The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Aug 2012
Matrix metalloproteinase 14 and 19 expression is associated with thoracic aortic aneurysms.
It is hypothesized that an altered turnover of extracellular matrix mediated by matrix metalloproteinases (MMPs) is present in thoracic aortic aneurysms. Here, we analyzed the occurrence of MMPs and MMP inhibitors in ascending aortic aneurysms in patients with bicuspid and tricuspid aortic valves. ⋯ The present study identifies MMP14 and MMP19 as proteolytic enzymes potentially involved in aneurysm formation in the ascending aorta of patients with tricuspid aortic valves.
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J. Thorac. Cardiovasc. Surg. · Aug 2012
Modern surgical results of lung cancer involving neighboring structures: a retrospective analysis of 531 pT3 cases in a Japanese Lung Cancer Registry Study.
The aim of the present study was to identify the modern surgical results of pathologic T3 lung cancer and to examine the heterogeneity of this group from the nationwide database. ⋯ The modern 5-year survival rates of patients with T3 lung cancer involving any neighboring structures have been 40% to 55%, and the current pT3 group was proved to have a relatively uniform prognosis.
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J. Thorac. Cardiovasc. Surg. · Aug 2012
In vitro assessment of prosthesis type and pressure recovery characteristics: Doppler echocardiography overestimation of bileaflet mechanical and bioprosthetic aortic valve gradients.
Pressure recovery results in Doppler gradients greater than catheter gradients and is well established in association with bileaflet mechanical aortic valves. Because pressure recovery is influenced by orifice geometry, it might manifest differently with various valve prostheses. If true, then the reliability of Doppler echocardiography for the estimation of aortic valve gradients might be different with different prostheses. The purpose of the present study was to test, in an in vitro setting, the degree to which pressure recovery results in Doppler overestimation of gradients for three commonly used aortic valve prostheses. ⋯ In an in vitro model with a normal aorta size, substantial pressure recovery occurred with all three aortic valve prostheses. Although statistically significant differences were found between valve types in the percentage of pressure recovery and percentage of pressure recovery complete at 1 cm, the differences were small and clinically unimportant. Clinically, among patients with an ascending aorta diameter less than 3.0 cm, Doppler echocardiography likely substantially overestimates aortic valve mean gradient, regardless of prosthesis type.
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J. Thorac. Cardiovasc. Surg. · Aug 2012
A near 100% repair rate for mitral valve prolapse is achievable in a reference center: implications for future guidelines.
Although mitral valve repair is the recommended treatment for severe mitral regurgitation of degenerative etiology, valve replacement remains common, particularly for complex lesions or anterior leaflet involvement. We sought to characterize the feasibility and outcomes of an "all comers" repair strategy applied systematically in all cases of degenerative mitral valve disease, regardless of age, complexity, or leaflet involvement. ⋯ A systematic strategy of mitral valve repair that uses a variety of techniques allows repair of all degenerative valves in a reference center, with good short-term outcomes and mid-term durability. Further study is required to document the long-term efficacy of an "all comers" mitral valve repair strategy in degenerative subgroups with very complex valve morphology.
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J. Thorac. Cardiovasc. Surg. · Aug 2012
The pumpless extracorporeal lung membrane provides complete respiratory support during complex airway reconstructions without inducing cellular trauma or a coagulatory and inflammatory response.
Our objective was to investigate the capacity of a pumpless extracorporeal lung membrane (iLA) (Novalung; Novalung GmbH, Hechingen, Germany) to provide adequate respiratory support and the impact on morbidity/mortality during complex airway reconstruction. ⋯ Data suggest that iLA provides complete intraoperative respiratory support in patients who cannot receive conventional intubation/ventilation without relevant effects on cellular trauma, coagulatory response, and inflammatory response.