T3-T4 Disc Herniations: Clinical Presentation, Imaging, and Transaxillary Approach.

Objective: To describe a cohort of T3-T4 thoracic disc herniations (TDHs), their clinical and radiologic characteristics, and unique thoracoscopic transaxillary approach (TAA).

Methods: All patients operated on for a T3-T4 TDH with minimal follow-up of 1 year were selected.

Results: Eight TAA procedures (6 males and 2 females) were included (1.

Neurologic Injury in Adults Supported With Veno-Venous Extracorporeal Membrane Oxygenation for Respiratory Failure: Findings From the Extracorporeal Life Support Organization Database.

Objectives: To assess in-hospital neurologic (CNS) complications in adult patients undergoing veno-venous extracorporeal membrane oxygenation for respiratory failure.

Design: Retrospective analysis of the Extracorporeal Life Support Organization's data registry.

Setting: Data reported to Extracorporeal Life Support Organization from 350 international extracorporeal membrane oxygenation centers during 1992-2015.

Deep sternal wound infection after open heart surgery: current treatment insights. A retrospective study of 36 cases.

The aim of this study was to retrospectively evaluate the results of reconstructing infected post-sternotomy wounds, with either sternal plating and/or pectoralis major flap transposition or pedicled omentoplasty after previous vacuum-assisted closure (VAC) therapy. Between January 2005 and December 2010, 36 patients, suffering from deep sternal wound infection (DSWI) after coronary artery bypass grafting procedure, received (plastic) reconstructive surgery. All patients, treated in the Maastricht University Medical Centre (Departments of Plastic Surgery and Cardiothoracic Surgery), were selected for this study.

A completely subcutaneous implantable cardioverter defibrillator system functioning simultaneously with an endocardial implantable cardioverter defibrillator programmed as pacemaker.

Because of multiple ventricular lead fractures with inappropriate shocks, a 31-year-old male received a completely subcutaneous implantable cardioverter defibrillator (ICD) system with the already existing 'endocardial' ICD functioning as an atrial pacemaker.

Open window thoracostomy treatment of empyema is accelerated by vacuum-assisted closure.

Background: Recurrent thoracic empyema in the presence of residual lung tissue can be treated with an open window thoracostomy (OWT). Vacuum-assisted closure (VAC) of these large thoracic defects is a novel option.

Methods: Nineteen patients with residual lung tissue received an OWT for treatment of recurrent thoracic empyema.

Can we optimize chemo-radiation and surgery in locally advanced stage III non-small cell lung cancer based on evidence from randomized clinical trials? A hypothesis-generating study.

Purpose: Improved local tumor control (LC) improves survival of patients with non-small cell lung cancer (NSCLC). We estimated the capability of surgical and non-surgical options to improve LC further in this disease.

Methods: Eligible studies were phase III trials reporting 2-year survival data as well as the incidence of LC and/or distant metastases.

Correlation of intra-tumour heterogeneity on 18F-FDG PET with pathologic features in non-small cell lung cancer: a feasibility study.

We evaluated the feasibility to correlate intra-tumour heterogeneity as visualized on 18F-FDG PET with histology for NSCLC. For this purpose we used an ex-vivo model. The procedure was feasible in all operated patients.

Venous graft perforation leading to cardiac tamponade.

We describe a cardiac tamponade after venous graft perforation due to stent inflation. The complications and therapeutic options are discussed.

Elective high-risk percutaneous coronary interventions supported by extracorporeal life support.

This study investigated the feasibility of high-risk percutaneous coronary intervention (PCI) in hemodynamically unstable patients supported by modified cardiopulmonary bypass (extracorporeal life support [ELS]). Over a 38-month period, 15 patients (10 men, 5 women, mean age 72 +/- 9 years, mean ejection fraction 34 +/- 15%, angina pectoris New York Heart Association class III to IV) who were not eligible for coronary artery bypass grafting because of high co-morbidity underwent elective high-risk PCI supported by ELS. All lesions were technically challenging.

Preoperative localization of herniated thoracic discs using myelo-CT guided transpleural puncture: technical note.

Objective: In recent years, video-assisted thoracoscopic microdiscectomy has gained acceptance as a minimally invasive, safe, and efficient technique suited for herniated thoracic discs from T4T5 until T11T12. However, correct localization is difficult and wrong level exploration is an ever-present threat. We present a reliable and time-efficient localizing technique.

Synchronously counterpulsating extracorporeal life support enhances myocardial working conditions regardless of systemic perfusion pressure.

Objective: A new pulsatile extracorporeal life support (pECLS) system has entered the market. We wanted to investigate what potential advantages pECLS may have over current non-pulsatile systems (NPS). Our research was focused on the pump's functional interaction with the left ventricle and the coronary circulation.

Physiologic-insensitive left ventricular assist predisposes right-sided circulatory failure: a pilot simulation and validation study.

Right-sided circulatory failure (RSCF) is a serious complication in 15-30% of patients receiving a left ventricular assist device (LVAD). It is hypothesized that left ventricular support which lacks physiologic properties predisposes to RSCF. An integral computer simulation and experimental validation protocol was performed.

Miniature intracardiac assist device provides more effective cardiac unloading and circulatory support during severe left heart failure than intraaortic balloon pumping.

Background: Hemodynamic assistance with a miniature intracardiac pump may fill the treatment gap between use of an intraaortic balloon pump (IABP) and the current, more invasive ventricular assist devices. The objective of this study was to compare the hemodynamic efficacy of a miniature intracardiac pump device with that of IABP.

Methods And Results: Reversible acute mitral regurgitation (AMR) was induced in eight calves by stenting the mitral valve using a vena cava filter.

Epicardial left ventricular lead placement for cardiac resynchronization therapy: optimal pace site selection with pressure-volume loops.

Objectives: Patients in heart failure with left bundle branch block benefit from cardiac resynchronization therapy. Usually the left ventricular pacing lead is placed by coronary sinus catheterization; however, this procedure is not always successful, and patients may be referred for surgical epicardial lead placement. The objective of this study was to develop a method to guide epicardial lead placement in cardiac resynchronization therapy.

Coronary sinus catheter placement: assessment of placement criteria and cardiac complications.

Study Objectives: To evaluate the placement and complications of a coronary sinus (CS) catheter in human subjects.

Design: Sixty-two CS catheters inserted in patients scheduled for coronary artery bypass graft surgery (CABG).

Setting: University hospital, anesthesia and cardiothoracic surgery departments.

Efficacy of a new intraaortic propeller pump vs the intraaortic balloon pump: an animal study.

Objective: To compare the efficacy of a new intraaortic propeller pump (PP) to provide hemodynamic support to the intraaortic balloon pump (IABP) in an acute mitral regurgitation (MR) animal model.

Background: A new intraaortic PP (Reitan catheter pump; Jomed; Helsingborg, Sweden) recently has been introduced. The pump's aim is a reduction in afterload via a deployable propeller that is placed in the high descending aorta and can be set at rotational speeds of View Article and Find Full Text PDF

Intra-aortic balloon pumping in acute mitral regurgitation reduces aortic impedance and regurgitant fraction.

Acute mitral regurgitation (MR) is present in 10% of patients presenting with cardiogenic shock. To stabilize these patients, intra-aortic balloon pumping (IABP) is recommended, but the mechanism of IABP support in these patients is unknown. This animal study was designed to describe the hemodynamic effect of intra-aortic balloon pumping during cardiogenic shock induced by acute MR.

The effect of glutamate infusion on cardiac performance is independent of changes in metabolism in patients undergoing routine coronary artery bypass surgery.

In a double-blind randomized placebo-controlled study, the effects of intravenous glutamate infusion on myocardial haemodynamics and metabolism were studied in 22 patients undergoing routine coronary artery bypass graft (CABG) surgery. Immediately after aortic cross-clamp release, an intravenous infusion of a solution of glutamate (125 mmol x l(-1)) at a rate of 1.5 ml x h(-1) x kg(-1) was given over 1 h to 11 patients (G group).

Ruptured aneurysm of the left sinus of Valsalva into the pericardium.

Recently, a 67-year-old female patient came to our attention after a collapse, due to cardiac tamponade caused by a ruptured sinus of Valsalva aneurysm (SVA) and intrapericardial bleeding. Despite surgical intervention the patient died before correction.

Right ventricular support for off-pump coronary artery bypass grafting studied with bi-ventricular pressure--volume loops in sheep.

Objectives: Tilting the heart during off-pump coronary artery bypass grafting (OPCABG) causes a strong decrease in cardiac output. It is hypothesized that this decrease is caused by reduced right ventricular filling and that right ventricular support is thus the best way to restore cardiac output. Simultaneous left and right ventricular pressure-volume loops were used to test this hypothesis.

The enabler right ventricular circulatory support system for beating heart coronary artery bypass graft surgery.

Background: Beating heart coronary artery bypass graft surgery of the left anterior descending, diagonal, and right coronary artery can be performed safely with the Octopus Stabilization System. However, tilting of the heart, which is necessary to reach the obtuse marginal and distal right coronary arteries, causes hemodynamic instability. This study was performed to investigate the possible role of the Enabler right ventricular circulatory support system in counteracting this instability.

Myocardial substrate uptake and oxidation during and after routine cardiac surgery.

Objective: This study was designed to clarify whether myocardial substrate uptake and oxidation change after a period of hypothermic cardioplegic arrest during coronary artery bypass grafting procedures.

Methods: In 30 patients arterial and coronary sinus blood was sampled and coronary sinus flow measurements were performed before and after sternotomy and 10 minutes, 20 minutes, 50 minutes, and 6 hours after release of the aortic crossclamp. Measurement of free fatty acids, lactate, glucose, oxygen content, and carbon dioxide content in arterial and coronary sinus blood allowed calculations of myocardial substrate use, respiratory quotients, and myocardial oxidation rates of carbohydrates and fat.

Glutamate metabolism of the heart during coronary artery bypass grafting.

Glutamate infusion has been shown to exert beneficial hemodynamic effects in patients with heart failure after cardiac surgery. To elucidate the underlying mechanism we studied the possibility that glutamate is a Krebs-cycle precursor in the human heart. Therefore [1-13C]glutamate was infused in order to show production of 13CO2 by the heart.

Systemic inflammation present in patients undergoing CABG without extracorporeal circulation.

Study Objectives: This study was conducted to evaluate to what extent the cardiopulmonary bypass (CPB) procedure in patients undergoing coronary artery bypass grafting (CABG) contributes to the systemic inflammatory response. Therefore, we measured bactericidal permeability increasing protein (BPI) as an indicator of neutrophil activation, interleukin 6 as inducer of the acute phase response, and lipopolysaccharide binding protein and C-reactive protein as parameters of the acute phase response in patients undergoing CABG either with or without the use of CPB.

Design: Prospective study.

Comparison of arterial wall reaction after passage of the Hydrolyser device versus a thrombectomy balloon in an animal model.

Purpose: This study was designed to compare the reaction of the vessel wall after application of the Hydrolyser hydrodynamic thrombectomy device to the reaction after use of a balloon thrombectomy catheter. The influence of the vessel inner diameter on vessel wall reaction was evaluated after passage of the Hydrolyser.

Materials And Methods: After measurement of the vessel inner diameter with intravascular ultrasound (US), 102 segments of femoral and carotid arteries of goats were treated with one of the following four procedures: passage of the intravascular US catheter alone; passage of the Hydrolyser without or with an activated jet; or passage of an inflated thrombectomy balloon.