BACKGROUND: Our objective was to review the long-term prognosis of patients with preoperative mild to moderate ischemic mitral regurgitation who underwent off-pump coronary artery bypass grafting. MATERIAL AND METHOD: We prospectively followed 1,000 consecutive and systematic off-pump coronary artery bypass grafting patients who were operated on between September 1996 and March 2004; follow-up was achieved for 97%. Sixty-seven patients (6.7%) had mild to moderate ischemic mitral regurgitation at the time of surgery. Operative mortality, actuarial survival and major adverse cardiac event free survival were compared to assess the effect of ischemic mitral regurgitation. RESULT: Average follow-up was 66+/-22 months. Patients with ischemic mitral regurgitation were older (p<0.001), had lower ejection fractions (p<0.001) and more comorbidities. Significantly more female patients presented with ischemic mitral regurgitation (p=0.002). There was no significant difference in operative mortality and perioperative myocardial infarction in ischemic mitral regurgitation patients (p=0.25). Eight-year survival was decreased in ischemic mitral regurgitation patients (39.6+/-11.8% vs 76.7+/-2.2%, p<0.001). However, after correcting for risk factors, mild to moderate ischemic mitral regurgitation was not found to be a significant independent risk factor for long-term mortality (p=0.42). Major adverse cardiac event free survival at 8 years was significantly lower in ischemic mitral regurgitation patients (53+/-12% vs 77+/-2%, p<0.001). After correction for risk factors, ischemic mitral regurgitation remained a significant independent cause of major adverse cardiac events (HR: 2.31), especially congestive heart failure and recurrent myocardial infarction. CONCLUSION: In our series, patients with preoperative mild to moderate ischemic mitral regurgitation had a higher prevalence of preoperative risk factors than patients without ischemic mitral regurgitation. They had comparable perioperative mortality and morbidity, but, in the long term, were found to be at elevated risk for recurrent cardiac events.
Comorbidity ; Coronary Artery Bypass, Off-Pump ; Disease-Free Survival ; Female ; Follow-Up Studies ; Heart Failure ; Humans ; Mitral Valve Insufficiency ; Myocardial Infarction ; Prevalence ; Prognosis ; Prospective Studies ; Risk Factors ; Transplants

Neurilemmomas of the trachea are extremely rare. The most common site of them is the distal third of the trachea and the age of the patients at presentation varied from 6 to 78 years old. They usually have a freqeuntly very long natural history, causing symptoms only after they have attained a considerable size. We experienced a case of near-total obstruction of the trachea by an intraluminal sessile neurilemmoma. The patient was a 66-year-old man with 2-year history of progressive exertional dyspnea and had several episodes of pneumonitis associated with productive cough. Grossly, the tumor was a well-circumscribed mass. Microscopically, typical cellular Antoni A and myxoid Antoni B areas were revealed.
Aged ; Cough ; Dyspnea ; Humans ; Natural History ; Neurilemmoma* ; Pneumonia ; Trachea

No abstract available.
Histiocytosis*

Diffuse leiomyomatosis of the esophagus is a rare condition and usually extends from the mid-esophagus to the proximal third of the stomach. Macroscopically, there is a marked diffuse thickening of the esophageal wall, with or without nodularity, predominantly affecting the circular muscle coat. Microscopically, the disorder is characterized by the loss of the normal orientation of the smooth muscle fibers of all three layers. We report a case in a 37-year-old woman which was incidentally discovered at exploratory thoracotomy.
Female ; Humans

Perioperative nutritional status is an important factor for the prognosis of cardiac surgery. Preoperatively debilitated or cachectic patients (i.e., more than 10% weight loss over 6 months) with decreased albumin level are exceptionally prone to complications, such as infections following surgery. For better support of the perioperative nutritional intake, exact preoperative monitoring of nutritional status and supplement of essential nutritional factors are necessary for cardiac patients. I will describe here the nutritional states assessment and monitoring methods of infants with congenital heart diseases and consider essential nutritional factors in patients with heart disease. For the conditions where enteral nutrition is not possible, postoperative control of blood sugar is important, or special nutritional considerations for heart disease patients is needed. I will discuss the clinical problems related to these conditions and suggest possible methods of improvement for each condition.
Blood Glucose ; Child ; Enteral Nutrition ; Heart Diseases ; Humans ; Infant ; Nutrition Assessment ; Nutrition Disorders ; Nutrition Therapy ; Nutritional Status ; Prognosis ; Thoracic Surgery ; Weight Loss

No abstract available.
Central Nervous System Infections* ; Central Nervous System*

Mediastinal paragangliomas are very rare neuroendocrine tumors. Complete resection is the standard treatment of a paraganglioma because of the tumor's potential malignancy and poor response to chemo- or radiotherapy. However, the highly vascular nature of the tumor and its characteristic anatomic location make complete resection difficult. We report a case of an anterior mediastinal paraganglioma, which was incidentally found on a chest computed tomography scan for chronic cough work-up of a 55-year-old woman. Complete resection was accomplished using video-assisted thoracoscopic surgery, and the patient recovered without any complications.
Cough ; Female ; Humans ; Mediastinal Neoplasms ; Middle Aged ; Neuroendocrine Tumors ; Paraganglioma* ; Radiotherapy ; Thoracic Surgery, Video-Assisted* ; Thorax

No abstract available.
Aneurysm* ; Arteries* ; Cardiopulmonary Bypass* ; Circulatory Arrest, Deep Hypothermia Induced*

Acute aortic dissection (AAD) during pregnancy can be fatal to both the pregnant mother and the baby, particularly in patients with the Marfan syndrome. We report a case of the modified Bentall procedure in surgery for AAD in a 31-year-old pregnant woman at 24 weeks of gestation with the Marfan syndrome. The patient recovered well after the operation, but unfortunately, the fetus could not be saved.
Adult ; Female ; Fetus ; Humans ; Marfan Syndrome* ; Mothers ; Pregnancy* ; Pregnant Women

Diaphragmatic hernia was found in a patient who had undergone transhiatal esophagectomy for early esophageal cancer. Chest X-ray was not helpful, but abdominal or chest computed tomography was useful for accurate diagnosis. Primary repair through thoracotomy was performed and was found to be feasible and effective. However, long-term follow-up is required because hernia recurrence is common.
Diagnosis ; Esophageal Neoplasms* ; Esophagectomy* ; Follow-Up Studies ; Hernia ; Hernia, Diaphragmatic* ; Humans ; Recurrence ; Thoracotomy ; Thorax