Evaluation of ascending aortic atherosclerosis with 16-multidetector computed tomography is useful before total endoscopic coronary bypass surgery.

BACKGROUND: The purpose of this study was to investigate the assessment of ascending aortic atherosclerosis with 16-multidetector computed tomography (16-MDCT) angiography prior to total endoscopic coronary artery bypass (TECAB) surgery. METHODS: Forty-five patients were examined with electrocardiogram-gated, 16-MDCT angiography. The presence of atherosclerosis at the ascending aorta was graduated as severe (>50% of circumference) or as mild (<50% of circumference). Ascending aortic plaque composition was evaluated based on CT densities expressed as Hounsfield units (HU). TECABs using the Da Vinci telemanipulator were performed either on the arrested heart (n = 39) with an intra-aortic cardiopulmonary bypass (CPB) perfusion device or on the beating heart (n = 6) in patients with severe atherosclerosis. RESULTS: The presence of mild atherosclerosis at the ascending aorta (11/39) was associated with intra-aortic CPB perfusion device-related difficulties such as intra-aortic balloon migration (BM) or balloon rupture (P = .007) in arrested heart TECABs. The CT density of atherosclerotic plaque in patients with BM was mean 58 HU +/- 51 standard deviation (SD), suggesting noncalcifying plaque. In patients without BM, CT density of plaque was mean 526 HU +/- 306 SD corresponding to calcifying plaque (P < .001). Balloon rupture occurred in 2 patients who had calcifying plaque at the ascending aorta. CONCLUSION: Evaluation of ascending aortic atherosclerosis with 16-MDCT angiography is useful prior to TECAB surgery. Even mild atherosclerosis of the ascending aorta is associated with intraoperative difficulties regarding the remote-access perfusion system that is used for arrested heart TECAB surgery.

Does preoperative multislice computed tomography predict operative times in total endoscopic coronary artery bypass grafting?

OBJECTIVE: Multislice computed tomography (MSCT) is currently discussed as a potential tool for procedure planning in endoscopic heart surgery. We aimed to assess the influence of various thoracic measurements on operative times in arrested heart totally endoscopic coronary artery bypass grafting (AHTECAB). METHODS: 34 patients (aged 59 years, 71% male) scheduled for AHTECAB were examined prospectively with ECG-gated 16-channel MSCT angiography of coronary arteries and internal mammary arteries. All AHTECABs were single LIMA to LAD bypass operations using the Da Vinci telemanipulator and the ESTECH remote access perfusion system. RESULTS: The LIMA-LAD distances were: I (at origin of the first diagonal branch) 4.3 cm (2.5-6.0), II (aortic valve level) 3.7 cm (1.1-6.4), III (mitral valve level) 2.9 cm (0.7-5.0), and IV (basis cordis) 2.3 cm (0.6-4.3). The anterioposterior thoracic diameter was 12.4 cm (8.9-15.6), and the transverse diameter was 24.9 cm (21.1-26.8). LIMA-LAD distances I (P = .025, r = .396) and III (P = .042, r = .356) significantly correlated with the anastomotic time. Increased rotation of the heart to the left was associated with a decreased cardiopulmonary bypass time (p = .016, r = -.451). CONCLUSION: These data suggest that MSCT has the potential to predict operative times in robotic AHTECAB.

High-resolution 16-MDCT evaluation of radial artery for potential use as coronary artery bypass graft: a feasibility study.

OBJECTIVE: The objective of our study was to assess the feasibility of using 16-MDCT angiography for the preoperative assessment of the radial and ulnar arteries and the palmar arches in patients scheduled for radial artery harvesting for coronary artery bypass graft (CABG) surgery. CONCLUSION: Sixteen-MDCT angiography shows promise for the noninvasive preoperative assessment of the radial artery as a CABG donor site.

Endotracheal neurofibroma in neurofibromatosis type 1: an unusual manifestation.

Tracheal involvement is an extremely rare manifestation in patients with neurofibromatosis type 1 (NF-1). We present a 33-year-old women with NF-1 suffering from progressive dyspnea. Multislice spiral CT revealed a neurofibroma located within the trachea with intratracheal extension. To our knowledge, this is the first report of an intratracheal neurofibroma which has been documented by CT. This indicates that multislice spiral CT allows accurate demonstration of localization and extent of this rare manifestation of neurofibromas.

Internal fixation of displaced proximal humeral fractures with two one-third tubular plates.

BACKGROUND: Operative treatment of displaced proximal humeral fractures often results in poor functional outcome. We report a technique that provides improved rotational stability of the fracture and thus allows early functional treatment. METHODS: Seventy-one consecutive patients (67 +/- 18 years) with displaced fractures of the proximal humerus (two-part, n = 10; three-part, n = 41; four-part, n = 20) were treated by open reduction and internal fixation using two one-third tubular plates on the anterior and lateral aspects of the proximal humerus. Passive motion was started on the third postoperative day, followed by actively assisted exercises on day 6. RESULTS: Seven patients (12%) had complications (fracture redisplacement, avascular necrosis of the humeral head, frozen shoulder, subacromial impingement, and implant loosening) that required further surgical intervention. Sixty patients (85%) were available for follow-up evaluation 17 +/- 10 months after the injury. Using the Constant score, 34% of the patients had very good results, 29% had good results, 25% had fair results, and 12% had poor results. Age (< 60 years or > or = 60 years) and fracture type had no influence on functional outcome. CONCLUSION: These results demonstrate the high stability of internal fixation with two one-third tubular plates that allowed early mobilization of the shoulder in all patients and emphasize this technique as a preferred treatment option for displaced fractures of the proximal humerus.