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1.  Painless Aortic Dissection Presenting as Paraplegia 
Texas Heart Institute Journal  2012;39(2):273-276.
Acute dissection of the aorta can be life-threatening. As a presenting manifestation of aortic dissection, neurologic complications such as paraplegia are rare.
Herein, we report the case of a 51-year-old man who presented with sudden-onset paraplegia and ischemia of the legs, with no chest or back pain. His medical history included coronary artery bypass grafting. Physical examination revealed pulseless lower extremities, and computed tomography showed aortic dissection from the ascending aorta to the common iliac arteries bilaterally. A lumbar catheter was inserted for cerebrospinal fluid drainage, and axillary arterial cannulation was established. With the use of cardiopulmonary bypass, the aortic dissection was corrected, and the previous coronary artery grafts were reattached. The surgery restored spinal and lower-extremity perfusion, and the patient walked unaided from the hospital upon his discharge 5 days later.
Although acute aortic dissection presenting as paraplegia is rare, it should be considered in patients who have pulseless femoral arteries bilaterally and sudden-onset paraplegia, despite no pain in the chest or back. Prompt diagnosis and intervention can prevent morbidity and death.
PMCID: PMC3384028  PMID: 22740752
Aneurysm, dissecting/complications/diagnosis/surgery; aortic aneurysm/complications/diagnosis/surgery; diagnosis, differential; extremities/blood supply; ischemia/complications; pain/physiopathology; paraplegia/etiology/physiopathology; spinal cord ischemia/etiology/surgery; treatment outcome
2.  Surgical Treatment of a Giant External-Iliac-Vein Aneurysm in a Patient with a Post-Traumatic Femoral Arteriovenous Fistula 
Texas Heart Institute Journal  2011;38(2):187-190.
Iliac vein aneurysm is a rare vascular abnormality. It has been reported as a primary aneurysm of unknown cause, or, when a cause could be identified, as a secondary iliac vein aneurysm. Occasionally, iliac vein aneurysm develops in association with distal arteriovenous fistula. Although venous aneurysms occur most commonly in the neck and central thoracic veins, they also have been reported in the visceral veins and the extremities.
Herein, we present the case of a 34-year-old man in whom a giant external-iliac-vein aneurysm was incidentally found during the investigation of a post-traumatic femoral arteriovenous fistula. The aneurysm was surgically resected, the iliac vein was reconstructed by means of lateral venorrhaphy, and the patient had an uneventful, complete recovery. We discuss the origin of the aneurysm and our choice of surgical techniques.
PMCID: PMC3066812  PMID: 21494534
Aneurysm/etiology/radiography/surgery; arteriovenous fistula/complications/etiology/pathology/surgery; femoral artery/injuries/surgery; femoral vein/surgery; iliac vein/radiography/surgery; incidental findings; suture techniques; treatment outcome; ultrasonography, Doppler, color; vascular surgical procedures/methods; wounds, gunshot/complications
3.  Carotid Endarterectomy versus Carotid Artery Stenting 
Texas Heart Institute Journal  2008;35(4):395-401.
The purpose of our study was to evaluate prospectively the frequency and significance of brain lesions after elective carotid endarterectomy (CAE) and carotid artery stenting (CAS) by using diffusion-weighted magnetic resonance imaging (DW MRI) and then to correlate imaging findings with neuroclinical outcomes.
From February 2003 through March 2005, 95 consecutive patients underwent surgical endarterectomy or CAS (with a cerebral protection device) at our institution. A total of 59 CAE procedures were performed in 46 consecutive patients (mean age, 65.8 ± 9 yr), and 56 CAS procedures were performed in 49 consecutive patients (mean age, 66.3 ± 9 yr). Diffusion-weighted magnetic resonance imaging of the brain was performed in all patients within 24 hours of the procedure, both before and after.
The post-procedural stroke rate was slightly higher in the CAS group, but this difference was not significant (5.4% vs 0). One early and 1 late death occurred in the stent group. Although the incidence of ischemic lesions was similar in both groups (surgery group, 12.5%; stent group, 13.5%), new DW MRI lesions were higher in the endarterectomy group (27.1% vs 12.5%, P=0.041). This difference was due chiefly to nonischemic lesions such as hemorrhage and watershed ischemia. In the analysis of patients with embolic ischemia, incidences of symptomatic stroke (P=0.046) and large infarct (P=0.013) were higher in the stent group.
When we used protective devices during CAS, the incidence of embolic complications was similar to that of surgical enarterectomy. On the other hand, the clinical results of CAS need improvement.
PMCID: PMC2607080  PMID: 19156231
Arterial occlusive diseases; brain ischemia; carotid stenosis; cerebral infarction; cerebrovascular disorders; endarterectomy, carotid; intracranial embolism and thrombosis; ischemic attack, transient; prospective studies; stents; stroke/prevention & control
4.  Transpulmonary Surgical Closure of Patent Ductus Arteriosus with Hypothermic Circulatory Arrest in an Adult Patient 
Texas Heart Institute Journal  2005;32(1):88-90.
Untreated patent ductus arteriosus carries a higher risk in adults than in children, especially when the defect is large (>4.0 mm in diameter), short, or friable. Therefore, various technical precautions have been suggested for application during surgical closure of a patent ductus arteriosus in an adult. We report the case of a 47-year-old woman with a patent ductus arteriosus who underwent transpulmonary surgical closure of the ductus under hypothermic total circulatory arrest. We discuss the technique in light of the current English-language medical literature.
PMCID: PMC555833  PMID: 15902831
Adult; cardiopulmonary bypass; circulatory arrest; congenital heart disease; ductus arteriosus, patent/surgery; female
5.  Intracutaneous versus Transcutaneous Suture Techniques 
Texas Heart Institute Journal  2005;32(3):277-282.
In open-heart surgery, sternal wound infection after median sternotomy is a critical complication. The intracutaneous suture is conventionally used in closing sternal incisions. In this prospective, randomized, controlled clinical trial, intracutaneous and transcutaneous suture techniques for closing the sternum were compared with respect to postoperative sternal wound infections and cosmetic results.
In this study, we included 100 patients who had undergone open-heart surgery. Skin wounds were closed with intracutaneous suture in 50 patients and with transcutaneous suture in the remaining 50. Superficial or deep sternal infections that developed within 6 postoperative weeks were evaluated.
Cosmetic results were similar in the 2 groups. Deep wound infections were not observed in either group. Superficial infection of postoperative sternal wounds occurred at rates of 2% (n = 1) and 16% (n = 8) for transcutaneous and intracutaneous techniques, respectively (P = 0.016). One patient in the transcutaneous group and 6 patients in the intracutaneous group who developed superficial sternal infections were diabetic.
Although the use of the transcutaneous suture technique in closing sternal incisions of cardiac surgery patients provided no cosmetic improvement, it decreased the risk of superficial sternal infection and reduced the length of postoperative hospital stay, particularly in diabetic patients.
PMCID: PMC1336695  PMID: 16392205
Comparative study; diabetes complications; drainage; mediastinitis/etiology; postoperative complications/prevention & control; prospective studies; risk factors; sternum/surgery; suppuration; surgical wound dehiscence; surgical wound infection/prevention & control; suture techniques
6.  Replacement of a Björk-Shiley Delrin Aortic Valve Still Functioning after 25 Years 
Texas Heart Institute Journal  2004;31(3):303-305.
We report the case of a patient who had undergone implantation of a Björk-Shiley Delrin valve in the aortic position 25 years earlier and who now presented with severe mitral stenosis. The patient underwent mitral valve replacement and aortic valve re-replacement. We review the justification for prophylactic replacement of Björk-Shiley Delrin heart valves.
PMCID: PMC521776  PMID: 15562853
Aortic valve; delrin; heart valve prosthesis/history; human; middle aged; mitral valve; prosthesis design/history; reoperation; risk factors; time factors

Results 1-6 (6)