Iatrogenic bronchopleural fistula occuring during redo cardiac surgery.

Cardiac re-operations are associated with increased morbidity and mortality rates due to adhesion of tissues in the anterior mediastinum. Especially, previous usage of left internal thoracic artery constitutes a major challenge for cardiovascular surgeons. In such cases, the left lung frequently adheres to the thoracic wall and may be injured during dissection. This leads to air leak and the complication may in turn increase the risk of mediastinal infections and the hospital stay. A bronchopleural fistula case treated by a novel technique is reported. In patient iatrogenic bronchopleural fistula occured during dissection of the adhesions which resulted due to the first coronary artery bypass grafting and left internal thoracic artery usage. The air leakage was successfully controlled and treated by a novel method: self adhesive BioGlue immersed and coated Surgicel patch. Although it is a single case experience it may be a promising method as it is less traumatic when compared to the classical treatment methods of bronchopleural fistula.

Cyanoacrylate gluing increases the effectiveness of systemic antimicrobial treatment in sternal infection: experimental study in a rodent model.

BACKGROUND: Sternal infection is a serious complication of cardiac surgery requiring resternotomy and radical debridement. In this experimental study, we aimed to test our hypothesis that the use of cyanoacrylate gluing (application of an acrylic resin, a monomer of cyanoacrylate molecules, which rapidly polymerizes in the presence of water, forming long, strong chains and joining the bonded surfaces together) together with systemic antimicrobial therapy will provide synergy for the treatment of sternal infection caused by methicillin-resistant Staphylococcus aureus (MRSA). METHODS: Forty Wistar albino rats were randomly divided into four groups: Group I, uncontaminated sham group; Group II, untreated contaminated control group; Group III, contaminated group receiving only systemic vancomycin therapy; Group IV, contaminated group treated with a combination of cyanoacrylate gluing and systemic vancomycin. Cyanoacrylate gluing was applied on the 3rd postoperative day and all rats alive at the end of 8th week were sacrificed. The degree of sternal infection was assessed histologically and also by quantitative culture analysis. RESULTS: Histological evaluation revealed that cyanoacrylate was degraded and replaced by connective tissue at the end of the 8th week. Culture analysis revealed that the average growth of microorganisms was significantly reduced in Groups III and IV. In Group IV, the reduction in the amount of growing microorganisms was found to be more pronounced and significantly lower than in Groups II and III. CONCLUSION: Our experimental model suggests that cyanoacrylate gluing provides significant synergy for systemic antimicrobial therapy. However, further clinical trials are required in order to use this treatment modality safely in patients, even though our study demonstrated successful results in the treatment of mediastinitis and sternal osteomyelitis in rats.

A retrospective comparison of bovine pericardium and polytetrafluoroethylene patch for closure of ventricular septal defects.

This retrospective study compared the immediate post-operative (first month) and mid-term (up to 5 years post-operation) results of 22 patients with isolated ventricular septal defects who underwent surgical correction with bovine pericardium with 57 similar patients who received a polytetrafluoroethylene (PTFE) patch. There were no cases of early (in the first month) mortality in either group and the 3-month post-operative echocardiographical studies showed no evidence of calcification or aneurysm formation around the patch. Recurrent ventricular septal defects due to dehiscence of the patch occurred in the early follow-up period in four patients who had the PTFE patch but this was not statistically significant. Annual echocardiographical examination revealed some calcification in both groups. We conclude that although there are no significant differences between the two materials in outcome after ventricular septal defects closure, we prefer bovine pericardium because of its handling characteristics, elasticity and the lower risk of endocarditis.

Sternal cyanoacrylate gluing in mediastinitis. Effects on infection, stability and bone healing.

BACKGROUND: It is crucial to determine stability, histocompatibility and antibacterial properties of the cyanoacrylate used for sternal fixation. METHODS: Clinical study: in 17 cases of mediastinitis, debridement and rewiring the sternum, was applied as the treatment method (Group I). Eighteen cases of mediastinitis were treated with the same method added sternal cyanoacrylate gluing (Group II). A comparative study was done; the follow-up period was 36.7+/-4 and 18.5+/-6.9 months in Group I and II, respectively. Animal study: in 10 rats, upper sternotomy was done and the sternal bone was contaminated. Direct wound closure was done in 4 rats (Group A), in 6 animals, wounds were closed after applying cyanoacrylate in sternal split (Group B). In this prospective study, all rats alive were sacrificed at the 3rd and 8th weeks and sternums were examined histologically. RESULTS: Clinical study: in Group I, 6 patients required additional interventions due to recurrent sternal detachment and osteomyelitis (35.3%). In Group II neither osteomyelitis nor sternal detachment occurred, 3 patients required re-intervention related to cyanoacrylate histotoxicity. Hospital stay was higher in Group I than Group II (24.06+/-4.7 vs 14.16+/-3.98 days, respectively). Experimental study: all of the animals in Group A died of sepsis. In Group B all rats survived the procedure. At the 3rd week histologic evaluations showed that cyanoacrylate was not degraded, and no infection or foreign body reaction was observed. At the 8th week histologic examination showed that cyanoacrylate was completely degraded and replaced by connective tissue. CONCLUSIONS: Cyanoacrylate is effective in diminishing sternal wound complications and related cost and hospital stay of mediastinitis.

Efficacy of topically applied glutamate-aspartate and pentoxifylline solutions in decreasing myocardial damage during open-heart surgery in rats.

During open-heart surgery, the period between cross-clamping and maintenance of homogeneous diastolic arrest is often accompanied by significant ischaemic-hypoxic injury. The topical application of glutamate-aspartate or pentoxifylline may reduce energy demands during this period and thus prevent myocardial damage. Fifty rats were divided into five groups. In group A (control) the pericardial cavity was opened, all inlet and outlet vasculature cross-clamped, and the heart excised after 60 s. In groups B-E, the pericardial cavity was opened, all inlet and outlet vasculature cross-clamped for 60 s (groups B and D) or 90 s (groups C and E), and the pericardial cavity filled with glutamate-aspartate solution (groups B and C) or pentoxifylline solution (groups D and E) for 2 min. Following clamping, blood was withdrawn from the right atrium for biochemical analysis, and the heart excised for histological analysis. Histopathological and biochemical analysis showed a significant reduction in ischaemic-hypoxic cardiac injury in rats treated with topically applied glutamate-aspartate or pentoxifylline.

Comparison of the effects of hypertonic saline and crystalloid infusions on haemodynamic parameters during haemorrhagic shock in dogs.

Haemorrhagic shock, a leading cause of mortality, frequently accompanies cardiac interventions. The administration of small volumes of hypertonic saline solutions and crystalloid solutions may reduce the severity and duration of shock, and result in a decrease in adverse outcomes. Under general anaesthesia, hypotension was induced in 12 healthy dogs. After 30 min, dogs received either hypertonic saline solution or lactated Ringer's solution for fluid, resuscitation. In both groups, decreases in haemodynamic variables were observed during the shock period. Following resuscitation, increases in haemodynamic variables were observed. This increase lasted longer in dogs receiving hypertonic saline. In both groups, haematocrit and oxygen content values decreased after resuscitation and lactate levels increased. During resuscitation, lactate levels decreased. Sodium and osmolarity increased with resuscitation, then subsequently decreased. In conclusion, in a model of haemorrhagic shock, the administration of hypertonic saline solutions provides haemodynamic stability and tissue oxygenation more rapidly.