Black tea reduces uric acid and C-reactive protein levels in humans susceptible to cardiovascular diseases.

The effect of black tea on the level of uric acid (UA) and C-reactive proteins (CRP) in humans susceptible to ischemic heart diseases was assessed in a prospective randomized controlled study. The study group consumed 9 g of black tea (equivalent to three cups of tea) daily for 12 weeks without additives followed by a 3-week wash-out (with control group consuming equivalent volume of hot water). Black tea consumption induced a highly significant decrease in the high uric acid baseline groups > 6 mg/dL by 8.

Postinfarction ventricular septal rupture: early repair through the right atrial approach.

Objective: Early repair of posterior ventricular septal rupture associated with myocardial infarction by means of transinfarct ventriculotomy is technically challenging and can be associated with significant mortality and morbidity. An alternative route of exposing the septum is through the right atrium. This technique, which avoids direct incision of the ventricle in select patients, reduces postrepair bleeding and impairment of ventricular contractile function.

Aortic balloon entrapment complicating intra-aortic balloon counterpulsation.

Short-term balloon counterpulsation may be complicated by aortic balloon entrapment. We report a patient in whom video-coronary surgery was performed using beating heart anastomosis. This patient developed intra-aortic balloon (IAB) entrapment 4 days after initiation of the counterpulsation previously implanted for a preoperative low ejection fraction.

Non-penetrating subclavian artery trauma: management by selective transluminally placed stent device.

Non-penetrating injury to the subclavian artery has not often been reported. The limited experience of surgeons with this type of trauma and the difficult vascular control required for its management make it a surgical challenge. We report on two cases, one after blunt trauma and the other with a subclavian artery aneurysm following anterior dislocation of the shoulder.

A special adapted retractor for the mini-sternotomy approach.

Minimally invasive cardiac operations are now possible through different approaches. To provide the best exposure and sufficient space to manipulate the heart, a special adapted thoracic retractor has been developed for the ministernotomy approach. It is universally adjustable and provides excellent and consistent exposure especially below the incision edges.

Spontaneous native aortic valve thrombosis.

Spontaneous thrombosis of a native aortic valve is an uncommon event that usually follows local trauma, such as cardiac surgery or left heart catheterization, or occurs as a complication of bacterial endocarditis. We report the case of a 65-year-old woman with a history of retinal artery occlusion and severe aortic valve stenosis, in whom transesophageal echocardiography revealed a mobile mass attached to the ventricular surface of the aortic valve. There was no evidence of any hypercoagulable state or infection process.

Minimally invasive internal thoracic artery harvest: the hybrid approach.

Background: Safe harvesting of the left internal thoracic artery is a difficult problem during minimally invasive coronary artery bypass grafting without cardiopulmonary bypass. A complete internal thoracic artery dissection through a limited approach is technically demanding and time consuming and different techniques have been proposed.

Methods And Results: Based on our experience, the different surgical approaches and technical considerations are reviewed.

Pulmonary artery bullet injury following thoracic gunshot wound.

Thoracic trauma occurs frequently but seldom requires surgery (10-20%, [1]). The mortality rate for gunshot wound of the chest varies from 14.3 to 36.

Less-invasive heart surgery: the preservation of median approach.

Objective: Cardiac surgery has been traditionally performed via a median sternotomy incision where a large exposure of the mediastinum assured most of the cardiac procedures. Recently, the concepts of less-invasive surgery, well affirmed in many surgical specialties, led cardiac surgeons to develop limited accesses in coronary, valves and congenital operations.

Methods: Between January and May 1997, 30 patients were operated on with a less-invasive approach.

[Leiomyosarcoma of the heart and great vessels].

Leiomyosarcomas (LMS) of the heart are exceptional primary malignant tumours with a catastrophic prognosis and a mean survival measured in months. Extensive radical surgical resection clearly remains the most appropriate treatment. We report three cases observed over a 3-year period, consisting of an LMS of the inferior vena cava, an LMS of the pulmonary artery trunk and an LMS of the left atrium.

Less invasive cardiac operations through a median sternotomy: 100 consecutive cases.

Background: In the beginning of 1997, we developed a routine approach to intracardiac operations through a less invasive median sternotomy. A limited (6 to 9 cm) median skin incision followed by a subcomplete (manubrium and body) median sternotomy makes opening and closing of the chest easier; conventional central cardiopulmonary bypass is instituted, and no modifications to the surgical techniques are necessary.

Methods: In 100 consecutive patients (mean age, 62.

Modified biatrial approach for the extensive resection of left atrial myxomas.

Surgical excision of left atrial myxomas is usually curative. When the root of the pedicle and the full thickness of the adjacent interatrial septum are excised, the repair of the created atrial septal defect requires a pericardial or Dacron patch. The biatrial approach generally has been accepted as the technique having the advantages of well identifying the site of attachment and inspection of the four cardiac chambers.

Pregnancy with aortic dissection in Ehler-Danlos syndrome. Staged replacement of the total aorta (10-year follow-up).

Pregnancy complicated by aortic dissection in patients with hereditary disorder of connective tissue presents interesting considerations including management of caesarean section with the unexpected need for cardiac surgery in emergency. Generalizations can be made on management principles with long-term follow-up requiring an aggressive individualized approach by a multidisciplinary team. A 33-year-old parturient presenting an aortic dissection at 37 weeks gestation required prompt diagnosis of Ehlers-Danlos syndrome in combination with correct surgical therapy resulted in the survival of both the mother and infant.

Aorto-pulmonary fistula: a rare event in the evolution of a dissecting aneurysm of the thoracic aorta.

The natural history of a thoracic aneurysm is usually towards the dissection or free rupture; rarely an aorto-pulmonary fistula can complicate this lesion. We present two cases of Aorto-pulmonary fistula as acute complication of an aneurysm of thoracic aorta; the etiopathology seem to be related to the same mechanism: a dissecting aneurysm of the ascending aorta leading to a secondary fistulation in the main pulmonary artery. In our two cases the diagnosis was suggested by clinical findings and by Doppler-echocardiography.

Leiomyosarcoma of the inferior vena cava: novel surgical reconstruction preserves renal function.

Leiomyosarcoma of the inferior vena cava is rare and to date 145 cases have been reported. Here a new case of primary leiomyosarcoma of the inter-renal vena cava is reported. Surgical treatment consisted of excision of the vena cava on top of the renal arteries allowing radical resection.

Operation for atrial septal defect through a right anterolateral thoracotomy: current outcome.

Background: Operative closure of atrial septal defect is today considered a high-benefit and low-risk operation. Patients are often young and sensitive to the cosmetic results of the procedure. The midline scar of median sternotomy may be unsightly and can provoke dissatisfaction and psychological distress.

[Cardiac transplantation. Evaluation of a consecutive series of 75 grafts].

Objectives: The global results of various series of heart transplantation (HT) are essential to assess the life expectancy provided by this technique. Due to the increasing graft shortage, it appears essential to very strictly candidates for HT.

Methods: From March 8, 1989 to December 7, 1994, 75 orthotopic Hts were performed in 62 men and 12 women (1 case of retransplantation).

Aortopulmonary fistula: an uncommon complication in dystrophic aortic aneurysm.

Wall dissection is a typical complication in the evolution of Marfan aortic aneurysm and usually is associated with valve regurgitation. Formation of a fistula with adjacent structures is very uncommon. We report the case of a 32-year-old man who presented with the typical features of Marfan's syndrome, with chronic aneurysm of the ascending aorta and acute aortopulmonary fistula.