The contralateral rectus abdominis musculocutaneous flap for treatment of lower extremity lymphedema.

Lymphedema is common after inguinal lymphadenectomy or resection of groin tumors. Animal studies have shown success using the rectus abdominis musculocutaneous (RAM) flap as a treatment for lymphedema. Four patients with acquired lower extremity lymphedema were treated with a contralateral RAM flap with an inferior cutaneous pedicle left intact to facilitate lymphatic drainage into the unaffected groin.

Operative and long-term survival of elderly is significantly improved by mitral valve repair.

Background: We review our 10-year experience of mitral valve (MV) repair in comparison with MV replacement in the elderly for floppy mitral valves/mitral valve prolapse (FMV/MVP). The use of MV repair for this entity has not been fully utilized by surgeons.

Methods: Two hundred ninety-two consecutive patients aged > or = 70 years receiving mitral surgery for regurgitation due to FMV/MVP were reviewed from our prospective database between January 1, 1992, and December 31, 2002.

Intraluminal coronary shunting preserves regional myocardial perfusion and function.

Background: Coronary artery hemostasis during offpump coronary artery bypass (OPCAB) may be achieved with extraluminal coronary occlusion or intraluminal coronary shunting. We sought to determine with a normal porcine beating-heart model whether coronary shunting preserves regional myocardial perfusion and function compared with coronary occlusion.

Methods: Six pigs (50-60 kg) underwent sternotomy and instrumentation.

Metastatic carcinoid tumor of the heart.

Although carcinoid heart disease has been well described in the literature, metastatic implantation in the heart is rare. We describe a 79-year-old man with no previous history of cancer who presented with progressive dyspnea. He was found to have a septal implantation of a previously undiagnosed metastatic carcinoid tumor.

Cardiac positioning using an apical suction device maintains beating heart hemodynamics.

Background: Cardiac positioning during off-pump coronary artery bypass (OPCAB) using deep pericardial sutures (DPS) typically results in some degree of hemodynamic compromise. We sought to determine whether cardiac positioning using an apical suction device was hemodynamically superior to DPS.

Methods: Five healthy pigs underwent sternotomy and instrumentation to measure right atrial (RA) pressure, left ventricular (LV) pressure and volume, and aortic pressure and flow.

Open inferior vena caval anastomosis during bicaval heart transplantation.

Performing a precise inferior vena caval (IVC) anastomosis during bicaval orthotopic heart transplantation can sometimes be challenging because of crowding of the operative field by the venous cannula and tourniquet. We performed bicaval orthotopic heart transplantation in 10 patients using an open IVC anastomotic technique with vacuum-assisted venous drainage. A long venous cannula was passed into the IVC through the femoral vein.