Cardiothoracic Medicine Research Articles

The digital heart-lung unit: applications of exponential technology.

Exponential technologies such as virtual reality (VR), computational modelling, and additive manufacturing have emerged in the field of cardiology and cardiothoracic surgery. An increasing number of publications that evaluate the clinical role of these technologies are becoming available. Moreover, there is an increase in the number of hospitals and departments that have implemented digital and exponential solutions in clinical workflow. In our centre, we have adopted various exponential technologies in order to improve clinical pre-procedural workflow, patient care, and training and education. In order to provide our view and approach on the implementation of these technologies, in this article, we provide an overview of the currently applied modalities including immersive VR, three-dimensional (3D) computational modelling, VR-based simulations, and additive manufacturing (3D printing). Moreover, we present the potential of these applications in cardiovascular and cardiothoracic medicine, and additionally, we will provide key facilitators, challenges, and recommendations to adopting these technologies in clinical practice.

Coronary CT in Australia has high positive predictive value unaffected by site volume: An analysis of 510 positive CTCA scans with invasive angiographic correlation

BackgroundIt was hypothesized that the accuracy of coronary CT angiography would be affected by case volume of the referring sites. MethodsThe positive predictive value (PPV) of CTCA performed at a tertiary hospital specialising in cardiothoracic medicine and services with lower case-volumes were calculated. The tertiary hospital used as the high case-volume reference centre was The Prince Charles Hospital, which performed >1500 CTCA scans per annum over the study period. The low case-volume services used in the study were suburban radiology services, each with <500 cases per year. The PPV of positive CTCA at the reference site was compared to the pooled PPV of all other sites as a combined cohort, using invasive angiography as the reference standard. 512 scans were included, n = 199 subjects in the reference centre cohort, and n = 311 subjects in the pooled community radiology practice cohort. ResultsThe positive predictive value (PPV) of the high case-volume group (n = 199) was 0.7538. The PPV of the pooled low case-volume services (n = 589) was 0.7331, p = 0.604, with no statistically significant difference in positive predictive values. ConclusionsThere was no significant difference in PPV between the two groups. This suggests that high-volume and lower-volume sites both have high PPV in Australia, above the published pooled PPV of four large prospective diagnostic accuracy studies (Miller et al., 2008; Budoff et al., 2008; Meijboom et al., 2008; Achenbach, 2007).

Editorial introductions

Editorial introductions

Editorial introductions

Editorial introductions

Cannulation Strategies and Pitfalls in Minimally Invasive Cardiac Surgery.

For any given cardiac surgery, there are two invasive components: the surgical approach and the cardiopulmonary bypass circuit. The standard approach for cardiac surgery is the median sternotomy, which offers unrestricted access to the thoracic organs-the heart, lung, and major vessels. However, it carries a long list of potential complications such as wound infection, brachial plexus palsies, respiratory dysfunction, and an unpleasant-looking scar. The cardiopulmonary bypass component also carries potential complications such as end-organ dysfunction, coagulopathy, hemodilution, bleeding, and blood transfusion requirement. Furthermore, the aortic manipulation during cannulation and cross clamping increases the risk of dissection, arterial embolization, and stroke. Minimally invasive cardiac surgery is an iconic event in the history of cardiothoracic medicine and has become a widely adapted approach as it minimizes many of the inconvenient side effects associated with the median sternotomy and bypass circuit placement. This type of surgery requires the use of novel perfusion strategies, especially in patients who hold the highest potential for postoperative morbidity. Cannulation techniques are a fundamental element in minimally invasive cardiac surgery, and there are numerous cannulation procedures for each type of minimally invasive operation. In this review, we will highlight the strategies and pitfalls associated with a minimally invasive cannulation.

Letter of Editor-in-Chief

Dear colleagues, It is my pleasure to welcome you in the third issue of Journal of Cardio-Thoracic Medicine and I hope you find it interesting. In this issue, beside the valuable original articles and an interesting case report, a useful review article have been published concerning the role of nuclear medicine in the management of solitary pulmonary nodule.I am proud to announce you that Journal of Cardio-Thoracic Medicine has been approved by Medical Journal Commission of Ministry of Health and Medical Education to be a Scientific Research Journal.Additionally Journal of Cardio-Thoracic Medicine is now indexed in DOAJ, EBSCO, Index copernicus, ISC, Magiran.Hopefully, the Journal of Cardio-Thoracic Medicine helps you through conveying your valuable experiences in the field of cardio-thoracic medicine. We kindly ask our readers to share their opinions for exploring new ways to make the journal more useful and practical.Finally, I would like to thank all of our dear authors for submitting their articles.

Editorial introductions

Editorial introductions

Career lifetime advances in nuclear medicine

When I qualified in 1967, medicine was much simpler, but becoming more interesting. There were new diuretics (ethacrynic acid and furosemide) which really worked ‐ I’m probably one of the last housemen to have used Southey’s tubes for drainage of intractable oedema. We also had new antibiotics such as ampicillin. My surgical skills were minimal, and my first house job was as house surgeon to the cardiothoracic unit at Westminster Hospital, where I clerked the patients, held the retractor and looked after the patients in the postoperative period. This was basically applied physiology ‐ and I enjoyed it. My medical house job was in cardiothoracic medicine, and here I came across my first real taste of what was to become nuclear medicine when we were able to send patients over to University College Hospital (UCH) to have their pulmonary perfusion assessed. 1 Remember, there was no computed tomography (CT), no magnetic resonance imaging (MRI), no ultrasound and little angiography. I enjoyed applied physiology, so I managed to persuade the cardiothoracic unit that they needed a senior house officer in what would now be called intensive care, and they persuaded the Garfield Weston Foundation to fund a post. This included looking after postoperative patients, as well acting as resident doctor to the respiratory and coronary care units (including two hyperbaric tanks). I also found time to go on the course in clinical measurement run by Dr Percy Cliffe’s department, and to teach myself programming in FORTRAN on the IBM 1800 computer. Having decided that a physician’s life was for me, I went to work for Dr Phillip Harvey at St Stephen’s Hospital in Fulham, where I passed MRCP part I, and took part II. I then decided that to be a general physician I needed to learn more neurology, so I got a registrar post in neurology at the Royal Free Hospital ‐ where nuclear medicine re-entered my life. The standard methods of diagnosing intracerebral pathology involved basic ultrasound to look for a shift of the midline structures, followed by angiography, usually by direct carotid puncture. If this did not resolve the issue, the patient went to Queens Square for a pneumoencephalogram. However, the medical physics department at the Royal Free had a rectilinear scanner, and one of my tasks was to inject the patients with the pertechnetate to allow imaging. The images were amazing ‐ it was possible to see a tumour without risk to the patient. I also helped set up and run a Parkinson’s disease clinic for trials of L-DOPA and related agents. 2 Still trying to be a general physician, I went on to a short spell as a locum senior registrar in rheumatology, and then was offered a locum post at Guy’s in endocrinology and nuclear medicine. These were two specialties I had not tried, so I accepted the offer. The nuclear medicine was a revelation. There was exposure to a wide new field. We were measuring glomerular filtration rate using Cr-51-EDTA, looking for pulmonary emboli, carrying out renography using probes to assess kidney function, and localising the placenta in pregnant patients with antepartum haemorrhage using a Sn/In-1113m generator, a probe and a calibrated tea towel. I knew that this felt right for

Kenneth James McGhee

After registration, Kenneth James McGhee specialised in cardiothoracic medicine, working at St Mary’s Paddington, Norfolk and Norwich, and Central Middlesex Hospitals, before entering general practice in Seaford, East Sussex. He...

The surgeon and the musician☆

These two quotations encapsulate my personal thinking about music. I cannot imagine my life without listening to music most of the time. Being both a surgeon and an amateur musician, I have been, for a long time, intrigued by the potential relations between medicine and music (Fig. 1). Indeed there have been in history, many famous people who were both musicians and physicians or surgeons [1]. Just in the field of cardio-thoracic medicine, Leopold Joseph Auenbrugger (1722—1809) and Rene Theophile Hyacinthe Laennec (1781—1826) provide brilliant examples; both were composers and excellent musicians; the former described chest percussion and the latter invented the stethoscope; both were able to use their musical abilities to implement their medical achievements. In a recent paper, H.M. Evans described three potential relations between medicine and music: (1) medical employment of music, (2) medical explanation of music and (3) music as a metaphor for medicine [2]. I would like to follow the same pathway to explore the potential relations between surgery and music and to try to convince the readers that surgery may also be music.

From nurse to student midwife: do they have the advantage?

I have been a senior staff nurse in cardiothoracic medicine for seven years. Just over a year ago I accepted a place on the 18-month midwifery course to train to do a job I had always wanted to do, accept that careers advice led me to train as a nurse first. It did not occur to me that the transition from nurse to student midwife could be so difficult.