 1341-1098
ISSN-L : 1341-1098
Volume 24, Issue 4
Displaying 1-9 of 9 articles from this issue
Original Articles
  • Sasha Still, Marissa Mencio, Estrellita Ontiveros, James Burdick, Stev ...
    2018 Volume 24 Issue 4 Pages 173-179
    Published: 2018
    Released on J-STAGE: August 20, 2018
    Advance online publication: June 07, 2018

    Background: To investigate the efficacy of primary and rescue endoluminal vacuum (EVAC) therapy in the treatment of esophageal perforations and leaks.

    Methods: We conducted a retrospective review of a prospectively gathered, Institutional Review Board (IRB) approved database of EVAC therapy patients at our center from July 2013 to September 2016.

    Results: In all, 13 patients were treated for esophageal perforations or leaks. Etiologies included iatrogenic injury (n = 8), anastomotic leak (n = 2), Boerhaave syndrome (n = 1), and bronchoesophageal fistula (n = 2). In total, 10 patients underwent primary treatment and three were treated with rescue therapy. Mean Perforation Severity Scores (PSSs) in the primary and rescue treatment groups were 7 and 10, respectively. Average defect size was 2.4 (range: 0.5–6) cm. The rescue group had a shorter mean time to defect closure (25 vs. 33 days). In all, 12 of 13 defects healed. One death occurred following the implementation of comfort care. One therapy-specific complication occurred. Hospital length of stay (LOS) was longer in the rescue group (72 vs. 53 days); however, the intensive care unit (ICU) duration was similar between groups. Totally, 10 patients (83%) resumed an oral diet after successful defect closure.

    Conclusion: Utilized as either a primary or rescue therapy, EVAC therapy appears to be beneficial in the management of esophageal perforations or leaks.

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  • Victoria Khoronenko, Danil Baskakov, Marc Leone, Anna Malanova, Andrey ...
    2018 Volume 24 Issue 4 Pages 180-186
    Published: 2018
    Released on J-STAGE: August 20, 2018
    Advance online publication: June 20, 2018

    Purpose: Our study aimed to assess whether the type of regional anesthesia influenced the incidence of chronic postthoracotomy pain syndrome (CPTPS).

    Methods: This was a prospective, randomized study that included 300 patients undergoing lung cancer resection using thoracotomy. They were randomized into three groups: paravertebral nerve block (PVB), thoracic epidural anesthesia (TEA), and intercostal nerve block (INB). General anesthesia was similar in the groups. A horizontal visual analogue scale (VAS) was used to assess the intensity of the pain syndrome. It was assessed and recorded 7 days, 1 month, and 6 months after surgery.

    Results: At 6 months after surgery, the incidence (p <0.05) of the CPTPS was higher in the INB group (40%) than in the TEA group (23%). The CPTPS frequency in the PVB group did not differ from the other groups (34%).

    Conclusion: The use of the TEA in patients who underwent open lung cancer surgery contributed to a significant decline in the CPTPS frequency compared to patients who were administered INB. Using PVB did not decrease the CPTPS frequency.

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  • Yoshiyuki Nishimura, Yasushi Takagi
    2018 Volume 24 Issue 4 Pages 187-192
    Published: 2018
    Released on J-STAGE: August 20, 2018
    Advance online publication: April 20, 2018

    Antithrombin III (ATIII) deficiency is a rare disorder in which thrombosis can be induced by stimuli that do not usually lead to thrombus formation, including minor injuries and surgery. Therefore, patients with ATIII deficiency undergoing cardiovascular surgery that involves heparinization require careful perioperative management. We experienced five patients with ATIII deficiency who underwent cardiovascular surgery and were managed with ATIII replacement. By administration of ATIII concentrate, preoperative ATIII activity was maintained at ≥120% and postoperative ATIII activity at ≥80%. All five patients were treated successfully without postoperative complications such as hemorrhage or thrombosis. In patients with ATIII deficiency undergoing cardiac surgery, it is important to perform ATIII replacement to achieve preoperative ATIII activity ≥120% and postoperative ATIII activity ≥80%, while the activated clotting time (ACT) is maintained at >400 seconds during cardiopulmonary bypass. In addition, long-term postoperative anticoagulant therapy is necessary in hereditary ATIII deficiency patients with a history of thrombosis.

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  • Cengiz Ovalı, Aykut Şahin
    2018 Volume 24 Issue 4 Pages 193-199
    Published: 2018
    Released on J-STAGE: August 20, 2018
    Advance online publication: May 18, 2018

    Purpose: To determine to what extent chronic obstructive pulmonary disease (COPD) affects mortality and morbidity rates in patients treated with off-pump coronary artery bypass graft (CABG).

    Methods: A total of 321 patients treated with off-pump CABG were included in the present study. Of the 321 patients, 46 patients had COPD and they were designated as Group 1 and the remaining 275 patients did not have COPD and they were considered as Group 2. We compared the data obtained from the patients in both groups.

    Results: While preoperative spirometry values and arterial blood gas oxygen saturation levels were significantly lower, the partial values of carbon dioxide were higher in Group 1. Likewise, extubation time, the amount of drainage and blood transfusion, inotropic support, prolonged intubation, pulmonary complications, the use of bronchodilators, and steroids were statistically higher in Group 1 when compared with Group 2. Overall, there was no marked difference between the two groups in terms of mortality incidence.

    Conclusion: We found similar morbidity and mortality rates among the patients with COPD and without COPD when they were treated with off-pump CABG. Therefore, the present results indicate that the presence of COPD is not associated with in-hospital mortality or severe morbidity post-CABG by off-pump approach.

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Case Reports
  • Takuya Inoue, Ryuzo Kanno, Arata Moriya, Koichiro Nakamura, Yuzuru Wat ...
    2018 Volume 24 Issue 4 Pages 200-204
    Published: 2018
    Released on J-STAGE: August 20, 2018
    Advance online publication: December 20, 2017

    Background: Thymoma is known to cause autoimmune neuromuscular disease. However, anti-glutamate receptor antibody limbic encephalitis (LE) with thymoma is relatively rare.

    Case Presentation: A 68-year-old woman was admitted with progressive memory impairment and personality change. Brain magnetic resonance imaging (MRI) revealed high intensity in the bilateral limbic areas on T2-weighted fluid-attenuation inversion recovery (FLAIR) images. Chest computed tomography revealed a mass in the anterior mediastinum. Surgical resection of the tumor, which was consistent with a type B3 thymoma, resulted in clinical improvement. After surgery, the cerebrospinal fluid (CSF) was found to be positive for anti-N-methyl-D-aspartate (NMDA) type glutamate receptor antibodies. These findings led to the diagnosis of paraneoplastic LE (PLE) associated with thymoma.

    Conclusion: When a patient presents with neurologic symptoms of unknown origin, the possibility of LE accompanied by thymoma should be considered. Rapid treatment is desirable before the symptoms become irreversible.

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  • Supomo, Handy Darmawan
    2018 Volume 24 Issue 4 Pages 205-207
    Published: 2018
    Released on J-STAGE: August 20, 2018
    Advance online publication: November 24, 2017

    Penetrating foreign bodies in the heart is rare and may lead to life-threatening complications. Early diagnosis and removal are crucial for these rare cases. We report a case of accidental penetrating sewing needle in the right ventricle. The needle was successfully removed without open heart surgery and cardiopulmonary bypass (CPB), after accurate localization using transthoracic echocardiography (TTE).

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  • Tetsuro Uchida, Azumi Hamasaki, Yoshinori Kuroda, Mitsuaki Sadahiro, N ...
    2018 Volume 24 Issue 4 Pages 208-210
    Published: 2018
    Released on J-STAGE: August 20, 2018
    Advance online publication: December 27, 2017

    Immunoglobulin G subclass 4-related disease (IgG4-RD) is a recently recognized systemic inflammatory disease characterized by an elevated serum IgG4 level and an IgG4-positive lymphocyte infiltrate mainly in exocrine tissues. Previous reports documented IgG4-RD in several cardiovascular disorders. We present a case of type A aortic dissection associated with IgG4-RD. A 52-year-old man diagnosed with a type A aortic dissection was referred for surgical treatment. He underwent emergency hemiarch reconstruction with a prosthetic graft. His postoperative recovery was uncomplicated. Histopathologic examination of his aortic tissue showed marked adventitial thickening with fibrosis and an IgG4-positive plasma cell infiltrate. He was diagnosed with type A aortic dissection incidentally complicated by IgG4-RD. The relationship between IgG4-RD and the pathogenesis of aortic dissection remains unknown and requires further investigation.

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Letter to the Editors