Heart transplantation in a low-organ-donation environment: a single center experience.

OBJECTIVE: Heart transplantation is the "gold standard" for treating patients in end-stage heart failure who satisfy strict selection criteria. However, infrequent transplant performance, eg, less than nine per year, may be associated with suboptimal results. METHODS: We reviewed our 13-year clinical experience (1996-2008) with 73 orthotopic heart transplants performed under strict selection criteria and followed closely thereafter at the only accredited center in Greece, a country with an annual rate of only seven donors per million population. RESULTS: Low perioperative (5.47%) and long-term (7.5%) mortality rates were responsible for a 94% survival rate in the first year, 92% at five years, and 70% at ten years-similar to those reported worldwide-along with excellent functional recovery. CONCLUSION: Strict recipient and donor selection criteria, combined with a rigorous multidisciplinary follow-up, yield excellent results despite the existing shortage of available grafts.

Mitral valve replacement and Hunter syndrome: case report.

We report a rare case of mitral valve stenosis secondary to Hunter syndrome, mucopolysaccharoidosis (MPS) type II in a 33-year-old man. Anatomical abnormalities in patients with MPS present anesthetic and surgical challenges during cardiac surgery. Management of this particular patient was complicated by excessive oral secretions and atrial fibrillation. With a detailed preoperative assessment and planning for airway management, this patient successfully underwent mitral valve replacement and had an uncomplicated hospital course. After 6 months of follow-up, the patient was still in stable condition.

Inhaled iloprost in eight heart transplant recipients presenting with post-bypass acute right ventricular dysfunction.

BACKGROUND: During heart transplantation, weaning from cardiopulmonary bypass may be particularly laborious as a result of superimposed acute right ventricular dysfunction in the setting of pre-existing pulmonary hypertension. Research in recent years has focused on inhaled vasodilatory treatment modalities which selectively target the pulmonary circulation. METHODS: We present a series of eight patients in whom inhaled iloprost, a synthetic prostacyclin analog, was used to treat pulmonary hypertension and right ventricular dysfunction detected by transesophageal echocardiography during a heart transplant procedure. In addition to conventional inotropic support, 20 mug of inhaled iloprost was administered via nebulized aerosol for a 20-min period. Complete sets of hemodynamic measurements were obtained before inhalation and during and after cessation of the inhalation period. RESULTS: Inhaled iloprost decreased the transpulmonary gradient at the end of the inhalation period relative to baseline (8.2 +/- 1.6 mmHg vs. 11.2 +/- 0.9 mmHg, P < 0.05). The mean pulmonary artery pressure to systemic artery pressure ratio decreased over this period (0.24 +/- 0.07 vs. 0.44 +/- 0.09, P < 0.05). A statistically significant decrease in the pulmonary vascular resistance to systemic vascular resistance ratio was also observed (0.10 +/- 0.02 vs. 0.19 +/- 0.02, P < 0.05). Improved indices of right ventricular function were observed in echocardiographic monitoring. CONCLUSION: During heart transplantation procedures, episodes of pulmonary hypertension can be successfully treated with inhaled iloprost administration, without untoward side-effects or significant systemic impact.

Thoracoscopy, bronchoscopy and mediastinoscopy in the staging of lung cancer.

PURPOSE: To estimate the benefit of Video-Assisted Thoracoscopy (VAT) in the staging of patients with lung cancer. PATIENTS AND METHODS: Between October 1998 and January 2001 VAT was used in 250 patients with histologically proven lung cancer. They were staged by more conventional techniques including magnetic resonance imaging (MRI), bronchoscopy, and mediastinoscopy. RESULTS: As a result of VAT 30 patients were upstaged and spared a thoracotomy receiving neo-adjuvant chemotherapy at that point. In 40 patients the procedure was converted into an open thoracotomy and a curative resection was performed during the same session. The remaining 180 patients were deemed inoperable and they received chemotherapy and radiation treatment. CONCLUSION: VAT enhanced our bronchoscopic and medistinoscopic findings. It was especially useful in assessing the extent of invasion of various thoracic structures amenable to surgical removal "en block" with the tumor, and in differentiating simple contact of the tumor with an intrathoracic structure from tumor invasion. In addition, it allowed access and sampling of lymph nodes in spaces not easily accessible by mediastinoscopy.

Completion pneumonectomy for lung cancer.

PURPOSE: Completion pneumonectomy is a trully challenging operation associated with increased mortality and morbidity. The aim of this study was to present a series of 18 patients who underwent completion pneumonectomy for lung cancer during a 15-year period and to evaluate the postoperative outcomes and long-term results. PATIENTS AND METHODS: Between January 1985 and December 2000,18 patients underwent completion pneumonectomy for lung cancer; 10 for local recurrence ,6 for second primary lung tumor and 2 for lung tumors in patients who had previously been operated on for benign disease. RESULTS: No intraoperative deaths occurred. Postoperative mortality and morbidity were 11.11% and 33.33%, respectively. The median operational time was 212.7 minutes. The mean blood loss during the procedure was 1.042,5 ml. The complication rate was 33.33%. The 5-year survival was 18.75% for all patients. The 5-year survival was 25% for the local recurrence group and 50% for the primary lung cancer group. The 5-year survival of the patients in the second primary tumor group has not been reached yet. CONCLUSION: Completion pneumonectomy can be performed with an acceptable operative mortality rate and offers a second chance for cure to patients with lung cancer. Although complications are common ,they can successfully be managed with proper understanding of them.

Incisional metastasis after cervical mediastinoscopy: a case report.

The risk of iatrogenic tumor seeding from mediastinoscopy is low. The etiology of this complication remains unclear. We present the case of a patient with this condition, discuss the cause and management, and review the literature.