Pressure-induced monotonic enhancement of Tc to over 30 K in superconducting Pr0.82Sr0.18NiO2 thin films.

The successful synthesis of superconducting infinite-layer nickelate thin films with the highest Tc ≈ 15 K has ignited great enthusiasm for this material class as potential analogs of the high-Tc cuprates. Pursuing a higher Tc is always an imperative task in studying a new superconducting material system. Here we report high-quality Pr0.82Sr0.18NiO2 thin films with Tconset ≈ 17 K synthesized by carefully tuning the amount of CaH2 in the topotactic chemical reduction and the effect of pressure on its superconducting properties by measuring electrical resistivity under various pressures in a cubic anvil cell apparatus. We find that the onset temperature of the superconductivity, Tconset, can be enhanced monotonically from ~17 K at ambient pressure to ~31 K at 12.1 GPa without showing signatures of saturation upon increasing pressure. This encouraging result indicates that the Tc of infinite-layer nickelates superconductors still has room to go higher and it can be further boosted by applying higher pressures or strain engineering in the heterostructure films.

[Clinical analysis of hepatic perivascular epithelioid cell neoplasm: a report of eleven cases].

Objective: To investigate the clinical features, diagnosis and therapy of hepatic perivascular epithelioid neoplasms (PEComa). Methods: The clinical data of eleven patients with hepatic PEComa who received surgical treatment at Shengjing Hospital Affiliated to China Medical University from April 2012 to October 2017 were collected. The clinical manifestations, imaging features, diagnostic and therapeutic strategies, pathologic features, prognosis were analyzed. Results: The patients aged from 35 to 55 years (mean: 47 years , 3 males and 8 females). Two patients had epigastric pain, the others rarely had any clinical symptom. Hepatitis C virus (HCV) infection was present in one patient 9.09%(1/11), the rate of correct diagnosis by imageological examination before operation was only 9.09%(1/11). All patients received a surgical resection, the final diagnosis of hepatic PEComa was made with pathology and immunohistochemistry. The antibodies used for immunohistochemistry varied from patient to patient. The positive rates of Melan A, HMB45, smooth muscle actin and S-100 were 100%(10/10), 90%(9/10), 77.8%(7/9)and 33.3%(3/9) respectively, the Ki-67 positive index was 1%-10%. One patient died after surgery because of hemorrhage, other ten patients received long-term follow-up(5-71 months), and no recurrence or metastasis was observed. Conclusion: Hepatic PEComa is a rare mesenchymal neoplasm which expresses both melanocytic and myogenic markers. Middle aged females are susceptive to hepatic PEComa, and patients rarely have any specific clinical presentation. It's difficult to make a correct diagnosis before operation. The diagnosis finally depends on the pathological examination. Surgical resection and close follow-up are the principal methods for the management of hepatic PEComa.

[Inflammatory myofibroblastic tumor of the hepatobiliary pancreatic system: report of three cases and literature review].

Objective: To improve the understanding, diagnosis and treatment of inflammatory myofibroblastic tumor (IMT) of the hepatobiliary pancreatic system through the cases review. Methods: The clinical data of three cases of pathologically-proved IMT of the hepatobiliary pancreatic system was reported and relevant literatures were reviewed. Results: Among three cases of IMT discussed, there consisted of a case of liver, a case of gallbladder and a case of pancreas. The clinical manifestations were nonspecific, and the preoperative diagnosis was difficult. All the patients with suspected malignant tumors underwent surgical treatment. The prognosis was good, with no recurrence. Conclusion: IMT is a benign tumor and is rare in hepatobiliary pancreatic system. The clinical manifestations are not typical and the imaging examinations are not specific. Its diagnosis depends on pathology. Surgery is an effective treatment. IMT has a tendency of recurrence, and its postoperative follow-up is of great significance.

[Clinical study on the relationship between pancreatic fistula and the degree of pancreatic fibrosis after pancreatic and duodenal resection].

Objective: To explore the risk factors of pancreatic fistula after pancreatoduodenectomy and its relationship with pancreatic fibrosis. Methods: Retrospective analysis was made including 408 patients who underwent pancreaticoduodenectomy from January 2013 to December 2015 in Department of Hepatobiliary Surgery of the First Affiliated Hospital of Third Military Medical University. There were 274 males and females, aging from 14 to 82 years with an average age of 54.6 years. Postoperative pathological diagnosis: 285 cases with pancreatic ductal adenocarcinoma, 81 cases with gastrointestinal tumors, 13 cases with neuroendocrine tumors, 16 cases with inflammatory changes, 8 cases with pancreatic papillary tumors, 4 cases with serous cystadenoma, 1 case with retroperitoneal liposarcoma.Univariate analysis using pearson's χ(2) test, multivariate analysis using binary Logistic regression analysis, correlation analysis using Spearman rank correlation analysis and the predictive value of pancreatic fibrosis in pancreatic fistula after pancreaticoduodenectomy was assessed using the area under the receiver operating characteristic(ROC) curve. Results: There were 123 cases (30.1%) with postoperative pancreatic fistula among 408 patients. Univariate analysis showed that body mass index(BMI)(P=0.005), preoperative gamma-glutamyltranspeptidase content(P=0.046), pancreatic duct diameter(P=0.001), CT value of pancreatic tissue(P=0.049), operation time(P=0.037), pancreatic stiffness (intraoperative judgment)(P=0.001) and percentage of pancreatic fibrosis(P=0.034) were the prognostic factors of pancreatic fistula. Multivariate analysis showed that BMI≥25 kg/m(2), pancreatic duct diameter ≤3 mm, pancreatic tissue CT value <40 Hu, pancreatic hardness (intraoperative judgments) for the soft and pancreatic lobular fibrosis percentage ≤25% of postoperative pancreatic fistula occurrence of high-risk factor(P<0.05). Pancreatic fistula's CT value and percentage of pancreatic fibrosis were significantly lower than non-pancreatic fistula group, the difference was statistically significant(P<0.05). There were significant differences in CT value and pancreatic lobular fibrosis among different grades of pancreatic fistulae(P<0.05). Pancreatic fistula severity was negatively correlated with the CT value of pancreatic body and the percentage of fibrosis of the pancreas(P=0.005, 0.019), and there was a significant correlation between CT value of pancreatic body and the percentage of fibrosis of the pancreas(r=0.699, P=0.028). The areas under the ROC curve of percentage of pancreatic fibrosis and CT value of the pancreatic body were 0.745 and 0.714, respectively. Both of them were moderate predictive value for pancreatic fistula after pancreaticoduodenectomy. Conclusions: The degree of pancreatic fibrosis is a prognostic factor for pancreatic texture and pancreatic fistula after pancreaticoduodenectomy. CT value of pancreatic body can be used as a quantitative index of pancreatic fibrosis, and predict the prognostic of pancreatic fistula after pancreaticoduodenectomy.

Genetic polymorphisms in the prostaglandin pathway genes and risk of head and neck cancer.

OBJECTIVE: Previous studies examining the association between genetic variations in prostaglandin pathway and risk of head and neck cancer (HNC) have only included polymorphisms in the PTGS2 (COX2) gene. This study investigated the association between genetic polymorphisms of six prostaglandin pathway genes (PGDS, PTGDS, PTGES, PTGIS, PTGS1 and PTGS2), and risk of HNC. METHODS: Interviews regarding the consumption of alcohol, betel quid, and cigarette were conducted with 222 HNC cases and 214 controls. Genotyping was performed for 48 tag and functional single-nucleotide polymorphisms (SNPs). RESULTS: Two tag SNPs of PTGIS showed a significant association with HNC risk [rs522962: log-additive odds ratio (OR) = 1.42, 95% confidence interval (CI): 1.01-1.99 and dominant OR = 1.58, 95% CI: 1.02-2.47; rs6125671: log-additive OR = 1.49, 95% CI: 1.08-2.05 and dominant OR = 1.96, 95% CI: 1.16-3.32]. In addition, a region in PTGIS tagged by rs927068 and rs6019902 was significantly associated with risk of HNC (global P = 0.007). Finally, several SNPs interacted with betel quid and cigarette to influence the risk of HNC. CONCLUSIONS: Genetic variations in prostaglandin pathway genes are associated with risk of HNC and may modify the relationship between use of betel quid or cigarette and development of HNC.

The ratio of plasma neutrophil gelatinase-associated lipocalin predicts acute kidney injury in patients undergoing liver transplantation.

BACKGROUND: Postoperative acute kidney injury (AKI) is associated with high morbidity and mortality after liver transplantation (OLT). Previous studies have shown the value of plasma neutrophil gelatinase-associated lipocalin (NGAL) taken 2 hours after reperfusion of the liver graft as an early marker predicting AKI. The study was performed to determine whether plasma NGAL concentrations obtained as early as 1 hour after reperfusion was predictive of AKI and whether the NGAL ratio was an early predictor for AKI in the first 48 hours after OLT. METHODS: Twenty-six liver transplant recipients donated plasma samples for NGAL determinations at induction (T1), at graft reperfusion (T3) as well as after 1 (T4) and hours 2 (T5), and at the end of the surgery (T7). AKI was defined at 48 hours after liver transplantation according to the acute kidney injury network criteria. Predictive ability was assessed using areas under the curve of receiver operator characteristic analyses. RESULTS: The area under the curve of the receiver operator characteristics curve of (plasma NGAL concentration at T4)/(plasma NGAL concentration at T1) to predict AKI was 0.717 at T5, 0.765 at T7, 0.714 at T8 (24 hours post-OLT), and 0.781 at T9 (48 hours post-OLT). CONCLUSION: The plasma NGAL concentrations taken 1 hour after reperfusion of the liver graft seem to be predictive of AKI; the NGAL changing ratio may be an early predictor for AKI in the first 48 hours after OLT.

Cardiac output derived from arterial pressure waveform analysis in patients undergoing liver transplantation: validity of a third-generation device.

BACKGROUND: Hemodynamic monitoring is essential to a successful liver transplantation procedure. FloTrac, a hemodynamic monitor that uses arterial-waveform-based pulse contour analysis for cardiac output (CO) measurement, has proven useful in many clinical settings. One of the primary foci of FloTrac's recent third-generation software upgrade was improving its accuracy in low systemic vascular resistance status. We evaluated the accuracy of the upgraded FloTrac monitor during liver transplantation. MATERIALS AND METHODS: Twenty-eight patients undergoing liver transplantation were enrolled in the study. Two sets of CO were measured with a radial arterial line connected to a FloTrac monitor (COFT) and a pulmonary artery catheter connected to a continuous cardiac output Vigilence monitor (COPAC). Simultaneous CO measurement was performed and recorded every 5 minutes throughout the surgery. Bland-Altman analysis was used to estimate the accuracy. The comparative method and reference method were considered interchangeable if the limits of agreement did not exceed a threshold set a priori at the greater of ±1 L/min, or a percentage error of lesser than 30%. RESULTS: In all, 3234 paired data were collected. The bias was -0.8 L/min and the limits of agreements were -5.6 to 4.0 L/min. Percentage error was 75%. Regression analysis of the systemic vascular resistance index (SVRI) and the bias between COPAC and COFT showed that the bias was inversely related to the SVRI [r2=0.49; P<.001, y=-32.1983+9.9978 Log(x)]. CONCLUSIONS: Despite a software upgrade, the effectiveness of the FloTrac artery-derived cardiac output monitor for CO measurement during liver transplantation remains limited.

Stroke volume variation derived by arterial pulse contour analysis is a good indicator for preload estimation during liver transplantation.

BACKGROUND: Accurate determination of preload during liver transplantation is essential. Continuous right ventricular end diastolic volume index (RVEDVI) has been shown to be a better preload indicator during liver transplantation than the filling pressures. However, recent evidence has shown that dynamic variables, in this case stroke volume variation (SVV), are also good indicators of preload responsiveness. In this study, we evaluated the correlation between SVV, which we derived from arterial pulse contour analysis and RVEDVI. METHODS: In this study, we looked for possible relationships between SVV obtained through FloTrac/Vigileo monitor, central venous pressure (CVP), pulmonary arterial occlusion pressure (PAOP), and RVEDVI in 30 patients undergoing liver transplantation. Measurements were taken at 11 defined points during different phases across liver transplantation. Each set of measurement was taken during a steady state, which means at least 15 minutes elpased after any changes occured in either the infusion rate of catecholamines or ventilator settings. Pearson's test was used for correlation estimation. RESULTS: There was a statistically significant (P<.01) relationship between SVV and RVEDVI with a correlation coefficient of -0.87. The correlations between CVP (r=0.42), PAOA (r=0.46), and RVEDVI were less strong. CONCLUSION: We conclude that SVV is a good indicator for preload estimation during liver transplantation. A higher SVV value is associated with a more hypovolemic fluid status.

Facilitation of alternative one-lung and two-lung ventilation by use of an endotracheal tube exchanger for pediatric empyema during video-assisted thoracoscopy.

BACKGROUND: Video-assisted thoracoscopic surgery (VATS) has emerged as an innovative and popular procedure for the management of postpneumonic empyema in children refractory to medical response. Alternative uses of two- and one-lung ventilations have been required during VATS. This study evaluated the efficacy of alternating one- and two-lung ventilation through intraoperatively through the same single-lumen endobronchial tube using a tube exchanger during a thoracoscopic procedure for pediatric empyema. METHODS: Between May 1995 and August 2001, 62 consecutive pediatric patients undergoing VATS for evacuation of the loculated empyema cavity were studied. The same single-lumen endobronchial tube was used, with an indwelling endotracheal tube exchanger in place for readjustment of the tube position to provide alternation of one- and two-lung ventilations in a thoracosopic procedure. Duration of operation, heart rate, mean arterial pressure, peak airway pressure, an partial pressure of oxygen (PaO(2)) and carbon dioxide (PaCO(2)) changes during one- and two-lung ventilations were recorded. The quality of lung deflation and inflation was rated by the surgeon using direct visualization as excellent, fair or poor. RESULTS: The mean operating time was 90 min (range, 50-120 min). No differences were found in heart rate, mean arterial pressure, or PaO(2) during one- and two-lung ventilations. Peak airway pressure and PaCO(2) during two-lung ventilation were significantly higher than during one-lung ventilation. The quality of lung deflation and inflation was judged excellent for all the patients. CONCLUSIONS: The VATS procedure can be performed safely and effectively in children using proper anesthetic technique. Retention of a tube exchanger within a single-lumen endobronchial tube an easily provide alternative one- and two-lung ventilations without inducing any significant airway flow obstruction during the operation.

Evaluation of learning effectiveness in endotracheal intubation by the use of a laryngoscope in combination with a flexible fiberoptic bronchoscope.

BACKGROUND: Accidental esophageal intubation may cause lethal complications when undetected. We developed a laryngoscope, which utilizes a laryngoscope blade incorporating with a flexible fiberoptic bronchoscope for teaching new learners. We compared two teaching methods, i.e. the traditional method and the new method we contemplated, for teaching new interns. METHODS: We selected new interns as our study group. Everyone had six turns, four of which for the traditional method (T) and two of which for the new method (N), to perform the procedure under the guidance of a teaching supervisor. The interns were assigned randomly to one of three groups. Group 1 used the series of TTTTNN; group 2, TTNNTT; and group 3, NNTTTT. We used success or failure of intubation as the result of our evaluation. Statistical analyses were performed by chi-square test. RESULTS: 84 interns performed 504 endotracheal intubation trials during a period of 4 years. There was a 91.7% success rate with the new method and a 78.9% success rate with the traditional technique (P < 0.05). The group to which the new method was initially taught achieved the highest success rate of intubation and the greatest feeling of satisfaction according to a self-evaluation record. Of the failed intubations, 82.4% were due to performing the procedure in more than one minute, 15.3% due to esophageal intubation and the remaining 2.3% due to contact bleeding of teeth or oral trauma. CONCLUSIONS: By using the new teaching method, the supervisor could easily teach and assess the success of the new learners. Besides, esophageal intubation could be reduced to a minimum with subsequent increase of success rate.

Diagnosis of progressive compression of the aortic true lumen with intraoperative transesophageal echocardiography during repair of dissection of thoracic aorta--a case report.

We report an incident of progressive compression of the true lumen of aorta which happened immediately after cardiopulmonary bypass (CPB) and was diagnosed with intraoperative transesophageal echocardiography (TEE) in a patient undergoing an emergent repair of type A aortic dissection under femoral perfusion. During the CPB period, intraoperative TEE revealed gradual expansion of the false lumen which nearly obstructed the true lumen of the dissected aorta. The possible mechanism was related with distension of the false lumen by a dominant flow from retrograde femoral perfusion of CPB. With the application of intraoperative TEE, we could easily detect the hemodynamic changes of thoracic aorta and find the real causes so as to solve the perfusion abnormalities.

Anesthetic management of a patient with relapsing polychondritis--a case report.

Relapsing polychondritis is a rare multisystem disorder of uncertain etiology. It is characterized by recurrent and progressive destruction of both elastic and hyaline cartilages as well as connective tissue. Respiratory tract involvement is associated with high mortality and morbidity. General anesthesia may be required in these patients for tracheostomy, bronchoscopy, nasal reconstruction, aortic valve replacement, and recent tracheobronchial stenting which they usually sustain. Tracheostomy was once the most likely surgical procedure in relapsing polychondritis. However, this procedure is only effective in patients with upper subglottic involvement. In cases of extensive tracheobronchial involvement, tracheostomy is ineffective because the distant tracheal collapse below the tracheostomy is still unresolved. We would like to report a case of relapsing polychondritis with tracheobronchial involvement, who underwent an emergent tracheostomy. Tracheostomy with continuous positive airway pressure (CPAP) effectively improved her airway collapse. Herein, we also discuss the anesthetic management after review of the current literature.

The use of multiplane transesophageal echocardiography to evaluate residual patent ductus arteriosus during video-assisted thoracoscopy in adults.

BACKGROUND: Video-assisted thoracoscopic surgery (VATS) has emerged as an innovative and popular procedure for interruption of patent ductus arteriosus (PDA), while intraoperative transesophageal echocardiography (TEE) has proven to be an effective monitor in the evaluation of residual patency. Previous reports on the adequacy of surgical interruption of PDA under VATS and TEE are available for pediatric patients, but only limited information is available for adults with PDA. MATEIALS AND METHODS: Between August 1995 and October 1997, we monitored 35 adult patients undergoing PDA interruption via VATS with Hewlett-Packard color Doppler multiplane TEE throughout the procedure. The average PDA diameter was 10.2 +/- 1.8 mm. All the PDA were completely ligated. RESULTS: Thirty-two patients showed no ductal flow after double ligation. In the other three patients, residual flow was detected intraoperatively after double ligation, but it was quickly abolished by the third ligation. One patient showed faint ductal flow by transthoracic echocardiography at postoperative follow-up, but no reintervention was needed. CONCLUSIONS: Our study showed that, with the refinement of adult PDA interruption via VATS, intraoperative multiplane TEE provides higher resolution for direct evaluation of the entire course of PDA ligation without interrupting the surgical procedure and minimizes the incidence of complications.

Airway compression by a biplane pediatric transesophageal echocardiography probe: case report.

Transesophageal echocardiography (TEE) has been extensively used in cardiac surgery to assess cardiac function and anatomical relationships in both adults and children. Newer monitoring devices, despite being labeled "noninvasive", often present significant risks. Physicians should be cautious with the use of TEE in infants and small children, recognizing that oversized probes may inadvertently compress vital structures, resulting in airway or vascular compromise. If severe compression of the airway or vascular structures occurs, TEE monitoring may need to be discontinued. Although technological progress has yielded smaller ultrasonic probes, the TEE probe is significantly larger than most other devices placed in the esophagus. We present in this report a case of airway compression using a small-sized biplane pediatric TEE probe in a child undergoing Blalock-Taussig shunt surgery. Pediatric patients may be more at risk for airway obstruction because of the over-size of the probe-distended esophagus in relation to adjacent airway structures.

Power spectral analysis of arterial blood pressure after spinal anesthesia.

BACKGROUND: The continuous, on-line and real-time analysis of the power spectrum (CORAPS) of systemic arterial pressure (SAP) and heart rate (HR) signals is one of the current progresses in the development of non-invasive indexes for autonomic nervous system. It might be a useful clinical tool to monitor the progress of preganglionic block of sympathetic nervous system and the homeostatsis of cardiac neuroregulation after spinal anesthesia. The purpose of this study is to examine the relationship between the hypotensive response and the changes of components in CORAPS throughout the course of spinal anesthesia. METHODS: In 10 ASA class I-II patients (aged from 17 to 75 years) scheduled for elective surgery, we analyzed the changes of spectrum of systemic arterial blood pressure signals during spinal anesthesia. Spinal anesthesia was performed with 0.5% bupivacaine (dosage at 13-15 mg). For CORAPS, SAP signals were simultaneously relayed to an analog-digital converter connected to a computer. Power spectral density of the data was computed using a fast Fourier transform. The areas of the spectral peaks within each measurement were calculated as the follows: very low (BVLF, 0.01-0.08 Hz), low (BLF, 0.09-0.15 Hz), and high (BHF, 0.16-0.25 Hz). RESULTS: During the time interval (S2 period) when spinal anesthesia was initiated and 15 min thereafter the power density of low frequency (BLF), (1.2 vs. 2.3), and very low frequency (BVLF) components decreased, (3.4 vs. 7.8), in comparison with that at the baseline level (S1 period). We also found the shift of dominance between low frequency (BLF) and high frequency (BHF) in S2 period. The effects of intrathoracic pressure on the venous return may contribute to the increase of power density of BHF components (1.7 vs. 1.1). We also found that even in patients with stable hemodynamic variability, the decrease of BLF and BVLF components, and the shift of dominance were the same as in patients with unstable hemodynamic variability. CONCLUSIONS: It might prove that the cephalic spread of spinal block abolished the sympathetic tone of the autonomic nervous system. These results validated previous speculations of a sympathetic block during spinal anesthesia. More importantly, patients with stable hemodynamic variability still have profoundly sympathetic block with decreased power density of BLF and BVLF. The CORAPS is a good clinical monitoring tool to evaluate the homeostatsis of cardiac neuroregulation after spinal anesthesia.

Totally minimally invasive cardiac surgery for coronary artery disease.

OBJECTIVE: We report our experience using minimally invasive techniques both to perform coronary artery bypass and harvesting of saphenous vein grafts in 25 patients with left main or triple vessels disease. METHODS: From March 1997 to June 1997, 25 patients received elective coronary artery bypass grafting using minimally invasive surgical techniques for left main or triple vessels disease. Saphenous vein grafts were harvested using minimally invasive techniques under direct vision. The coronary artery bypass grafting was performed through a limited left anterior parasternal minithoracotomy under femoro-femoral or aorto-atrial cardiopulmonary bypass. The myocardium was protected by antegrade infusion of cold blood cardioplegic solution while the aorta was cross-clamped. RESULTS: Three to four distal anastomoses were performed with the saphenous vein graft and the left internal thoracic arterial graft. The aortic cross-clamp time was 60-135 min. The duration of cardiopulmonary bypass was 89-172 min. The postoperative course was uneventful for all patients. All patients were found to be in New York Heart Association functional class I or II on follow-up from 3-7 months after surgery. CONCLUSIONS: Minimally invasive coronary artery surgery is technically feasible and can be performed in left main or triple vessel disease safely and effectively for complete revascularization.

Minimally invasive cardiac surgery for intracardiac congenital lesions.

OBJECTIVE: Minimally invasive cardiac surgery has recently been applied to the correction of intracardiac lesions. This report reviews our experience of minimally invasive cardiac surgery in 119 patients with intracardiac congenital lesions. METHODS: From October 1995 to April 1997, 119 patients (48 male and 71 female, aged 0.9-65 years old, 18.5+/-17.8) received elective minimally invasive cardiac surgery at Chang Gung Memorial Hospital, Taipei, Taiwan for repair of atrial septal defect (96 patients) or ventricular septal defect (23 patients). The operations were performed through right submammary incision (ASD) or left parasternal minithoracotomy (VSD), under femoro-femoral or femoro-atrial cardiopulmonary bypass with fibrillatory arrest. RESULTS: All of the defects were repaired successfully. The bypass time was 25-125 min (46+/-18). The operation time was 1.5-5.2 h (2.8+/-0.8). The postoperative course was uneventful in all patients. Follow-up (1.0-18.2 months, mean 7.3) was complete, with no late deaths or residual shunt. All patients were found to be in NYHA functional class I or II. CONCLUSION: Our experience demonstrate that minimally invasive cardiac surgery is a technically feasible, safe, and effective procedure in surgical correction of selective simple intracardiac congenital lesions, yielding good short-term results.

Video-assisted cardiac surgery for intracardiac tumors.

OBJECTIVE: To present our experience in surgical excision of intracardiac tumors in three patients using video-assisted cardiac surgical techniques. METHODS: Three patients received emergency video-assisted cardiac surgery for excision of right atrial or left atrial tumors. These surgeries were performed through right anterior submammary minithoracotomies and guided by video-assisted endoscopic techniques by projected images on a video monitor while under femoro-femoral cardiopulmonary bypass. The myocardium was protected by continuous coronary perfusion with fibrillatory arrest. Conventional instruments were used. RESULTS: All but one of the tumors were excised completely. The bypass time was 88-148 min. The operation time was 3.5-4.4 h. There were no operative deaths. Pathological examination of the tumors showed left atrial myxoma, metastatic left atrial choriocarcinoma, and right atrial lymphoma. One patient died from non-cardiac origin 5 weeks after discharge. Follow-up was completed with the two survivors. Transthoracic echocardiographic examination showed good ventricular function without any residual tumors. They were both in New York Heart Association functional class I or II. They were satisfied with the cosmetic healing of their incisions. CONCLUSION: Video-assisted cardiac surgery is technically feasible and can be performed in surgical excision of intracardiac tumors.

Video-assisted minimal access in excision of left atrial myxoma.

BACKGROUND: Minimal access surgery with video-assisted endoscopy has been applied to the correction of intracardiac lesions. We report our experience using this technique in surgical excision of left atrial myxoma in 3 patients. METHODS: From November 1995 to March 1997, 3 female patients, ages 45 to 80 years (mean, 62.7 years), received emergency operations for excision of left atrial myxoma. These operations were performed through a right anterior submammary minithoracotomy or right parasternal incision with the assistance of endoscopy during femoro-femoral cardiopulmonary bypass. The myocardium was protected by continuous coronary perfusion with fibrillatory arrest or cardioplegic arrest with aortic cross-clamping. RESULTS: All the tumors were excised completely through the right atrial approach. The bypass time was 92 to 148 minutes (mean, 111 minutes). The operation time was 3.2 to 4.4 hours (mean, 3.7 hours). There were no hospital deaths. Follow-up, which ranged from 6 to 19 months (mean, 10.5 months), was complete in all patients. Transthoracic echocardiographic examination showed good ventricular function without any residual tumors. Patients were found to be in New York Heart Association functional class I or II. They were satisfied with the good cosmetic healing of the incision. CONCLUSIONS: Our experience demonstrates that minimal access surgery is a technically feasible, safe, and effective procedure in surgical excision of left atrial myxoma.