Visual diagnosis of pectus excavatum: An inter-observer and intra-observer agreement analysis.

Background/purpose: Among patients suspected of pectus excavatum, visual examination is a key aspect of diagnosis and, moreover, guides work-up and treatment strategy. This study evaluated the inter-observer and intra-observer agreement of visual examination and diagnosis of pectus excavatum among experts.

Methods: Three-dimensional surface images of consecutive patients suspected of pectus excavatum were reviewed in a multi-center setting.

Patency of the internal mammary arteries after removal of the Nuss bar: an initial report.

Objectives: Surgical correction of pectus excavatum (PE) has shifted to the modern minimally invasive Nuss procedure, which proved to be safe and effective. In order to restore the dented deformity, custom-curved metal bars provide continuous retrosternal pressure but cross the habitat of the internal mammary arteries (IMAs) directly affecting their patency. In this initial report, we sought to assess the patency of the IMAs in the first 6 patients who underwent Nuss bar removal in our department.

Does removal of steel wires relieve post-sternotomy pain after cardiac surgery?

Background: Post-sternotomy pain in the absence of cardiac ischemia and sternal instability is most commonly due to the sternal wire sutures or a protruding wire. We performed a retrospective study to investigate the effect of removal of the steel wires for relief of post-sternotomy pain.

Methods: All 206 patients who underwent sternal wire removal in our institution from January 2003 through August 2011 were included in this study.

Does the body mass index predict mortality after isolated aortic valve replacement?

Background And Aim Of The Study: Data relating to the impact of body mass index (BMI) on outcomes after isolated aortic valve replacement (AVR) are scarce and controversial. The study aim was to investigate the predictive value of BMI for early and late mortality after isolated AVR.

Methods: Data obtained from patients who underwent isolated AVR between January 1998 and December 2010 at the authors' institution were analyzed retrospectively.

Preoperative hemoglobin level as a predictor of mortality after aortic valve replacement.

Objectives: The predictive value of preoperative hemoglobin (HB) level on the outcome of patients undergoing valve surgery is not well established. This study evaluated the predictive value of preoperative HB level on survival after aortic valve replacement (AVR).

Design: This was a retrospective analysis of prospectively collected data.

Cardiac herniation after operative management of lung cancer: a rare and dangerous complication.

Cardiac herniation after pneumonectomy is recognized as a rare complication. This case report describes two cases. The mortality rate of this complication remains high as reported in the literature; in early-recognized cases 50 % and in late or unrecognized cases 100 %.

Increased septum wall thickness in patients undergoing aortic valve replacement predicts worse late survival.

Background: Following guidelines, aortic valve replacement (AVR) in asymptomatic patients with severe aortic valve stenosis is often postponed until symptoms do occur. Delaying AVR will inevitably lead to progression of left ventricular hypertrophy. We studied the relationship between septum wall thickness indexed for body surface area (SWTI) as a measure for LV hypertrophy and 30-day and late all-cause mortality after AVR.

Can the EuroSCORE predict midterm survival after aortic valve replacement?

Objectives: The EuroSCORE as a predictor for midterm survival after isolated aortic valve replacement (AVR) and combined AVR with coronary artery bypass graft (CABG) surgery was tested. Survival in different risk-stratification groups also was compared to the survival of the general Dutch population.

Design: A retrospective analysis of prospectively collected data.

An unusual case of left chest stab wound.

A 72-year-old man was admitted with one blade of a huge pair of shears in his left thorax. His hemodynamics deteriorated due to life-threatening vascular lesions. An urgent thoracotomy revealed several injuries to the intercostal vessels and left apical inferior lung lobe.

Preoperative atrial fibrillation and elevated C-reactive protein levels as predictors of mediastinitis after coronary artery bypass grafting.

Background: Mediastinitis is a serious complication after coronary artery bypass grafting (CABG). We studied the risk factors for the development of postoperative mediastinitis in a large group of patients who underwent isolated CABG at Catharina Hospital, Eindhoven, The Netherlands.

Methods: Data of all patients undergoing an isolated CABG between January 1998 and December 2008 were analyzed.

Is the use of Steri-StripTM S for wound closure after coronary artery bypass grafting better than intracuticular suture?

Several methods have been used in wound closure after coronary artery bypass grafting (CABG). In this study, the safety and efficacy of one of these methods, Steri-Strip S is compared with the traditional intracuticular suture method. Eighty-one patients undergoing CABG were prospectively randomized into two groups according to the method of skin closure: Steri-Strip S group and traditional suture group.

Prevalence of 90-days postoperative wound infections after cardiac surgery.

Objective: Postoperative wound infections generally cause considerable extra morbidity, mortality and costs. As nowadays length of hospitalization shortens, post-discharge surveillance is important to get reliable information on the prevalence of postoperative wound infections. In this study, the prevalences of sternal wound (SWI) and donor site infections (DSI) during hospitalization as well as, 30 and 90 days after cardiac surgery were studied paying special attention to the contribution of post-discharge surveillance.

Assessment of spinal cord integrity during thoracoabdominal aortic aneurysm repair.

Background: Monitoring motor-evoked potentials (MEPs) is an accurate technique to assess spinal cord integrity during thoracoabdominal aortic aneurysm (TAAA) repair, guiding surgical strategies to prevent paraplegia.

Methods: In 210 consecutive patients with type I (n = 75), type II (n = 103), and type III (n = 32) TAAA surgical repair was performed using left heart bypass, cerebrospinal fluid drainage, and MEPs monitoring.

Results: Reliable MEPs were registered in all patients.

Spinal cord blood supply in patients with thoracoabdominal aortic aneurysms.

Objective: In patients with thoracoabdominal aortic aneurysms (TAAAs), the blood supply to the spinal cord is highly variable and unpredictable because of obstructed intercostal and lumbar arteries. This study was performed for the prospective documentation of patent segmental arteries during TAAA repair and the assessment of their functional contribution to the spinal cord blood supply.

Methods: TAAA repair was performed in 184 consecutive patients (68 with type I aneurysm, 91 with type II, and 25 with type III) according to a protocol that included left heart bypass grafting, cerebrospinal fluid drainage, and the monitoring of motor-evoked potentials (MEPs).