Abstract:

Ministernotomy (MS) is a well-known procedure developed in the past ten years along with the rise of minimally invasive cardiac surgery. Upper, mid, or inferior partial sternotomies allow coronary surgery, as well as aortic and mitral valve approaches. Contrary to anterior thoracotomy, access to the great vessels is sometimes easy, which renders central cannulation possible. In opposition to total sternotomy (TS), MS could procure better postoperative stability that would aide in reduction of wound infections. Nevertheless, upper MS can be responsible for the lesion of the internal thoracic arteries (ITAs). Moreover, little evidence exists regarding blood sparing in MS approaches. MS presents the problem of hiding a part of the cardiac structures. For example, in the case of aortic surgery by way of upper sternotomy for example, left venting is risky or even impossible. However, partial inferior sternotomy can be interesting for aortic valve surgery in patients with in situ right ITA passing in front of the aorta, protecting the grafts during dissection. In coronary surgery, inferior T sternotomy and C sternotomy allow perfect access to the coronary network. Some authors also have described inferior "T" sternotomy for various congenital lesions. If mini-invasive cardiac surgery can offer reduced postoperative morbidity and faster rehabilitation, the advantages of MS upon TS—except for cosmetic aspects—remain to be defined. Thus, this approach should be reserved for selected patients and lesions.

Authors:

Fadi Farhat, M.D., Olivier Metton, M.D., Olivier Jegaden, M.D.

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Abstract:

Recent trends in computed tomography (CT) scanner technology has opened new frontiers in the field of non-invasive coronary angiography. Given the relatively important number of negative invasive angiographies performed each year, eliminating the risks inherent to this procedure by non-invasive methods greatly contribute to diminishing the risk. After injection of contrast, the procedure is performed under short apnea and triggered by electrocardiographic (ECG) recording that provides a multitude of possible image reconstructions; ie, volume rendering, virtual angioscopy, and three-dimensional (3D) reconstruction of the heart and coronary vessels. In 100 patients, adequate visualisation of the coronary arteries was achieved in 98%, with the advantage of visualizing the coronary wall as well as the lumen. The main reasons for failure were arrhythmia and excessive motion. Besides evaluating coronary artery atherosclerosis, computed tomography angiography (CTA) allowed the diagnosis of coronary aneurysm and exact localization of postoperative false aneurysm. The main disadvantages of the technique are the absence of dynamic films and exposure to radiation. The increased accuracy and sensitivity of noninvasive coronary angiography make it an excellent diagnostic tool and a probable replacement to invasive procedures. It should reduce the morbidity and mortality as well as the cost of conventional coronary arteriography. Furthermore, it has the added benefit of offering spacial resolution of the examined vessels.

Authors:

Jean-Louis Sablayrolles, M.D., Nawwar Al Attar, F.R.C.S., M.Sc. (Surgery), F.E.T.C.S., Patrick Nataf, M.D., F.E.T.C.S.

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Abstract:

This study examines the role of sex and race in the diagnosis and outcome of deep vein thrombosis (DVT). A retrospective study was performed of 632 patients who underwent venous duplex ultrasound from August 1998 to July 1999. Comparisons were made by Chi-square analysis. Seventy-four percent of the patients were women and 79% of the total group was African American. Twenty-two percent (140) of the examinations were positive for DVT. Of all studies performed in men, 37% were positive for DVT, and of all studies performed in women, 18% were positive for DVT (P<0.05). Additionally, African-American women were more likely to be positive for DVT than Caucasian women. One-year follow up showed that 42% had residual thrombus and, regardless of sex, African-Americans were more likely to have persistent thrombus than Caucasians (60% vs. 19%). Findings in this study suggest, in our cohort, African American women were diagnosed with DVT twice as often as Caucasian women and African Americans were more likely to have a persistent DVT as compared to Caucasians.

Authors:

Daphne Pierre-Paul, M.D., Leila Mureebe, M.D., Vivian Gahtan, M.D., Morris D. Kerstein, M.D.

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Abstract:

Minimally invasive repair of thoracic and abdominal aortic aneurysms (AAAs) is rapidly becoming a vital tool in the arsenal of the vascular specialist. Historically, surgical replacement of the aorta has been the "gold standard" for treatment of aortic aneurysms. However, transfemoral placement of an endovascular stent graft, first described by Dr. Parodi and colleagues in 1991, marked the beginning of a new era in treatment of aortic aneurysms. This approach has evolved, allowing success with significantly less morbidity. Over time, if the long-term results continue to prove favorable, endovascular stent graft repair of aortic aneurysms may become the most effective means to treat this life-threatening disease.

Authors:

Michael D. Addis, M.D., Donald T. Baril, M.D., H. Ellozy, M.D, Tikva Jacobs, M.D., Alfio Carroccio, M.D., Victoria Teodorescu, M.D., Michael L. Marin, M.D.

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