Search

We report three cases of coronary fistula aneurysm associated with mitral valve insufficiency. The patients were referred to our cardiovascular department because of exertional dyspnea. Echocardiography showed severe mitral valve insufficiency resulting from leaflet flail or prolapse and normal left ventricular function. In all three cases, preoperative coronary angiography showed coronary-to-pulmonary artery fistula associated with significant aneurysm of the fistulous tract. All patients underwent uneventful mitral valve repair and external ligation of the fistulas. more...

Background. Risk-adjusted mortality was previously used to compare institutions as a whole or surgeons. Because the same surgical team is working in two different hospitals, the aim of our study was to assess whether the institution can make a difference in surgical mortality. Methods. Preoperative data of 554 patients in institution A and 500 in institution B were prospectively collected during the same period of time. All patients were operated on by the same surgeon with the same first assistant and anesthesiology staff in both institutions. Patient population was stratified according to Parsonnet's predictive model, in five risk groups, and mortality was adjusted by the direct standardization method. Results. At institution A it was observed that in-hospital mortality was 2.3% (95% confidence interval, 1.3% to 4.0%), and in institution B 4.0% (95% confidence interval, 2.5% to 6.1%). The difference between the two mortality rates (1.7%; 95% confidence interval, −0.5% to 3.8%) is not statistically significant ( p = 0.16), nor is the difference within each class. The standardized mortality ratio was 3.6% (95% confidence interval, 2.7% to 4.8%) and 5.8% (95% confidence interval, 4.6% to 7.2%), respectively. The difference of 2.2% (95% confidence interval, 0.5% to 3.8%) is statistically significant ( p = 0.01). Conclusions. The institution can affect mortality of patients undergoing open heart operations, regardless of the influence of the surgical team. more...

Preoperative autologous donation has been shown to be a highly effective measure in reducing homologous blood use in cardiac operations. The aim of our study was to verify the effectiveness of this procedure and to see whether it is compatible with a comprehensive blood conservation program. Three hundred forty-eight patients (group 1) donated an average of 657 +/- 199 mL of blood before open heart operation, whereas 344 patients (group 2) without autologous predonation were used as a control. The two groups were compared with regard to homologous blood use and the possibility of applying other blood conservation measures. Homologous transfusion rate in group 1 was 12.6%, whereas in group 2 it was 46% (p0.001). Patients with three units of predonated autologous blood had a transfusion rate of 0.8% (p0.001 compared with group 2). In group 1, acute normovolemic hemodilution was accomplished in a lower number of patients and with a lower average withdrawal (338 +/- 102 versus 403 +/- 145 mL; p0.001). Other blood conservation measures such as the return of mediastinal drainage and use of residual blood of extracorporeal circulation were applied with similar results in both groups. In our experience, preoperative autologous donation was compatible with the application of other blood conservation measures, but acute normovolemic hemodilution was achieved in a lower number of patients. Preoperative autologous donation proved to be a highly effective method for reducing banked blood use and therefore homologous blood exposure during and after cardiac operations. more...

Endovascular treatment of thoracic aortic aneurysms is limited in patients with small or calcified femoral arteries, with the most serious complication being rupture at the insertion site or distal sections of the artery. To overcome this, an iliac conduit is normally created by surgical exposure. We used an original access in a patient with a thoracoabdominal aortic aneurysm and narrow femoral artery to introduce the endovascular prosthesis directly into the surgically exposed iliac artery by a small laparotomy and abdominal wall tunnel without iliac conduit. The endoprosthesis was easily implanted, and complete hemostasis was achieved with minimal blood loss. more...