Ulf Hermansson

Hemodynamic aspects of mitral regurgitation assessed by generalized phase-contrast MRI.

To investigate the utility of MRI measurement of left atrial (LA) flow patterns and turbulent kinetic energy (TKE) in patients with clinically significant mitral regurgitation.

Video-Assisted Thoracic Surgery (VATS) Lobectomy: The Initial Swedish Experience

BACKGROUND This study was performed to evaluate the technical feasability and validity of video-assisted pulmonary lobectomy using simultaneous stapling of the hilar structures. METHODS Between December 1995 and July 1997, 30 video-assisted thoracic non-rib spread simultaneously stapled lobectomies (VATS(n)SSL) were performed. RESULTS Fourteen males and 16 females underwent 9 right upper, 4 right middle, 5 right lower, 4 left upper, and 8 left lower lobectomies for 15 adenocarcinomas, 7 squamous cell carcinomas, 4 benign and 2 metastatic lesions, 1 carcinoid and 1 mucosa-associated lymphoid tissue-lymphoma. All patients with primary lung carcinoma had peripheral lesions, 13 were T1 and 9 were T2 lesions. Lesions ranged from 1.0 cm to 4.0 cm, averaging 2.2 cm. Results of 10 cervical mediastinoscopies were negative. Two patients had positive nodes at postoperative examination. Operating time for the series averaged 128 minutes, for the first 10 patients 146 minutes, and for the last 10 patients 106 minutes. There was no surgical mortality and no transfusion. Perioperative bleeding averaged 185 mL. Two procedures were converted to open thoracotomy. Hospitalization averaged 4.4 days for the entire group. CONCLUSION Video-assisted thoracic surgical non-rib spread simultaneously stapled lobectomy is a technically feasible and safe procedure. Therapeutic outcomes for resected neoplasms need to be evaluated in long-term follow-up studies.

Lung Injury with Pleuropericardial Rupture Successfully Treated by Video-Assisted Thoracoscopy: Case Report

We present a case of lung injury with pleuropericardial rupture resulting from blunt chest trauma. A conclusive diagnosis and successful treatment was achieved by video-assisted thoracoscopy. The value of diagnostic modalities and the role of video-assisted thoracoscopy in the management of these challenging patients are discussed.

A Swedish consensus on the surgical treatment of concomitant atrial fibrillation

Abstract Atrial fibrillation (AF) is a common arrhythmia among patients scheduled for open heart surgery and is associated with increased morbidity and mortality. According to international guidelines, symptomatic and selected asymptomatic patients should be offered concomitant surgical AF ablation in conjunction with valvular or coronary surgery. The gold standard in AF surgery is the Cox Maze III (“cut-and-sew”) procedure, with surgical incisions in both atria according to a specified pattern, in order to prevent AF reentry circuits from developing. Over 90% of patients treated with the Cox Maze III procedure are free of AF after 1 year. Recent developments in ablation technology have introduced several energy sources capable of creating nonconducting atrial wall lesions. In addition, simplified lesion patterns have been suggested, but results with these techniques have been unsatisfactory. There is a clear need for standardization in AF surgery. The Swedish Arrhythmia Surgery Group, represented by surgeons from all Swedish units for cardiothoracic surgery, has therefore reached a consensus on surgical treatment of concomitant AF. This consensus emphasizes adherence to the lesion pattern in the Cox Maze III procedure and the use of biatrial lesions in nonparoxysmal AF.

An approach to intracardiac needles

Abstract A 45-year-old woman suddenly developed paroxysmal supraventricular tachycardia. A plain chest X-ray examination revealed a needle (a a Kirschner wire) in the heart Removal of the needle with video-assisted thoracic surgery (VATS) was attempted but was unsuccessful. VATS may have a role in certain types of intracardiac foreign bodies.

Resection of a plasma cell granuloma combining a conventional posterolateral left-sided thoracotomy with a minimally invasive valve approach

Plasma cell granuloma (PCG) is a rare benign tumor that is difficult to differentiate from malignancy. Depending on the location of the PCG, surgical management can be challenging. We describe a patient with a PCG involving the left lower lobe extending into the left atrium, that was resected en bloc using a conventional posterolateral thoracotomy combined with a surgical approach predominantly used for minimally invasive mitral valve surgery. This case illustrates how it is possible to utilize a technique used for cardiac surgery for tumors of pulmonary origin involving the heart.

Kiegészítő klinikai módszer a nyitott szívműtéteknél fellépő légembolisatio csökkentésére A complementary clinical method to minimize air embolism during open-heart surgery

Air from the left heart is ejected even up to several hours after cardiopulmonary bypass (CPB) despite the use of CO2. The following method is complementary in addition to surgical de-airing in order to further reduce the chance of air embolism, especially from the pulmonary veins. After re-expanding the lungs with standard bag inflation, the ventilation is restarted in consultation with the surgeon. The ventilator is set to the respiratory minute volume used before the CPB but at a respiratory frequency of 10/minutes whereas the regularly beating heart is filled from the heart lung machine. Transoesophageal echocardiography (TEE) reliably controls the effect.

[A complementary clinical method to minimize air embolism during open-heart surgery].

Air from the left heart is ejected even up to several hours after cardiopulmonary bypass (CPB) despite the use of CO2. The following method is complementary in addition to surgical de-airing in order to further reduce the chance of air embolism, especially from the pulmonary veins. After re-expanding the lungs with standard bag inflation, the ventilation is restarted in consultation with the surgeon. The ventilator is set to the respiratory minute volume used before the CPB but at a respiratory frequency of 10/minutes whereas the regularly beating heart is filled from the heart lung machine. Transoesophageal echocardiography (TEE) reliably controls the effect.

Kiegészítő klinikai módszer a nyitott szívműtéteknél fellépő légembolisatio csökkentésérer

Air from the left heart is ejected even up to several hours after cardiopulmonary bypass (CPB) despite the use of CO2. The following method is complementary in addition to surgical de-airing in order to further reduce the chance of air embolism, especially from the pulmonary veins. After re-expanding the lungs with standard bag inflation, the ventilation is restarted in consultation with the surgeon. The ventilator is set to the respiratory minute volume used before the CPB but at a respiratory frequency of 10/minutes whereas the regularly beating heart is filled from the heart lung machine. Transoesophageal echocardiography (TEE) reliably controls the effect.