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Query: UMLS:C0729233 (Thoracic)
 6,478 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The South Australian population of approximately 1,245,000 is 9.2% of the total Australian population. The Cardio-Thoracic Surgical Unit of the Royal Adelaide Hospital is the only one such unit in the State which is equipped for open heart surgery, and coronary artery grafting was first undertaken there in December, 1970. From that time until the end of December, 1976, 701 patients underwent coronary artery grafting with an overall hospital mortality of 3.0%, and a late mortality of 3.2%. The principal indication for operation was incapacitating angina, and of the 628 patients who have been followed-up after operation for a minimum period of six months, 78.6% were judged by their cardiologist to be completely relieved of this symptom. A further 8.9% of patients were considered to be significantly improved. Coronary artery surgery has rapidly assumed a dominant role in our Unit so that, in 1976, of the 435 open heart operations which were performed, 267 (61%) were procedures which necessitated coronary artery grafting. The rate of increase has slowed considerably over the past 18 months, and it is expected that, with current operative indications, the proportion of coronary artery cases will not rise much above 60% of the open heart work load of the Unit.
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PMID:Coronary artery surgery in South Australia 1970-1976. 60 Jan 73

During a two-year period (February 1973 to February 1975) 20 consecutive patients with post-infarction left ventricular aneurysm, seen at the Wessex Cardiac and Thoracic Centre, underwent aneurysmectomy with or without aorta-to-coronary artery saphenous vein bypass grafts, ventricular septal defect closure, or valve replacement. The diagnoses were established by clinical means, plain chest radiographs, left ventriculography, and selective coronary arteriography. The indications for surgery were uncontrollable congestive heart failure and angina, ventricular arrhythmias, or a rapidly growing aneurysm. Low cardiac indices or high left ventricular end-diastolic pressure were not considered to be contraindications to operation. Resection of the left ventricular aneurysm was performed with the use of normothermic cardiopulmonary bypass with haemodilution. In addition to the aneurysmectomy, four of these patients had concomitant closure of post-infarction ventricular septal defects; four had valve replacements; two had grafts to coronary arteries; and one had both replacement of the mitral valve and a right coronary vein graft. There were two hospital deaths (10%) and two late deaths (10%), making an overall mortality of 20%. All but one of the deaths were related to coronary artery disease. The survivors are active, and their rehabilitation was satisfactory. The longest survivor is doing well two years after left ventricular aneurysmectomy, ventricular defect closure, and tricuspid valve replacement. It is evident from our experience and from the reports of others that surgery has an established place in the management of post-infarction left ventricular aneurysm.
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PMID:Elective operations for post-infarction left ventricular aneurysms. 125 39

Percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG) are major coronary revascularization procedures to relieve angina, prevent myocardial infarction and improve long-term survival. The quality of their indication is widely discussed at present. The Swiss Societies of Cardiology, of Internal Medicine and of Thoracic and Cardiovascular Surgery decided to set up a consensus conference to evaluate the indications for coronary revascularization. For this a modified RAND approach (Delphi method) was used. An expert panel rated 992 indications for coronary revascularization twice for appropriateness (more benefits than risks for the patient), and once for necessity (procedure has to be offered or discussed with the patient). In the panel an agreement percentage of 65% was noted. In 35% we observed neither agreement nor disagreement, and there was almost no disagreement among the panelists. The results of the necessity ratings were 48% agreement, 49% indetermination and 3% disagreement. The average median rating for appropriateness on a 1-9 point scale (1 = extremely inappropriate, 9 = extremely appropriate or necessary) was 7.7 over all given single indications and 7.2 for necessity. The results of appropriateness and necessity ratings presented in this paper reflect the findings of a 15-member Swiss panel.
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PMID:Results of a Swiss consensus conference on coronary revascularization. Members of the Swiss Society of Cardiology, Swiss Society of Internal Medicine, Swiss Society of Thoracic and Cardiovascular Surgery. 926 Feb 97

Endoscopic Thoracic Sympathectomy (ETS) has gained an increasing popularity due to its minimal invasive character. Despite the simplicity of the procedure, non-surgical options should always be considered as the first line of treatment. The complication risk of ETS is low but side effects, primarily compensatory sweating (CS) of mainly the trunk may be severe enough to cause regret of the procedure. The risk/benefit ratio should always be discussed with the patient. Severe palmar hyperhidrosis and facial blushing respond very well to ETS with a high patient satisfaction rate. Facial hyperhidrosis is effectively treated with ETS but is associated with a high risk for severe CS. Axillary hyperhidrosis is best treated by other means than ETS. The use of ETS for pain syndromes, vascular insufficiency and angina pectoris is not well supported by scientific evidence, making mandatory careful patient selection.
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PMID:Specific complications and mortality of endoscopic thoracic sympathectomy. 1467 70

The goal of this study was to compare the clinical presentation and angiographic morphology of patients having an unstable angina pectoris. A total of 321 patients were consecutively studied and underwent cardiac catheterization, mean age 59 + 6 years. According to Braunwald classification, class III was predominant (58%) On coronary angiography, 148 patients had single vessel disease, double-vessel in 92 and triple-vessel in 64. Morphology of coronary artery lesions was classified according to Ambrose's classification, 100 patients had simple lesions (type I or IIA), 204 patients had complex lesions (type IIB, III, intracoronary thrombus or total occlusion). Thoracic rest pain (class III) or postinfarction angina (class C), were associated with the presence of complex lesions. This subgroup of high risk patients would benefit from either Glycoprotein IIb/IIIa blockers with an early revascularisation strategy.
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PMID:[Correlation of clinical and angiographic morphology in unstable angina]. 1512 9

Thoracic epidural analgesia (TEA) provides optimal perioperative anaesthesia and analgesia after thoracic and major abdominal surgery and decreases postoperative morbidity and mortality, mainly by blocking sympathetic nerve fibres. Surgery leads to a stress response characterized by sympathetic arousal, altered balance of catabolic and anabolic hormones, hypermetabolism, negative protein economy, and altered carbohydrate metabolism and immune function. A threefold increase of the plasma level of norepinephrine (noradrenaline) was detected up to 24 hours after surgery. These elevated catecholamine plasma levels are a risk, especially to patients with coronary artery disease, because unlike healthy coronary arteries, the stress response causes a vasoconstriction in arteriosclerotic coronary arteries. TEA results in a vasodilation in stenotic coronary arteries. In patients with instable angina pectoris, TEA reduced the number as well as the duration of episodes of cardiac ischaemia. Furthermore, TEA improves myocardial structure and function after coronary artery bypass grafting. Plasma levels of troponin T and I, as well as of atrial natriuretic peptides, were reduced and echocardiographic parameters of the ventricular wall motion were improved by TEA. Patients showed fewer arrhythmic episodes and postoperative myocardial infarction, and could be extubated earlier. The positive effects of TEA after coronary artery bypass grafting are not limited to a short postoperative period, the 2-year mortality rate also seems to be reduced. Optimized pain control and early mobilization decrease the riskof pulmonary complications, resulting in a shortened stay in intensive care units. In combination with early enteral nutrition, TEA leads to an earlier return of gastrointestinal function. Patients treated with thoracic epidural anaesthesia and analgesia have a better health-related quality of life.
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PMID:Update in thoracic epidural anaesthesia. 1596 93

Many patients with angina related to coronary artery disease respond to medical management or can be completely revascularized using available percutaneous coronary interventions or coronary artery bypass grafting (CABG). There is evidence, however, to indicate that up to 25% of patients are incompletely revascularized following CABG and that incomplete revascularization is a significant independent predictor of early and late mortality and adverse events. Transmyocardial revascularization (TMR) is a surgical option for patients with debilitating angina due to coronary artery disease in areas of the heart not amenable to complete revascularization using conventional treatments. In randomized, 1-year controlled trials with long-term follow-up and in additional clinical experience, TMR performed adjunctively to CABG in patients who would be incompletely revascularized by CABG alone has yielded significantly improved clinical outcomes. Based on these published results, the Society of Thoracic Surgeons has issued a practice guideline recommending adjunctive TMR in this difficult patient group.
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PMID:Transmyocardial laser revascularization as an adjunct to coronary artery bypass grafting. 1676 55

Primary pheochromocytomas located outside the adrenal glands account for only 10% of all pheochromocytomas. Mediastinal pheochromocytomas are even rarer and usually represent a therapeutic challenge as they often infiltrate adjacent structures. We report the case of a large primary mediastinal pheochromocytoma in a 65-year-old patient presenting with a sudden angina-like chest pain and dyspnea. Thoracic multislice computed tomography showed an 8 x 5 x 6-cm retrocardiac mass causing compression of both atria and infiltrating the left superior pulmonary vein. The tumor was highly vascularized and presented a blood supply derived from the circumflex artery. The mass was successfully removed by open heart surgery, and the patient was discharged 10 days postoperatively.
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PMID:Mediastinal pheochromocytoma with single coronary blood supply: a case report. 1738 10

A 50-year-old man was referred to the Department of Thoracic and Cardiovascular Surgery at the Johann Wolfgang-Goethe University (Frankfurt, Germany) with angina on exertion. An evaluation revealed critical stenosis involving the proximal portion of the left anterior descending artery and the first diagonal branch. The patient underwent successful sequential grafting of the left internal mammary artery to the left anterior descending artery and the diagonal branch using a totally endoscopic coronary artery bypass grafting technique on the beating heart with a new version of the da Vinci Surgical System (Intuitive Surgical, USA). To the authors' knowledge, this is the first report in literature to describe sequential arterial off-pump grafting of two anterior wall target vessels using a totally endoscopic technique on the beating heart.
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PMID:Totally endoscopic sequential arterial coronary artery bypass grafting on the beating heart. 1744 Jun 46

The autonomic nervous system plays an important role in the genesis of ventricular arrhythmias and sudden cardiac death. Evidence is substantial for a neural component in sudden cardiac death. Sympathetic nerve sprouting and regional myocardial hyperinnervation following myocardial injury promote cardiac arrhythmia and sudden cardiac death through several potential mechanisms. Modulating autonomic tone is a potential method to reduce the risk of ventricular arrhythmias. Thoracic spinal cord stimulation is showing promise as a treatment for refractory angina. In addition, spinal cord stimulation has protected against ventricular tachycardia/ventricular fibrillation in animal models of postinfarction heart failure.
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PMID:Heart-brain interactions in cardiac arrhythmias: role of the autonomic nervous system. 1854 Jan 55


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