Journal Of Cardio-thoracic Surgery Research Articles

ESC Textbook of Cardiovascular Medicine

John Camm, Thomas F. Luscher, Patrick W. Serruys, eds 1136 pages. Oxford, UK: Blackwell Publishing; 2006. $295. ISBN 1-4051-2695-7 Editor’s Note: In our effort to provide an insightful, balanced, and constructively critical review of the new first edition of the ESC Textbook of Cardiovascular Medicine edited by Drs A. John Camm, Thomas F. Luscher, and Patrick W. Serruys that was published under the auspices of the European Society of Cardiology by Blackwell Publishing Ltd (2006), we have obtained the opinions of 3 distinguished senior cardiologists, Drs Gottlieb Friesinger, Desmond Julian, and Elliot Rapaport, to serve as a Select Panel for Review. To ensure the book was read in its entirety, the text was divided into thirds and apportioned equally to each reviewer; all 3 reviewers were assigned 4 chapters in common to read as well. This summary review by 3 individuals, each of whom is internationally recognized for expertise in the broad field of general cardiology, is offered in the spirit of helping the ESC achieve its stated objective of providing a textbook that is successful in covering the knowledge that should be required of all general cardiologists. ### General Comments This textbook is primarily targeted at the specific audience of those wishing to be accredited with the European Board for Accreditation in Cardiology (EBAC). It is not intended to be a work of reference, but, as stated in the foreword, of producing “a clinically focused resource for general cardiologists and trainees.” It presents 36 chapters within 1092 pages, each authored by anywhere from 2 to 6 multinational collaborating members of the European Society of Cardiology. One of its remarkable achievements in addition to the high standard of writing is its superb illustrations, figures, and tables that appear on virtually every page. They are well placed within the text and contribute in making …

Spontaneous Left Atrial Dissection and Hematoma Mimicking a Cardiac Tumor

A 59-year-old woman with no history of cardiac surgery or thoracic trauma presented to the emergency department with tachycardia and dyspnea. The ECG showed sinus rhythm (110 bpm). X-rays showed interstitial pulmonary edema. Transthoracic echocardiography revealed a mild enlargement of the left atrium (LA), normal left ventricular function, and a large fixed mass occupying almost entirely the LA and arriving just near the posterior mitral annulus. Moderate mitral regurgitation was present. Transesophageal echocardiography confirmed the presence of an inhomogeneous cyst-like mass with a thin hyperechogenic wall coming from …

Corrigendum to "Allopurinol/uricase and ibuprofen enhance engraftment of cardiomyocyte-enriched human embryonic stem cells and improve cardiac function following myocardial injury" [Eur J Cardiothorac Surg 29 (2006) 50-55

Cardiothoracic Surgery/Falk Research Center, Stanford University Medical School, Stanford, CA, USA Department of Radiology, Stanford University Medical School, Stanford, CA, USA Geron Corporation, Menlo Park, CA, USA Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Carl Neuberg Street 1, 30625 Hannover, Germany www.elsevier.com/locate/ejcts European Journal of Cardio-thoracic Surgery 29 (2006) 1069

Near Sudden Death From Cardiac Lipoma in an Adolescent

A previously healthy 13-year-old boy collapsed at home. The emergency medical service diagnosed ventricular tachycardia and cardioverted to sinus rhythm. The left cardiac contour was abnormal on radiography (Figure 1). Echocardiography showed a large mass at the lateral mitral annulus (Figure 2), without impediment to valvar function or blood flow. Magnetic resonance imaging (MRI) confirmed an encapsulated, homogenous, 5×4×5-cm mass, embedded in the myocardium, adjacent to but not involving the circumflex coronary artery. This mass had hyperintense MRI T1-weighted …

Point:Counterpoint: Hypoxic pulmonary vasoconstriction is/is not mediated by increased production of reactive oxygen species

This series of debates was initiated for the Journal of Applied Physiology because we believe an important means of searching for truth is through debate where contradictory viewpoints are put forward. This dialectic process whereby a thesis is advanced, then opposed by an antithesis, with a

Acute Myocardial Infarction Caused by Extension of a Proximal Aortic Dissection Flap Into the Right Coronary Artery

A 69-year-old man with a history of hypertension was referred to our institution for management of acute myocardial infarction (AMI) and cardiogenic shock. The ECG showed a marked ST-segment elevation in leads II, III, and aVF and a reciprocal ST-segment depression in leads V2 through V6, suggesting an inferior wall AMI (Figure 1). Immediately after admission, the patient went into sudden cardiac and respiratory arrest and received cardiopulmonary resuscitation (CPR). A temporary pacemaker and an intra-aortic balloon pump were inserted during the CPR procedure, and emergent coronary angiography was performed. The right coronary angiogram showed no …

Welcome to the Journal of Cardiothoracic Surgery

Journal of Cardiothoracic Surgery (JCTS) is an open access, peer-reviewed, online journal, which will encompass all aspects of research in the field of cardiothoracic surgery. JCTS will provide a forum for the publication and free-access of high quality scientific reports documenting clinical and experimental advances in cardiac and thoracic surgery, and related fields. The following types of articles will be accepted: Research Article, Review, Study Protocol, Book Review, Case Report, Case Study, Commentary, and Editorial. The intended audience is cardiothoracic surgeons, cardiothoracic anaesthesiologists, cardiologists, chest physicians, and allied health professionals.

They’re here: Continuing medical education activities

T We have long believed that journals are a rich source for the continuance of learning that is critical for safe, innovative clinical practice. This belief is one of the reasons that articles submitted to The Journal of Thoracic and Cardiovascular Surgery (JTCVS) are subject to such stringent peer review. Articles that appear in print one day may well form the basis for practice the next. Although being a knowledgeable and contemporary surgeon should be reward enough for the hours spent digesting new information, various certifying and privileging entities require documentation of such efforts. Thus, we are particularly pleased that, through the auspices of the American Association for Thoracic Surgery, beginning with this issue of the Journal, it will be possible for JTCVS subscribers to acquire continuing medical education (CME) credits for thoughtful reading of selected published articles. The authors of these selected articles have accepted the additional burden of creating questions designed to evaluate the learner’s understanding of the content of their articles in such a way as to make them acceptable for CME credit. We think learners will enjoy the short tests and benefit from the accrued credits. The CME activities are accessible to all JTCVS subscribers via several paths: 1. Direct access to the CME Web site home page using the url http://cme. ctsnetjournals.org. From the CME home page, choose JTCVS. The next screen lists 3 general subject areas: surgery for acquired cardiovascular disease, general thoracic surgery, and surgery for congenital heart disease. Behind each subject area is a list of CME activities. Note, however, that the December issue, being the introductory issue, will contain just one article per category. Each month, another article will be added in each category. Articles will be available on the site for 2 years. 2. Direct access to an activity from the Journal table of contents. Click on the CME designation link next to the title of the CME article in the table of contents. The link will take the learner directly to the “take this course” screen. 3. Direct access to an activity from within the CME-designated article: In the section of the article-information box called “This Article,” click the CME link. 4. Indirect access via the print version of the Journal: CME articles will be designated with an appropriate icon both in the table of contents and on the article title page and Web site access information will be provided. This project has been a collaborative effort between CTSNet, the Annals of Thoracic Surgery, The Journal of Thoracic and Cardiovascular Surgery, and the European Journal of Cardio-Thoracic Surgery. The effort was led by L. Henry Edmunds, Jr, Editor, Annals of Thoracic Surgery, who helped the group construct exercises in keeping with the complicated rules behind the CME process and kept after the editors and managing editors until they got it right. The entire group extends thanks to Dr Edmunds for his perseverance and wisdom. Thanks also to Peter Green, Executive Editor, CTSNet, and Polly Siegel, Journal Manager, Highwire Press, who served as referees, peacekeepers, coordinators, and occasionally as enforcers for the project. The work done by Heide Pustzy, Managing Editor, Annals of Thoracic Surgery, in coordinating preparation of complicated content documents is also gratefully acknowledged.

Stem cell therapy for myocardial regeneration: creating hype ignoring reality

I read with interest the recent article in European Journal of Cardio-Thoracic Surgery by Siepe and colleagues [1] where they have reviewed the work done in the field of stem cell research for myocardial regeneration. It is an excellent review paper. I would like to add a few points which unfortunately have not been addressed in this article. Despite significant advances in medical and surgical management of heart failure, the mortality and morbidity associated with it continues to be high. Cardiomyocyte apoptosis (programmed cell death) has been implicated in the development of end-stage heart failure [2]. Myocardial regeneration will be the ideal treatment for these failing hearts. It explains the hype created around cellular therapy, more appropriately called ‘Cellular Cardiomyoplasty’ by many investigators. In fact, while this issue is getting debated, some centres in South East Asian countries have started charging fees from patients for treatment with coronary artery bypass grafting and stem cell therapy as single procedure. It means not only are we stretching things too far but also the fact that it constitutes unethical practice. The evidence in support of stem cell therapy as means for myocardial regeneration is not flawless, to say the least. We do not know which cell type to inject; how to inject (delivery of cells); where to inject (centre of the scar vs periphery of scar); when to inject (immediately after myocardial infarction vs delayed injection); how much to inject (dosing) and safety, efficacy and long-term results. Recently the critical question of host immune response to implanted cells has started to receive attention from the researchers [3]. Recent studies on immune interactions of bone marrow mesenchymal stem cells have raised doubts over the concept of myocardial regeneration leading to functional recovery. Do they really form new functioning cardiomyocytes or is the improvement in ventricular function cytokine/chemokines mediated [4]? Very few engrafted cells express specific cardiac markers like connexion 43 and cardiac troponin I and only limited gap junctions are formed between grafted and native cells [4]. Even if they form new cardiomyocytes, the question of proper integration and communication with the host tissues remains unanswered.

Traumatic Pseudoaneurysm of the Descending Thoracic Aorta

A 39-year-old man presented with complaints of chest pain, dyspnea, and cough after a long-distance flight. He gave a history of having been involved in a major traffic accident 20 years ago in which he was run over by a truck, which resulted in extensive musculoskeletal injuries that necessitated several operations. He had been experiencing intermittent chest pain and dyspnea for 2 years. At the emergency department, a large upper-mediastinal mass was found on chest radiography (Figure, panel A). CT showed a large thoracic aortic aneurysm, and the patient was referred for cardiovascular MRI before surgery. This revealed a large …

Cardiac Transplantation for Giant Sarcoma of the Left Ventricle

An 8-year-old boy with a growing left ventricular mass underwent cardiac surgery for tumor resection. Radical resection seemed impossible, and thus, only a large biopsy sample was taken with a concomitant patch closure of the left ventricular defect. Histological examination revealed a rare liposarcoma. The patient was discharged without further therapy. Five months later, the patient was transferred to our hospital because his clinical condition had worsened to New York Heart Association class IV, and a recurrent left ventricular tumor became evident. MRI (Figures 1, …

Pneumothorax and mediastinal emphysema due to an air leak from a bulla in an azygos lobe☆

1010-7940/$ see front matter Q 2005 Published by Elsevier B.V. doi:10.1016/j.ejcts.2005.06.045 * The patient was operated at the Section of General Thoracic Surgery, Department of Surgery, University of Catania, Catania, Italy. * Corresponding author. Tel.: C44 1480 364532; fax: C44 1480 831315. E-mail addresses: marcello.migliore@papworth.nhs.uk (M. Migliore), mmiglior@unict.it (M. Migliore). lobe. The suspected bulla was rather the mediastinal pleura blown-up by an air leak from a bulla of the azygos lobe (Fig. 1(b)). European Journal of Cardio-thoracic Surgery 28 (2005) 641 www.elsevier.com/locate/ejcts

Giant fibrovascular polyp of the oesophagus

A 57-year-old male patient presented with odynophagia and weight loss. Barium swallow was poor quality. Endoscopy was inconclusive. CT scan showed a filling defect in lower oesophagus. A giant fibrovascular polyp identified through a right thoracotomy and oesophagotomy was removed through a cervical oesphagotomy where the base was attached. Figs.1, 2A, 2B. European Journal of Cardio-thoracic Surgery 28 (2005) 643 www.elsevier.com/locate/ejcts

An accessory spleen misrecognized as an intrathoracic mass

1010-7940/$ see front matter Q 2005 Published by Elsevier B.V. doi:10.1016/j.ejcts.2005.06.042 * Corresponding author. Tel.: C82 2 2072 3161; fax: C82 2 765 7117. E-mail address: ytkim@snu.ac.kr (Y.T. Kim). A 31-year-old woman was referred for an incidentally detected intrathoracic mass (Fig. 1). At the video-assisted surgery, we found an accessory spleen attached to the diaphragmatic surface by mesenteric pedicle (Fig. 2). It is the first case of an intrathoracic accessory spleen fed by abdominal mesenchymal vessels without trauma history and hematologic disease. European Journal of Cardio-thoracic Surgery 28 (2005) 640 www.elsevier.com/locate/ejcts

ACC/AHA Key Data Elements and Definitions for Measuring the Clinical Management and Outcomes of Patients With Chronic Heart Failure

Table of Contents 1. Uses for HF Data Standards 1892 2. Balance Between Focus and Comprehensiveness 1893 3. Balance Between “Primary” and “Summary” Data Elements 1893 4. Variety of Disease States Leading to HF 1893 5. Acute and Chronic Care, Inpatient and Outpatient Care Venues 1893 6. Therapy for HF 1893 7. Outcomes Assessment for HF 1893 1. III. HF Clinical Data Standards Elements and Definitions 1893 The American College of Cardiology (ACC) and the American Heart Association (AHA) recognize …

Aortic Organ Disease Epidemic, and Why Do Balloons Pop?

As children, we learned that a balloon blown up to its limit of elasticity would pop. For similar aortic ballooning, we hardly know more. Furthermore, in the 21st century, with a nascent epidemic of aortic-related deaths, there have been no consequential advances in preventing the loss of aortic elasticity or in describing the etiology or injury that causes aortic disease. Nor is there an explanation as to why, in some people the aorta “pops” and in others, the aorta dissects. See p 1098 In the United States between 1999 and 2001, at least 129 533 people died from diseases of the aorta and its branches, excluding carotid and coronary disease—an average of 43 199/year, according to the Centers for Disease Control and Prevention ICD-10 codes (Table). The upper limit could potentially exceed 46 817 per year. This number is greater than the ≈40 000 people who die annually from breast cancer, homicides, pancreatic cancer, colon cancer, prostate cancer, or motor vehicle accidents.1 Despite this, little research and even less funding have been allocated to aortic disease research, possibly because disease of a supposedly utilitarian pipe that conveys blood to a pantheon of organs engenders less interest or sympathy in comparison with, for example, cancer. Furthermore, the dismal prognosis of aortic disease, a marker of systemic problems despite successful surgery, has not roused much concern, with a 5-year average survival rate of only 60% in most patients.2 This figure does not differ much from that of stage IB lung cancer. Even the aortic disease–related deaths of media figures such as Albert Einstein, Lucille Ball, Conway Twitty, and John Ritter have fomented little interest. As Western populations age, this most common cause of deaths including sudden death will become an increasing factor in long-term survival. View this table: Deaths Related to Aortic Disease …

Polytetrafluoroethylene Stent Deployment for a Left Anterior Descending Coronary Aneurysm Complicated by Late Acute Anterior Myocardial Infarction

We report the case of a 66-year-old man with a left anterior descending (LAD) coronary artery aneurysm. Cigarette smoking and hepatitis C virus infection were in his clinical history. Coronary angiography performed in 2002 showed a LAD aneurysm, a 50% stenosis of the right coronary artery, and a 30% stenosis of the left main artery (Figure 1, a through c). The ECG in 2002 was normal (Figure 2b i ). In 2002, the patient underwent successful Jomed polytetrafluoroethylene (PTFE)-coated stenting (3.0×20 mm) to cover the aneurysm (Figure 1d). After stenting, the patient was discharged on ticlopidine 250 mg/d for 1 year, aspirin 100 mg/d, metoprolol 25 mg/d, and transdermal nitrates. Figure 1. LAD …

Is Prosthesis–Patient Mismatch a Clinically Relevant Entity?

In this issue of Circulation , Koch and associates1 from the Cleveland Clinic published a study on the relationship between prosthetic valve size and the Duke Activity Status Index (DASI) after aortic valve replacement (AVR). The study was conducted with 1014 patients operated on from 1995 through 1998, completed 1 year later, and published now. DASI scores increased from a mean of 29 preoperatively to 46 postoperatively after a mean follow-up of 8.3 months. The investigators could find no obvious relationship between prosthetic valve size and postoperative DASI score. One of the limitations of the study was that prosthetic valve gradients and effective orifice areas were not measured by echocardiography to quantify prosthesis–patient mismatch. It is also interesting to note that more than two thirds of the patients were in New York Heart Association functional classes I and II preoperatively, and yet the DASI mean score before surgery was only 29 out of a maximum of 58.2. For this reason alone, it must be assumed that factors other than the aortic valve disease played a role in the DASI score. Nevertheless, this is not the first study to suggest that valve size plays no role in the clinical outcomes of AVR. See p 3221 Valve prosthesis–patient mismatch (PPM) is a term introduced by Rahimtoola in 1978 to describe a condition in which the in vivo prosthetic valve effective orifice area is smaller than that of the native valve.2 According to this broad definition, every patient with a prosthetic heart valve has PPM because the leaflets of both mechanical and bioprosthetic valves are mounted into frames that occupy …

An unusual foreign body in the tracheobronchial tree

1010-7940/$ see front matter Q 2005 Elsevier B.V. All rights reserved. doi:10.1016/j.ejcts.2005.02.011 * Corresponding author. Address: Department of Thoracic Surgery, Hospital Clinico, C/Villarroel, 170, 08036 Barcelona, Spain. Tel.: C34 93 2275400; fax: C34 93 2279380. E-mail address: toracica@hotmail.com (M. Iglesias). bronchus. The object was removed and tracheal inflammation and chordal oedema were seen. The patient was discharged at 24 h after procedure without incidences (Fig. 1). European Journal of Cardio-thoracic Surgery 27 (2005) 1112 www.elsevier.com/locate/ejcts

A left ventricular pseudoaneurysm due to mitral valve replacement

* Corresponding author. Address: Department of Cardiac Surgery, Florence Nightingale Hospital, Abide-i Hurriyet Cad. No. 280 Sisli, Istanbul, Turkey. Tel.: C90 212 2244950 4173; fax: C90 212 2258396. E-mail address: isanisoglu@yahoo.com (I. Sanisoglu). (Figs. 1 and 2). The patient, who is in NYHA class II, refused to be reoperated and is under follow-up with medical treatment. European Journal of Cardio-thoracic Surgery 27 (2005) 713 www.elsevier.com/locate/ejcts