Predictors of nephrological morbidity after coronary artery bypass surgery.

Aim: The aim of this study was to analyse the nephrological morbidity after myocardial revascularization.

Methods And Results: We analysed the pre- per and postoperative data of 3815 patients who underwent a primary isolated coronary bypass grafting between January 1987 and December 1995. Nephrological complications were divided into renal dysfunction and requiring dialysis.

Surface of localized pleural plaques quantitated by computed tomography scanning: no relation with cumulative asbestos exposure and no effect on lung function.

To evaluate if there is a relation between the size of asbestos plaques and the level of past exposure and pulmonary function, we measured the surface of localized pleural plaques found on high-resolution (HR) CT scan, using a computerized video display unit-imaging system, in 73 workers (mean age, 43.5 yr) who had worked from 23 to 27 yr in an asbestos-cement factory. Their estimated cumulative exposure to asbestos ranged from 16.

Concomitant coronary artery revascularization and right pneumonectomy without cardiopulmonary bypass.

Combined coronary artery bypass grafting (CABG) and pneumonectomy has a high morbidity and mortality rate, especially when the right lung has to be removed. A patient is described who underwent a CABG operation through a midline sternotomy without the use of cardiopulmonary bypass (CPB), and a right pneumonectomy through a right lateral thoracotomy in one operative session. To our knowledge, this is the first case in which this operative strategy was employed.

Predictors of neurological morbidity after coronary artery bypass surgery.

Objective: The aim of this study was to analyze the postoperative neurological complications after myocardial revascularization.

Methods: We analyzed the pre-, peri- and postoperative data of 3834 patients who underwent a primary isolated bypass grafting between January 1987 and December 1995. Postoperative neurological complications (A) were divided into mild complications (B) and major complications (C).

Myocardial revascularization in patients < or = 45 years old: evaluation of cardial and functional capacity, and return to work.

Objective: To investigate whether patients < or = 45 years old benefit from myocardial revascularization, measured by New York Heart classification, functional status and return to work.

Methods: The data of 188 consecutive patients 45 years old and younger, and who were undergoing primary isolated aortocoronary bypass operation, were studied. Follow-up information was obtained from our follow-up databank.

Expiratory CT in cigarette smokers: correlation between areas of decreased lung attenuation, pulmonary function tests and smoking history.

The aim of this study was to determine the correlation between cigarette-smoke-related bronchial disease and air trapping as assessed by expiratory high-resolution CT (HRCT) scans. Thirty healthy subjects (11 non-smokers, 7 ex-smokers for > 2 years, 12 current smokers; age range 35-55 years) with a smoking history between 0 and 28.5 pack-years underwent pulmonary function tests (PFT) and HRCT in inspiration and expiration in supine and prone position.

Long-term results after correction of anterior chest wall deformities.

Background: Surgical correction of pectus deformities was mainly performed for cosmetic and psychologic reasons but eventual cardiopulmonary symptoms improved. Whether this results from alterations in cardiopulmonary physiology is still controversial

Methods: In 25 years 662 patients underwent correction (390 for pectus excavatum-funnel chest, 235 for pectus carinatum-chicken chest, 37 for pectus arcuatum-pouter pigeon chest). Surgical correction was mainly performed for cosmetic and psychologic reasons.

Surgical repair of subacute left ventricular free wall rupture.

Background: The natural course of subacute ventricular free wall rupture (FWR) as a complication of acute myocardial infarction (MI) is usually lethal. The aim of this study was to investigate the curability of this entity and to report on five patients successfully treated by rapid diagnosis, hemodynamic stabilization, and emergency surgical repair.

Methods: Five patients with subacute FWR of the left ventricle after previous MI were operated on.

Coronary bypass surgery: what is changing? Analysis of 3834 patients undergoing primary isolated myocardial revascularization.

Objective: The patient population undergoing myocardial revascularization has changed during the last few years. Knowledge of these changes, and of the subsequent influence on morbidity and/or mortality is important, not only for up-dating quality control, but also to support decision-making in financial and economical aspects, and in further research concerning coronary artery surgery.

Methods: Pre-, per- and postoperative data of 3834 primary isolated coronary bypass operations, January 1987 December 1995 were analyzed.

Surgical treatment of a fistula between the right pulmonary artery and the left atrium: presentation of two cases and review of literature.

Objective: A direct communication between the pulmonary artery and the left atrium is a rare anomaly. On the basis of two cases of our own and a literature review of 49 cases, we focus on clinical presentation, anatomy, diagnosis, and the role of surgery.

Methods: Two cases of a fistula between the right pulmonary artery and the left atrium are described in a girl of 4 years and a boy of 15 years.

Effect of alveolar volume on the interpretation of single breath DLCO.

Single-breath carbon monoxide diffusing capacity in the whole lung (DLCO) and per unit alveolar volume (DLCO/VA), as expressed in percentage of normal values, gave discordant results when VA of the patients was abnormal. It was hypothesized that normal reference values were inappropriate to interpret data collected in such patients. To substantiate this hypothesis, DLCO and DLCO/VA were measured in four groups: (1) normal volunteers in whom both indices were measured at five different VA; (2) patients with high VA; (3) emphysematous patients; and (4) patients with diffuse interstitial lung diseases (DILD).

[Chronic central cyanosis in children; always an indication for further diagnosis].

A girl and a boy, both aged 4 years, had displayed a blue discolouration of the skin for several years. In the girl, electrocardiography and roentgenography of the chest revealed no abnormalities; in the boy, the cardiac murmur was attributed to an insignificant ventricular septal defect. Further examinations were performed only when the children developed sleeping problems and decrease of exercise tolerance, respectively.

Lipomatous hypertrophy of the interatrial septum: indication for surgery?

A fortuitous finding during open heart surgery of lipomatous hypertrophy of the interatrial septum is described in a 65-year old man with ischaemic heart complaints due to coronary artery disease and with premature ventricular contractions. An incision biopsy confirmed the diagnosis. The choice of treatment of lipomatous hypertrophy of the interatrial septum is controversial.

Asymptomatic right atrial aneurysm: fortuitous finding and resection.

A rare right atrial aneurysm is described in a 36-year-old man. After median sternotomy for coronary bypass, a thin-walled aneurysmal dilatation of the right atrium was seen by chance. The patient was in sinus rhythm.

Morbidity and mortality in 200 consecutive coronary reoperations.

Objective: The morbidity and mortality of coronary reoperations is still higher than in primary myocardial revascularization. In the present paper we analyzed the relation between several preoperative and peroperative variables and the perioperative morbidity and mortality of coronary reoperations.

Methods: The data of 200 consecutive patients undergoing isolated aortocoronary bypass reoperation were studied by univariate and multivariate analysis.

Complete arterial revascularization using the mammary Y-graft.

The recent trend is to revascularize the entire heart with arterial grafts. Five selected patients were operated using the mammary Y-graft for complete arterial revascularization. The immediate postoperative courses were uneventful.

The present status of surgery for lung cancer.

Surgical resection of non-small cell lung cancer (NSCLC) is the treatment of choice if complete resection is possible. There is consensus regarding a pretreatment minimal staging. For the pre-operative exploration CT scan (with contrast) and mediastinoscopy are complemental.

Verapamil as prophylactic treatment for atrial fibrillation after lung operations.

Background: Atrial fibrillation is a frequently occurring arrhythmia after thoracic operations. Preventive strategies for this complication have been extensively evaluated after cardiac operations.

Methods: We performed a prospective, open randomized study, comparing intravenous verapamil and placebo in 199 patients after pneumonectomy or lobectomy at the University Hospital of Leuven.

Completion pneumonectomy. A retrospective analysis of indications and results.

Between 1970 and 1993, 446 patients underwent pneumonectomy. Completion pneumonectomy was performed in 37 patients (8.3%): 34 men and 3 women, with a mean age of 61 years (range 20-78 years).

Antegrade versus retrograde crystalloid cardioplegia: perioperative assessment of cardiac energy metabolism by means of myocardial lactate measurement.

The effects of retrograde and antegrade delivery of cold St. Thomas' Hospital cardioplegia were evaluated and compared in 21 patients who underwent elective myocardial revascularization. The patients were randomly separated into two groups: the antegrade group (n = 10), and the retrograde group (n = 11).