The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Aug 2012
Restricted cusp motion in right-left type of bicuspid aortic valves: a new risk marker for aortopathy.
Bicuspid aortic valve disease is heterogeneous with respect to valve morphology and aortopathy risk. This study searched for early imaging predictors of aortopathy in patients with a bicuspid aortic valve with right-left coronary cusp fusion, the most common morphotype. ⋯ In the bicuspid aortic valve commonly defined as normofunctional by echocardiographic criteria, restricted systolic conjoint cusp motion causes flow deflection. The novel measurement introduced can quantify restricted cusp opening, possibly assuming prognostic importance.
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J. Thorac. Cardiovasc. Surg. · Aug 2012
Randomized Controlled TrialTherapeutic angiogenesis in patients with severe limb ischemia by transplantation of a combination stem cell product.
Angiogenesis involves the interplay of endothelial progenitor cells, pericytes, growth factors, and cellular matrix components. The use of mesenchymal stem cells, which are closely related to pericytes and produce diverse angiogenic growth factors and matrix molecules, seems to be a promising therapeutic modality. We postulate that the use of a combination cell product (mesenchymal stem cells in conjunction with a source of endothelial progenitor cells) is safe and efficient and may optimize the clinical results obtained with the use of endothelial progenitor cells alone. This study assessed whether the intramuscular infusion of a combination cell product represents a viable, effective, and lasting therapeutic modality to improve perfusion in severely ischemic limbs. ⋯ This phase II clinical trial shows that the use of a combination cell therapy is safe and effective in increasing blood flow in the ischemic legs of patients with limb ischemia.
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J. Thorac. Cardiovasc. Surg. · Aug 2012
Preoperative high-sensitivity C-reactive protein predicts depression in patients undergoing coronary artery bypass surgery: a single-center prospective observational study.
Our objective was to reveal the contribution of preoperative high-sensitivity C-reactive protein (hsCRP) levels to the risk of depression in patients undergoing coronary artery bypass grafting (CABG). ⋯ The present study is the first to report elevated serum hsCRP is an independent predictor for depression in CABG patients not only preoperatively but also up to 6 months after surgery. These clinical findings may reveal a potential target for improving prognosis in CABG patients with depression.
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J. Thorac. Cardiovasc. Surg. · Aug 2012
Multicenter StudyBiventricular strategies for neonatal critical aortic stenosis: high mortality associated with early reintervention.
To characterize the risk of reintervention after biventricular strategies to treat neonatal critical aortic stenosis, and the effect of reintervention on survival. ⋯ Success of index biventricular procedures has important survival implications: early reintervention implies a poor prognosis and might reflect incorrect management decisions. The morphologic characteristics can help identify such neonates, and univentricular repair might, instead, be preferable.
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J. Thorac. Cardiovasc. Surg. · Aug 2012
Preliminary clinical experience with a bifurcated Y-graft Fontan procedure--a feasibility study.
Optimizing flow and diminishing power loss in the Fontan circuit can improve hemodynamic efficiency, potentially improving the long-term outcomes. Computerized modeling has predicted improved energetics with a Y-graft Fontan. ⋯ The present preliminary surgical experience has demonstrated the clinical feasibility of the bifurcated Y-graft Fontan. Computational fluid dynamics showed acceptable hemodynamics with low calculated power losses and a balanced distribution of inferior vena cava flow to the pulmonary arteries as long as the branch grafts were anastomosed distally.