MyMedR

Strategy for ventricular septal defect closure after prior gastric pull-through

Sivalingam S, Krishnasamy S, Yakub MA

Asian Cardiovasc Thorac Ann, 2015 Jun;23(5):612-4.

PMID: 24962807 DOI: 10.1177/0218492314540667

A 9-year-old boy was referred with a perimembranous ventricular septal defect. At birth, he had undergone a right thoracotomy with ligation of a tracheoesophageal fistula, cervical esophagostomy, and feeding gastrostomy. At 2 years of age, he had gastric tube reconstruction with a pull-through retrosternally, anterior to the heart, and an end-to-end esophagogastric anastomosis. Via a right anterolateral thoracotomy through the previous scar, the entire gastric tube was mobilized away from the sternum to facilitate a median sternotomy. With the patient supine, a median sternotomy was performed without difficulty, and the ventricular septal defect was closed under cardiopulmonary bypass.

Bilateral central vein stenosis in a dialysis patient with a pacemaker

Yew KL, Anderson S, Farah R, Lim SH

Asian Cardiovasc Thorac Ann, 2014 Oct;22(8):979-80.

PMID: 24887840 DOI: 10.1177/0218492313491583

Central vein stenosis is not uncommon in hemodialysis-dependent patients as a result of mechanical damage to the vessel walls from prior cannulation. It can cause ipsilateral upper limb swelling and pain, resulting in suboptimal hemodialysis. It is unfortunate for bilateral central vein stenosis to develop concomitantly, and rare in the setting of an in-situ pacemaker. This case illustrates the successful ligation of a nondependent left arteriovenous fistula and stenting of the right subclavian vein with functioning ipsilateral arteriovenous fistula, to overcome the problem of symptomatic bilateral upper limb swelling.

Complete resolution of type B aortic intramural hematoma with medical treatment

Moorthy PS, Sakijan AS

Asian Cardiovasc Thorac Ann, 2014 Feb;22(2):231.

PMID: 24585805 DOI: 10.1177/0218492312468119

Myocardial infarction false alarm: initial electrocardiogram and cardiac enzymes

Gupta ED, Sakthiswary R

Asian Cardiovasc Thorac Ann, 2014 May;22(4):397-401.

PMID: 24771726 DOI: 10.1177/0218492313484917

The objectives of this study were to determine the incidence of a myocardial infarction "false alarm" and evaluate the efficacy of the initial electrocardiogram and cardiac enzymes in diagnosing myocardial infarction in Malaysia.

Blood pressure variability in patients with diabetes mellitus

Mokhtar RH, Ayob A, Mohd Noor N

Asian Cardiovasc Thorac Ann, 2010 Aug;18(4):344-8.

PMID: 20719784 DOI: 10.1177/0218492310375723

Reduced arterial compliance in patients with diabetes mellitus has been shown in several studies, but it has not been significantly associated with either atherosclerosis or vessel wall thickness. Blood pressure variability is still poorly explored in diabetic patients. The aim of this study was to compare blood pressure variability and arterial compliance in patients with type 2 diabetes mellitus and controls matched for sex, age, and weight. Arterial compliance was measured and noninvasive 24-h ambulatory blood pressure monitoring was performed in 18 diabetic patients and 18 controls. There was significantly higher 24-h systolic blood pressure variability (17.7 +/- 6.8 vs. 14.6 +/- 2.6 mm Hg), diastolic blood pressure variability (15.6 +/- 7.1 vs. 11.4 +/- 3.1 mm Hg), and mean arterial blood pressure variability (14.8 +/- 7.0 vs. 11.1 +/- 2.9) in diabetic patients. Systolic, diastolic, and mean arterial blood pressure variability was significantly higher during daytime but not night time in diabetic patients compared to controls. Diabetic patients also had significantly reduced small artery compliance, but no differences in large artery compliance, cardiac output, or systemic vascular resistance. The findings suggest that hyperglycemia may affect the compliance of the vascular system, resulting in high blood pressure fluctuations.

Figure-of-eight vs. interrupted sternal wire closure of median sternotomy

Ramzisham AR, Raflis AR, Khairulasri MG, Ooi Su Min J, Fikri AM, Zamrin MD

Asian Cardiovasc Thorac Ann, 2009 Dec;17(6):587-91.

PMID: 20026533 DOI: 10.1177/0218492309348948

Sternal dehiscence is a rare but devastating complication following median sternotomy for cardiac surgery. The optimal technique for sternal closure is unclear. We conducted this prospective randomized trial to compare the incidence of sternal dehiscence after figure-of-8 and simple interrupted suturing in patients undergoing coronary artery bypass grafting. Between January 2007 and June 2008, 98 patients had figure-of-8 suturing and 97 had interrupted sutures. The mean age of the patients was 60.9 +/- 7.6 years. The overall sternal dehiscence rate was 8%; 7 cases in the in figure-of-8 group and 9 in the interrupted group. Thirteen patients had no wound infection and healed with conservative treatment. Only 3 patients had sternal dehiscence with infection: 2 with simple interrupted closure and 1 with figure-of-8 sternal closure. There was no significant difference in rates of sternal dehiscence between the 2 groups. It was concluded that figure-of-8 sternal suturing is equally effective as simple interrupted suturing in preventing sternal dehiscence.

Is 6% hydroxyethyl starch 130/0.4 safe in coronary artery bypass graft surgery?

Ooi JS, Ramzisham AR, Zamrin MD

Asian Cardiovasc Thorac Ann, 2009 Aug;17(4):368-72.

PMID: 19713332 DOI: 10.1177/0218492309338101

The aim of this study was to compare 6% hydroxyethyl starch 130/0.4 with 4% succinylated gelatin for priming the cardiopulmonary bypass circuit and as volume replacement in patients undergoing coronary artery bypass, in terms of postoperative bleeding, blood transfusion requirements, renal function, and outcome after surgery. Forty-five patients received 6% hydroxyethyl starch 130/0.4 (Voluven) and another 45 were given 4% succinylated gelatin (Gelofusine) as the priming solution for the cardiopulmonary bypass circuit as well as for volume replacement. Postoperative bleeding was quantified from the hourly chest drainage in the first 4 h and at 24 h postoperatively. The baseline characteristics of both groups were similar. In the hydroxyethyl starch group, the total amount of colloid used was 1.9 +/- 1.0 L, while the gelatin group had 2.0 +/- 0.7 L. There was no significant difference in hourly chest drainage between groups. Blood transfusion requirements, estimated glomerular filtration rate, extubation time, intensive care unit and hospital stay were similar in both groups. It was concluded that 6% hydroxyethyl starch 130/0.4 is a safe alternative colloid for priming the cardiopulmonary bypass circuit and volume replacement in patients undergoing coronary artery bypass surgery.

Renal outcome following on- and off-pump coronary artery bypass graft surgery

Ooi JS, Abdul Rahman MR, Shah SA, Dimon MZ

Asian Cardiovasc Thorac Ann, 2008 Dec;16(6):468-72.

PMID: 18984756

A prospective study was carried out to compare the outcomes of patients with preexisting non-dialysis-dependent renal dysfunction who underwent coronary artery bypass grafting with or without cardiopulmonary bypass. Elective off-pump coronary artery bypass was performed in 29 patients with renal dysfunction. Their results were compared with those of a similar group of 35 patients who underwent the conventional on-pump coronary artery grafting. There was a significant deterioration in creatinine clearance in the on-pump group on days 1, 2, and 4 after surgery, while creatinine clearance in the off-pump group remained close to the baseline level. Both groups had improved to the preoperative creatinine clearance values on follow-up at 4 weeks. It was concluded that off-pump surgery provided better renal protection than the conventional on-pump technique in patients with preexisting non-dialysis-dependent renal dysfunction.

Tension enterothorax

Wong PS, Vendargon SJ

Asian Cardiovasc Thorac Ann, 2003 Dec;11(4):375.

PMID: 14681107

Single-stage open repair of severe asymmetric pectus excavatum and mitral valve replacement in connective tissue disease

Pau CP, Chong KS, Yakub MA, Khalil AA

Asian Cardiovasc Thorac Ann, 2021 May 04.

PMID: 33947231 DOI: 10.1177/02184923211014004

We present a 14-year-old boy with Loey-Dietz syndrome with severe mitral regurgitation, pectus excavatum and scoliosis. The Haller index was 25. The heart was displaced into the left hemithorax. The right inferior pulmonary vein was very close to the sternum and vertebral body. Single-stage surgery was performed. An osseo-myo-cutaneous pedicled flap was created by sterno-manubrial junction dislocation and rib resection with bilateral internal mammary arteries supplying the flap. Cardiopulmonary bypass and mitral valve replacement was performed. The defect was bridged with three straight plates. The flap was laid on top and anchored. Early outcome at three months was good.

Circumflex aorta: An uncharted territory

Haranal M, Srimurugan B, Sivalingam S

Asian Cardiovasc Thorac Ann, 2021 May 06.

PMID: 33957784 DOI: 10.1177/02184923211015092

BACKGROUND: Vascular rings are aortic arch anomalies with a spectrum of manifestations ranging from asymptomatic lesions detected incidentally to an acute presentation secondary to tracheo-esophageal compression. Circumflex retro-esophageal aortic arch is an extreme form of true vascular ring. It remains an uncharted territory to many surgeons.

METHODS: A comprehensive search of peer reviewed journals was completed based on the key words, "Circumflex aorta," "Circumflex retro-esophageal aorta" and "circumflex arch" using Google scholar, Scholars Portal Journals and PubMed. The reference section for each article found was searched to obtain additional articles. Literature on the circumflex aorta was reviewed starting from the embryogenesis to the latest management strategies.

RESULTS: Right circumflex aorta is more prevalent compared to left circumflex aorta. It can occur in isolation or in association with other intracardiac lesions. Mainly presents in children, however reported in adults too. The presentation may vary from asymptomatic lesion to acute respiratory distress secondary to airway compression. Computerized tomography (CT) and magnetic resonance imaging (MRI) are important tools in delineating the vascular anatomy. Aortic uncrossing is the definitive procedure. However, the role of concomitant tracheobronchopexy is emerging. Native tissue-to-tissue anastomosis is commonly preferred, but cases of extra-anatomic grafts are reported.

CONCLUSION: Circumflex aorta is amenable to complete repair. Preoperative delineation of anatomy is important for successful surgical outcome. Division of the retro-esophageal segment is crucial in relieving the compressive symptoms. In addition, tracheobronchopexy is helpful in addressing residual tracheomalacia but this accounts for a high-risk surgery.

Successful resection of a giant thoracic myxoid liposarcoma

Pui WC, Ling WHY, Najah M, Soon SY

Asian Cardiovasc Thorac Ann, 2018 Jun;26(5):410-412.

PMID: 29667901 DOI: 10.1177/0218492318772763

Primary liposarcoma is an extremely rare disease. We report a case of giant thoracic myxoid liposarcoma that occupied the whole left hemithorax and was successfully resected. We discuss the surgical considerations and difficulties encountered, and how we overcome these challenges. This is the third largest thoracic myxoid liposarcoma resection reported, weighing 4 kg.

Pediatric empyema thoracis: roles and outcomes of surgery in advanced disease

Ho YL, Jamaluddin MF, Krishinan S, Salleh A, Khamis AY, Abdul Kareem BA

Asian Cardiovasc Thorac Ann, 2020 Mar;28(3):152-157.

PMID: 32122151 DOI: 10.1177/0218492320910932

A risk score for predicting respiratory complications after thoracic surgery

Pipanmekaporn T, Bunchungmongkol N, Punjasawadwong Y, Lapisatepun W, Tantraworasin A, Saokaew S

Asian Cardiovasc Thorac Ann, 2019 May;27(4):278-287.

PMID: 30857395 DOI: 10.1177/0218492319835994

BACKGROUND: Respiratory complications are some of the most common complications following thoracic surgery and can lead to higher perioperative morbidity and mortality. The purpose of this study was to develop a simple clinical score for prediction of respiratory complications after thoracic surgery, and determine the internal validity.

METHODS: In this retrospective cohort study, all consecutive patients were aged 18 years and over and undergoing non-cardiac thoracic surgery at a tertiary-care university hospital. Respiratory complications included bronchospasm, atelectasis, pneumonia, respiratory failure, and adult respiratory distress syndrome within 30 days of surgery or before discharge.

RESULTS: A total of 1488 patients were included over a 7-year period, and 15.8% (235 of 1488 patients) developed respiratory complications. The significant predictors of respiratory complications were chronic obstructive pulmonary disease, American Society of Anesthesiologist physical status ≥ 3, right-sided surgery, duration of surgery longer than 180 min, preoperative arterial oxygen saturation on room air

A rare cause of left ventricular outflow tract mass in infancy: Cardiac papillary fibroelastoma

Haranal M, Febrianti Z, Latiff HA, Rahman SA, Sivalingam S

Asian Cardiovasc Thorac Ann, 2021 Oct;29(8):816-818.

PMID: 33641433 DOI: 10.1177/0218492321998500

Primary cardiac tumors are one of the rare causes of intracardiac masses in pediatric population. Cardiac papillary fibroelastomas are benign cardiac tumors with predilection for valvular endocardium, and the presentation is dictated by the cardiac structure involved and the tumor characteristics. We report an infant with cardiac papillary fibroelastoma manifesting as an asymptomatic left ventricular outflow tract mass. This case is being presented to emphasize the rare occurrence of cardiac papillary fibroelastoma in pediatric population and to be cognizant of this entity when considering differential diagnosis of intracardiac masses in this subgroup.

Fulltext Aerosol-generating procedures in thoracic surgery in the COVID-19 era in Malaysia

Sathiamurthy N, Balasubbiah N, Dharmaraj B

Asian Cardiovasc Thorac Ann, 2020 Oct;28(8):495-499.

PMID: 32787442 DOI: 10.1177/0218492320950898

BACKGROUND: The Covid-19 pandemic has caused changes in the surgical treatment of non-Covid patients, especially in thoracic surgery because most procedures are aerosol generating. Hospital Kuala Lumpur, where thoracic procedures are performed, was badly affected. We describe our experience in performing aerosol generating procedures safely in thoracic surgery during the Covid-19 era.

METHODS: Medical records of patients who underwent thoracic surgery from March 18, 2020 to May 17, 2020 were reviewed retrospectively. All patients undergoing thoracic surgery were tested for Covid-19 using the reverse transcriptase polymerase chain reaction method. Patients with malignancy were observed for 10 to 14 days in the ward after testing negative. The healthcare workers donned personal protective equipment for all the cases, and the number of healthcare workers in the operating room was limited to the minimum required.

RESULTS: A total of 44 procedures were performed in 26 thoracic surgeries. All of these procedures were classified as aerosol generating, and the mean duration of the surgery was 130 ± 43 minutes. None of the healthcare workers involved in the surgery were exposed or infected by Covid-19.

CONCLUSION: Covid-19 will be a threat for a long time and thoracic surgeons must continue to provide their services, despite having to deal with aerosol generating procedures, in the new normal. Covid-19 testing of all surgical candidates, using the reverse transcriptase polymerase chain reaction, donning full personal protective equipment for healthcare workers, and carefully planned procedures are among the measures suggested to prevent unnecessary Covid-19 exposure in thoracic surgery.

Modified Tran Viet-Neveux technique of truncus arteriosus repair

Haranal M, Latiff HA, Sivalingam S

Asian Cardiovasc Thorac Ann, 2021 Jul;29(6):563-564.

PMID: 33653150 DOI: 10.1177/0218492321998503

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