Atherosclerotic disruption of the aortic arch during coronary artery bypass operation

A 70-year-old-man presented with a symptomatic three vessel coronary artery disease and was scheduled for myocardial revascularization. During extracorporeal circulation an intrathoracal bleeding occurred and aortic rupture was suspected. An iatrogenic plaque rupture in the concavity of the aortic arch was found due to cannulation attempts. The aortic arch was grafted in the so-called elephant trunk technique. Thereafter bypass grafts were anastomosed to the stenosed coronary arteries. The patient was discharged from hospital after 2 weeks in good conditio

Benefits of cardiac surgery in octogenarians — a postoperative quality of life assessment

Objective: Assessment of postoperative quality of life in patients over 80 years after cardiac surgery including coronary artery bypass grafting (CABG), aortic valve replacement (AVR) and combined procedures. Methods: Quality of life of n=136 patients over 80 years at operation (82.3±2.1 years), undergoing isolated CABG in 61 patients (45%), isolated AVR in 34 patients (25%) and a combination of CABG and AVR in 41 patients (30%) between January 1999 and December 2003 was reviewed. Preoperatively 66.2% presented in NYHA-class III/IV or CCS-class III/IV. Mean ejection fraction (EF) was 59.5%±14.0 (range 25-90%). Quality of life assessment was performed via a Seattle Angina Questionnaire. Follow-up was 100% complete for a total of 890 days (69-1853 days). Results: Five-year survival was 70% for the CABG group, 75% for the AVR group and 65% for the CABG/AVR group. Quality of life was remarkable in all of the three groups after surgery. Overall 97 patients (81%) were not or little disabled in their daily activity. One hundred and twelve patients (93%) were free or considerably less symptomatic. Seventy-eight patients or 65% reported to be very satisfied with their current quality of life and 112 patients (93%) felt very reassured to have continuous full access to medical treatment despite of their advanced age. Conclusions: A remarkable quality of life and important improvement in the functional status after cardiac surgery in patients over 80 paired with a satisfactory medium-term survival justify early intervention for heart disease in this age group. Therefore, referral practice for patients over 80 years for heart surgery should be handled liberall

Trions, Exciton Dynamics and Spectral Modifications in Doped Carbon Nanotubes: A Singular Defect-Driven Mechanism

Doping substantially influences the electronic and photophysical properties of semiconducting single-wall carbon nanotubes (s-SWNTs). Although prior studies have noted that surplus charge carriers modify optical spectra and accelerate non-radiative exciton decay in doped s-SWNTs, a direct mechanistic correlation of trion formation, exciton dynamics and energetics remains elusive. This work examines the influence of doping-induced non-radiative decay and exciton confinement on s-SWNT photophysics. Using photoluminescence, continuous-wave absorption, and pump-probe spectroscopy, we show that localization of and barrier formation by trapped charges can be jointly quantified using diffusive exciton transport- and particle-in-the-box models, yielding a one-to-one correlation between charge carrier concentrations derived from these models. The study highlights the multifaceted role of exohedral counterions, which trap charges to create quenching sites, form barriers to exciton movement, and host trion states. This contributes significantly to understanding and optimizing the photophysical properties of doped SWNTs

Constrictive tuberculous pericarditis in a HIV-positive patient

Constrictive pericarditis is a relatively rare clinical manifestation nowadays. We present the case of an HIV-positive patient with constrictive calcified pericarditis due to an infection with Mycobacterium tuberculosis. Pericardectomie was performed. The therapeutical approach is discussed and the literature is reviewe

Risk factors for secondary dilatation of the aorta after acute type A aortic dissection

Objectives: Prompt diagnosis of subsequent dilatation of the dissected aorta is crucial to reduce late mortality in these patients. This study focuses on risk factors for dilatation of the aorta after type A aortic dissection (AADA) affecting a normal-sized or slightly dilated aorta. Methods: Overall 531 CT scans were analysed. Patients were included in the study if at least 3 CT scans were available after operative repair. 64 patients (59.8%) out of 107 patients full-field the inclusion criteria. Volumetric analyses of the aorta were performed. Patients were divided in 3 groups: group A included 26 patients (40.6%) without progression of the aortic diameter, group 2, 27 patients (42.2%) with slight progression and group 3, 11 patients (17.2%) with important progression, requiring surgery in 9 patients (81.8%). Risk-factors for progression of the aortic size were analysed and compared between the groups. Results: Patients from group 3 were younger 57.7±13.4 vs. 61.9±11.6 in group 1 (P≪0.05) and were more frequent female (45.4 vs. 23.1%; P≪0.05). Dissection of the supraaortic branches (100 vs. 80.8%; P≪0.05), the presence of preoperative cerebral, visceral or peripheral malperfusion (54.6 vs. 26.9%; P≪0.05) and contrast enhancement in the false lumen during the follow-up (72.7 vs. 57.7%; P=0.07) were additional risk factors for late aortic dilatation in these patients. Conclusions: Acute type A aortic dissection in younger patients, involving the supraaortic branches and/or combined with malperfusion syndrome favour secondary dilatation. A close follow-up is mandatory to prevent acute complications of the diseased downstream aorta following repair of a AAD

Risk factors for secondary dilatation of the aorta after acute type A aortic dissection

Objectives: Prompt diagnosis of subsequent dilatation of the dissected aorta is crucial to reduce late mortality in these patients. This study focuses on risk factors for dilatation of the aorta after type A aortic dissection (AADA) affecting a normal-sized or slightly dilated aorta. Methods: Overall 531 CT scans were analysed. Patients were included in the study if at least 3 CT scans were available after operative repair. 64 patients (59.8%) out of 107 patients full-field the inclusion criteria. Volumetric analyses of the aorta were performed. Patients were divided in 3 groups: group A included 26 patients (40.6%) without progression of the aortic diameter, group 2, 27 patients (42.2%) with slight progression and group 3, 11 patients (17.2%) with important progression, requiring surgery in 9 patients (81.8%). Risk-factors for progression of the aortic size were analysed and compared between the groups. Results: Patients from group 3 were younger 57.7±13.4 vs. 61.9±11.6 in group 1 (P≪0.05) and were more frequent female (45.4 vs. 23.1%; P≪0.05). Dissection of the supraaortic branches (100 vs. 80.8%; P≪0.05), the presence of preoperative cerebral, visceral or peripheral malperfusion (54.6 vs. 26.9%; P≪0.05) and contrast enhancement in the false lumen during the follow-up (72.7 vs. 57.7%; P=0.07) were additional risk factors for late aortic dilatation in these patients. Conclusions: Acute type A aortic dissection in younger patients, involving the supraaortic branches and/or combined with malperfusion syndrome favour secondary dilatation. A close follow-up is mandatory to prevent acute complications of the diseased downstream aorta following repair of a AADA

The Shelhigh No-React® bovine internal mammary artery: a questionable alternative conduit in coronary bypass surgery?

Background: Increasing age and comorbidities among patients undergoing coronary artery bypass surgery (CABG) stimulates the exhaustive research for alternative grafts. No-React® treatment should render the tissue resistant against degeneration and reduce early inflammatory response. The aim of the present study was an invasive assessment of the patency of No-React® bovine internal mammary artery (NRIMA grafts) used as bypass conduit in CABG surgery. Patients and methods: Nineteen NRIMA grafts were used in 17 patients (2.9%) out of a total of 572 patients undergoing CABG surgery within a 12-month period. All intraoperative data were assessed and in-hospital outcome was analysed. Follow-up examination was performed 7.0±4.0 months after initial surgery, including clinical status and coronary angiography to assess patency of the NRIMA grafts. Results: Average perioperative flow of all NRIMA grafts was 71±60ml/min. One patient died in hospital due to a multi-organ failure. Four patients refused invasive assessment. Follow-up was complete in 12 patients with overall 13 NRIMA grafts. Nine NRIMA grafts (69.2%) were used for the right coronary system, two NRIMA grafts (15.4%) on the LAD and two on the circumflex artery. Graft patency was 23.1% and was independent of the intraoperative flow measurement. Conclusions: NRIMA grafts show a very low patency and cannot be recommended as coronary bypass graft conduits. Patency was independent of the perioperative flow, assessed by Doppler ultrasound. Because of this unsatisfying observation, this type of graft should be utilised as a last resource conduit and used only to revascularise less important target vessels, such as the end branches of the right coronary arter