Can categorised values of maximal oxygen uptake discriminate patterns of exercise dysfunction in pectus excavatum: a prospective cohort study?

Cohort studies of patients with pectus excavatum have inadequately characterised exercise dysfunction experienced. Cardiopulmonary exercise test data were delineated by maximal oxygen uptake values >80%, which was tested to examine whether patterns of exercise physiology were distinguished. METHODS: Seventy-two patients considered for surgical treatment underwent assessment of pulmonary function and exercise physiology with pulmonary function tests and cardiopulmonary exercise test between 2006 and 2019. Seventy who achieved a threshold respiratory gas exchange ratio of >1.1 were delineated by maximal oxygen uptake >80%, (group A, n=33) and <80% (group B, n=37) and comparison of constituent physiological parameters performed. RESULTS: The cohort was 20.8 (±SD 6.6) years of age, 60 men, with a Haller's Index of 4.1 (±SD 1.4). Groups A and B exhibited similar demography, pulmonary function test results and Haller's index values. Exercise test parameters of group B were lower than group A; work 79.2% (±SD 11.3) versus 97.7 (±SD 10.1), anaerobic threshold 38.1% (±SD 7.8) versus 49.7% (±SD 9.1) and O2 pulse 77.4% (±SD 9.8) versus 101.8% (±SD 11.7), but breathing reserve was higher, 54.9% (±SD 13.1) versus 44.2% (±SD 10.8), p<0.001 for each. Both groups exhibited similar incidences of carbon dioxide retention at peak exercise. A total of 65 (93%) exhibited abnormal values of at least one of four exercise test measures. CONCLUSION: This study showed that patients with pectus excavatum exhibited multiple physiological characteristics of compromised exercise function. It is the first study that defines differing patterns of exercise dysfunction and provides evidence that patients with symptomatic pectus excavatum should be considered for surgical treatment.

Giant Circumflex Artery Aneurysm With a Coronary Sinus Fistula.

Giant coronary artery aneurysms are extremely rare entities, and the authors are aware of only 13 case reports of such aneurysms of the circumflex artery. This case report is provided to add evidence of the natural history and pathophysiology and describe the successful surgical treatment of this condition.

Does perioperative administration of thyroid hormones improve outcome following coronary artery bypass grafting?

The question addressed in this review is whether supplementation with thyroid hormones during the perioperative period improves the outcome of patients undergoing coronary artery bypass surgery. Altogether 88 relevant papers were identified using the below mentioned search, seven papers represented the best evidence to answer the question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses were tabulated. We conclude that although widespread interest has been shown on the use of thyroid hormones in the perioperative period, and the effect of cardiopulmonary bypass on thyroid hormone metabolism widely studied, there is no substantial evidence to justify routine use of thyroid hormones in patients undergoing coronary artery bypass grafting.

Nurse-led preoperative screening and targeted optimization of pulmonary dysfunction in patients undergoing cardiac surgery.

Postoperative pulmonary dysfunction prolonging intensive care treatment after cardiac surgery most commonly occurs in patients with a background of pre-existing pulmonary dysfunction. However, many patients have occult dysfunction and present primarily after surgery. We describe and discuss the results of a respiratory optimization program utilizing a peak expiratory flow rate below 400 L/min as a screening test to identify patients in a nurse-directed preoperative clinic.

Isolated severe ischemic tricuspid regurgitation: successful surgical repair.

Tricuspid regurgitation (TR) is a common association of left-sided valvular lesions that is occasionally seen with ischemic heart disease. However, isolated ischemic TR requiring surgical intervention is extremely rare, with very few reported cases. The case is presented of a 59-year-old woman who, after extensive non-cardiac investigations, was eventually diagnosed with severe functional TR due to chronic myocardial ischemia. The patient underwent successful surgical treatment.

Sutureless off-pump repair of post-infarction left ventricular free wall rupture.

Left ventricular free wall rupture after myocardial infarction has a high mortality. Suturing techniques of repair may be technically difficult and require cardiopulmonary bypass. We report a case of left ventricular rupture in a 47 year old man managed off pump employing a sutureless technique with Gelatine-Resorcin-Formalin glue and bovine pericardial patches.

Heparin induced thrombocytopenia type II complicating coronary artery bypass surgery: a tale of caution.

OBJECTIVE: To highlight an uncommon problem of heparin induced thrombocytopenia after coronary artery bypass operation. METHODS: We report the case of a 59-year-old man who suffered severe type II heparin induced thrombocytopenia (HIT) after coronary artery bypass operation. He experienced extensive skin necrosis at sites of saphenous vein harvesting, which progressed to cause soft tissue necrosis of both feet. He also exhibited secondary clinical features arising from pulmonary, hepatic and renal dysfunction suggestive of extensive venous thrombosis. Primary treatment of the haematological disorder was achieved by discontinuation of all forms of heparin and the administration of a heparinoid intravenously. Secondary treatment included forefoot amputations and skin grafting. RESULTS: Though the patient suffered a protracted period of recovery he was discharged home well. CONCLUSION: We have reported this complex case in order to familiarise cardiothoracic surgeons with the extreme characteristics of type II HIT and to emphasise that early diagnosis and treatment will facilitate a successful outcome.