Nedal Omran

Controlled Hemostasis in tHoraCiC surgery using drugs witH oxidized Cellulose

The authors demonstrate the possibility of improving surgical results by the reduction of perioperative bleeding in thoracic surgery associated with extended resection procedures. We focused on patients in whom the expected perioperative blood loss was greater than 500 ml. The first group consisted of patients with lung cancer stage III A after neoadjuvant chemotherapy had been indicated to extend the resection procedure. The second group consisted of patients with chest wall and mediastinum tumors of various etiologies. The third group consisted of patients with post-inflammatory thoracic complications in whom combined decortication and pleurectomy was necessary. By the using the local hemostyptic Traumastem TAF on the basis of oxidized cellulose, it is possible to minimize the perioperative blood loss, thus sparing the blood derivative requirement and enabling surgeons to provide the desired treatment even to high-risk patients.

Isolated Thoracic Aortitis

Isolated thoracic aortitis is a new pathological entity. We review the histopathological features of this disease, the role of imaging, and diagnostic modalities necessary to make the diagnosis of aortitis and discuss the management of patients with an established diagnosis of isolated thoracic aortitis. doi: 10.1111/jocs.12268 (J Card Surg 2014;29:225–230)

Broncho-Pleural Fistula Following Vacuum-Assisted Closure Therapy

We report a case of bronchopleural‐cutaneous fistula following long‐term vacuum‐assisted closure therapy to manage a sternal dehiscence after coronary artery bypass surgery. doi: 10.1111/jocs.12126 (J Card Surg 2013;28:397–398)

Myxoma in the left atrium

A74-year-old man was admitted for progressive exertional dyspnea. Physical examination was normal. Echocardiography showed a myxoma-like tumor in the left atrium that impinged to the left ventricle during diastole (Fig 1A). Chest computed tomography revealed the tumor (arrow) originated from the left lower lobar bronchus and descended to the left atrium through the left inferior pulmonary vein (Fig 1B). The patient underwent a simultaneous surgical procedure, during which the myxoma-like tumor was extirpated from the left atrium (Fig 2A) through a midsterno-

The dynamics of selected local inflammatory markers to talc in the treatment of malignant pleural effusions

BACKGROUND Malignant pleural effusions accumulate in the space between the visceral (inner) layer covering the lungs and the parietal (outer) layer covering the chest wall. Larger effusions compress the pulmonary parenchyma resulting in increasing dyspnoea. Treatment is always local and palliative. Among others, chemical pleurodesis using talc can be performed in selected patients. Talc is hydrated magnesium silicate (chemically H₂Mg₃(SiO₃)₄) and has been used for pleurodesis since 1935. Videothoracoscopic talc powder insufflation (talc poudrage) is the most effective.However, markers of inflammatory reactions to extraneous substances like talc are not fully understood. The aim of this study was to assess the course of local inflammatory changes in the pleural cavity after talc insufflation. METHODS The Department of Cardiac Surgery of the Faculty of Medicine and University Hospital in Hradec Kralove, treated 47 patients aged 65 on average; 29 males and 18 females with proven recurrent malignant pleural effusion of various aetiologies from January 2009 to December 2010. They were retrospectively divided into group A (40 patients) without recurring effusion, and group B (7 patients) with recurring effusion and the need for thoracentesis or chest drainage during the 9-month monitoring. RESULTS Major findings were made in soluble forms of cell receptors. Group B showed statistically higher levels of the anti-inflammatory form of sCD-163 receptor in pleural fluid before the talc poudrage. This showed limited ability to create an adequate inflammatory response to external stimuli. This group also showed lower levels of the inflammatory form of sTLR-2 receptor immediately after the talc insufflation. This revealed low local reactivity to external stimuli. The effect of the treatment was not influenced by morphologic tumour type. No statistically significant differences in postoperative complications were found. This confirmed the safety of both videothoracoscopy and treatment. CONCLUSIONS There was no correlation between the type of malignant affection and the outcome of the chemical pleurodesis. Patients with relapsing effusion have higher values of concentration of anti-inflammatory sCD-163 in pleural fluid even before the application of talc, and lower levels of concentration of inflammatory sTLR-2 immediately after application of talc.

Surgical Cryoablation of Drug Resistant Ventricular Tachycardia and Aneurysmectomy of Postinfarction Left Ventricular Aneurysm

Heart failure is usually associated with left ventricle remodelling, wall thickening, and worsening of the systolic function. Ventricular tachycardia is a common and a negative prognostic factor in patients with endocardial scarring following myocardial infarction and aneurysm formation. The authors present a case of a 51-year-old man with ischemic heart disease, who suffered myocardial infarction four years ago. The patient was admitted to the hospital with sustained ventricular tachycardia despite maximal pharmacotherapy and also underwent unsuccessful percutaneous radiofrequency ablation in the right ventricle. Transthoracic echocardiography revealed left ventricle dysfunction with ejection fraction of 25%, aneurysm of the apex of the left ventricle with thrombus formation inside the aneurysm. Surgical therapy consisted of the cryoablation applied at the transitional zone of the scar and viable tissue and the resection of the aneurysm. The patient remained free of any ventricular tachycardia four months later.

Predictive value of systemic and local inflammation parameters in talc pleurodesis assessment

BACKGROUND One option for the palliative treatment of recurrent malignant pleural effusion is powdered talc using thoracoscopy. This paper presents the results of selected systemic and local manifestations of the talc-induced inflammatory reaction using a videothoracoscope. METHOD A total of 114 patients with repeated malignant pleural effusion were treated at the Cardiac Surgery Clinic in Hradec Kralove from January 2010 to December 2012. Those with a life expectancy more than ≥ 3 months were eligible for talcage surgery. The group was retrospectively divided according to treatment results into Group A (N1 = 98 - successful) and Group B (N2 = 16 - relapsing). The pleural effusion was quantified using ultrasound over 1 year at 3-month intervals. Systemic changes due to the inflammatory reaction (body temperature, serum leukocyte and CRP levels) were evaluated. Local indicators of inflammation included changes in the leukocyte cell population in the effusion and changes in the pleural CRP levels. The dynamics of local expression of membrane receptors TLR-2 and CD-64 on granulocyte and monocyte cell populations in the pleural effusion were also evaluated. RESULTS The reaction after talcage, included a significant increase in axillary temperature and leukocyte count, 12 h after the procedure. The dynamics were different in the two groups. The dynamics of local inflammatory changes were an early increase in the pleural CRP levels in both groups. The time interval of local inflammatory development and duration was related to the treatment efficacy and showed a significant rise 2 h after talcage in Group A. In Group B the local inflammatory reaction was slower and the rise was only observed 24 h after talc application. A decrease in lymphocyte count and an increase in granulocyte count 2 h after talcage were found. After an initial drop in monocyte level, a rise occurred within 24 h after talcage. Changes in the expression of TLR-2 and CD-64 receptors in relation to their cell carriers were observed depending on time after talcage. CONCLUSION The differences in the serum and pleural effusion CRP levels suggest that the surgical stress manifests itself locally in the pleural space with a lower intensity and time delay. The TLR-2 and CD-64 receptors exhibit different behaviour depending on the type of cell membrane where they are found. The inverse relation between the granulocyte increase and TLR-2 receptor decrease in the membrane immediately after talcage is a new finding. The dynamics of TLR-2 expression on the monocytes demonstrates a direct proportion between the increasing expression of the TLR-2 receptor and increasing percent fraction of the cell carrier.

Cardiac Sarcoidosis: ISOLATEDCARDIACSARCOIDOSIS

Cardiac sarcoidosis is a rare entity and may be difficult to diagnose prior to cardiac surgery. We review the imaging and diagnostic studies necessary to make the diagnosis and discuss therapeutic algorithms to manage this disease. doi: 10.1111/jocs.12163 (J Card Surg 2013;28:525–528)

Endovascular management of an aortic rupture following transcatheter aortic valve replacement

We report a case of aortic rupture during transcatheter aortic valve replacement (TAVR) managed successfully by urgent stent‐graft implantation.

Surgical treatment of postinfarction ventricular septal defect: risk factors and outcome analysis

OBJECTIVES Postinfarction ventricular septal defect is a serious mechanical complication of acute myocardial infarction associated with high postoperative mortality. The aim of this study was to review our experience with surgical repair of postinfarction ventricular septal defect and to identify predictors of early and late outcomes. METHODS Thirty-nine patients (19 men and 20 women, mean age 68.4 ± 9.9 years) with postinfarction ventricular septal defect who underwent surgical repair at our institution between 1996 and 2016 were retrospectively evaluated. Risk factors were assessed by univariate analysis, with those found significant included in multivariate analysis. RESULTS The ventricular septal defect was anterior in 21 (54%) patients and posterior in 18 (46%) patients. Mean aortic cross-clamp time was 91.8 ± 26.8 min, and mean cardiopulmonary bypass time was 146.3 ± 49.7 min. Twelve (31%) patients underwent concomitant coronary artery bypass grafting. The 30-day mortality rate was 36% (n = 14). The 30-day survival rate was higher with than without concomitant coronary artery bypass grafting (83% vs 56%), but concomitant coronary artery bypass grafting did not influence late survival (P = 0.098). Univariate analysis identified age, emergency surgery, inotropic support, Killip class, preoperative aspartate aminotransferase concentration, renal replacement therapy and ventricular septal defect diagnosis to operation interval as predictors of 30-day mortality. However, multivariate analysis showed that age and renal replacement therapy were the only independent risk factors of 30-day mortality. CONCLUSIONS Surgical repair of postinfarction ventricular septal defect has a high 30-day mortality rate. Higher age at presentation and postoperative renal replacement therapy are independent predictors of early mortality.