Minimally Invasive Coronary Artery Bypass Grafting in a Patient With Chronic Tracheostoma: Alternative to Reduce Sternal Wound Complication Risk.

Patients with chronic tracheostoma present a challenge when they require coronary bypass surgery due to an elevated risk of sternal wound infections (SWI). Minimally invasive coronary artery bypass grafting (MICS CABG) is a robust technique that allows complete surgical revascularization while mitigating the risks of sternal complications and functional decline associated with sternotomy. In such patients at elevated risk for SWI, MICS CABG may represent a viable revascularization strategy to avoid sternotomy.

Dry granular avalanche impact force on a rigid wall: Analytic shock solution versus discrete element simulations.

The present paper investigates the mean impact force exerted by a granular mass flowing down an incline and impacting a rigid wall of semi-infinite height. First, this granular flow-wall interaction problem is modeled by numerical simulations based on the discrete element method (DEM). These DEM simulations allow computing the depth-averaged quantities-thickness, velocity, and density-of the incoming flow and the resulting mean force on the rigid wall.

Neighborhood Deprivation Negatively Impacts Children's Prosocial Behavior.

Children show stronger cooperative behavior in experimental settings as they get older, but little is known about how the environment of a child shapes this development. In adults, prosocial behavior toward strangers is markedly decreased in low socio-economic status (SES) neighborhoods, suggesting that environmental harshness has a negative impact on some prosocial behaviors. Similar results have been obtained with 9-year-olds recruited from low vs.

Biological markets explain human ultrasociality.

The evidence Gowdy & Krall (G&K) provide is more consistent with a biological markets explanation of human ultrasociality than a group selection explanation. Specifically, large-scale societies provide a better biological market for cooperation than do small-scale societies, allowing individuals to increase their fitness. Importantly, many of the quality-of-life costs G&K discuss (e.

Life-history theory explains childhood moral development.

Infants understand harm and fairness in third-party situations and yet children require years of development before they apply this understanding to their own interactions with others. We suggest that the delay is explained by a life-history analysis of when behaving morally becomes beneficial. The human species is characterized by an extended period of juvenile dependence during which cooperation with non-kin is mostly superfluous.

Measuring aortic valve coaptation surface area using three-dimensional transesophageal echocardiography.

Background: As aortic valve (AV) repairs become more sophisticated, surgeons need increasingly detailed information about the structure and function of this valve. Unlike two-dimensional transesophageal echocardiography (2D-TEE), using three-dimensional (3D)-TEE makes it possible to image the entire AV. We hypothesized that measuring coaptation surface area (CoapSA) would be feasible and reproducible, and CoapSA would decrease in patients with aortic insufficiency.

Clinical and echocardiographic outcomes after repair of mitral valve bileaflet prolapse due to myxomatous disease.

Objective: Repair of mitral regurgitation (MR) due to bileaflet prolapse poses many technical challenges. The late outcomes after repair are also not well characterized in this population. Published series have often included patients with mixed causes of prolapse and/or lack long-term echocardiographic follow-up.

Successful surgical repair of ventricular double rupture.

Cardiac rupture represents a catastrophic complication of myocardial infarction with an exceedingly high mortality rate. In rare instances, a myocardial infarction can be complicated by 2 separate forms of rupture. The most common form of ventricular double rupture consists of free wall rupture in association with ventricular septal rupture.

Proximal isovelocity surface area should be routinely measured in evaluating mitral regurgitation: a core review.

The proximal isovelocity surface area (PISA) measurement, also known as the "flow convergence" method, can be used in echocardiography to estimate the area of an orifice through which blood flows. It has many applications, but this review focuses only on its use in the intraoperative evaluation of mitral regurgitation. In that setting, PISA provides a quantitative assessment of the severity of mitral regurgitation and it is useful in clinical decision-making in the operating room.

Is PA-PWRmax truly a preload-independent index of myocardial contractility in anesthetized humans?

This study tested the hypothesis that the preload-adjusted maximal power index (PA-PWRmax) is a load-independent index of human myocardial contractility. Based on the ventricular pressure-volume relationship and derived from stroke work, the index is the product of instantaneous ventricular pressure and volume changes, divided by a correction term of end-diastolic volume (EDV2) or end-diastolic area (EDA3/2) to adjust for preload effects. Echocardiographic measures of instantaneous ventricular area change may be used to obtain PA-PWRmax noninvasively.

Right heart obstruction from a balloon-like sinus of Valsalva aneurysm in a patient with Down syndrome.

A 40-year-old man with Down syndrome presented with right heart failure. He was markedly obese and had severe developmental delay. There was marked edema and an early diastolic sound.

Survey of the members of the cardiovascular section of the Canadian Anesthesiologists' Society on the use of perioperative transesophageal echocardiography - a brief report.

Purpose: Transesophageal echocardiography (TEE) is a useful diagnostic and monitoring tool in the operating room. In the United States, an increasing number of centres are training anesthesiologists to preform intraoperative TEE. In Canada, TEE has been slow to gain acceptance as an intraoperative monitor and little information is available on its use by the anesthesiologists across the country.