Cardiothoracic Surgery

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Aneurysm of a peripheral pulmonary artery : case report and brief review of the literature
(Health and Medical Publishing Group (HMPG), 1975-08) Janson, P. M. C.; Barnard, P. M.; Weich, H. F. H.; MacMahon, A. G.
A patient is presented in whom a solitary aneurysm of a peripheral pulmonary artery was treated by left lower lobectomy. This is the eighth reported successful resection of such an aneurysm. A brief review of the literature is also presented and the importance of pulmonary arteriography in the diagnosis of this condition is mentioned.
Aortokoronêre omleidingschirurgie te Tygerberg-Hospitaal, 1978-1980
(Health & Medical Publishing Group, 1982-11) Barnard, P. M.; Lubbe, J. J. De W.; Rossouw, J. J.; Weich, H. F. H.
ENGLISH ABSTRACT: Between January 1978 and December 1980, 118 patients underwent saphenous vein bypass surgery for obstructive coronary artery disease at Tygerberg Hospital. Sixteen patients in addition to bypass surgery underwent mitral and/or aortic valve replacement or resection of a ventricular aneurysm. The operative and hospital mortality was 3.0% (4/134) for all patients and 3.3% (4/118) for patients who had aortocoronary bypass surgery as the sole procedure. Follow-up of the surviving patients for a mean period of 16.4 months revealed a low incidence of late myocardial infarction of 3.6% (4/112) resulting in the death of only 1 patient; 89.1% of patients were free of angina pectoris and the majority of these resumed their normal work or enjoyed their retirement.
A case report of an aorto-pulmonary-venacaval fistula after penetrating cardiac injury
(Oxford University Press, 2020-12-15) Koen, Johannes Gerhardus; Wagenaar, Riegardt; Janson, Jacques
Background: Penetrating cardiac injury (PCI) is an accepted burden in high violent crime areas. Traumatic intracardiac fistulae are however not that commonly detected on initial presentation, with most of these injuries being detected post-operatively or at routine follow-up. The literature is devoid of general principles around the pre-operative planning and intra-operative management in these cases, and thus warrant documented case reports by clinical units experienced in the management of these challenging clinical scenarios. Case summary: We describe a case report of a 29-year-old male patient presenting to our Cardiothoracic Unit with an aorto-pulmonary-venacaval fistula after a traumatic PCI. We describe the clinical presentation, diagnostic challenges, and institutional experience in the operative management of this case. Discussion: The patient was treated successfully with repair via sternotomy and femoral cardiopulmonary bypass with no neurological, pulmonary, or cardiac sequelae at early follow-up. The importance of selective pre-operative imaging in PCI, appropriate pre-operative surgical planning, and surgical experience in the management of these injuries is highlighted in this case presentation.
COVID-19 and cardiothoracic surgery : a risk-adjusted approach in the context of a global pandemic
(South African Heart Association, 2020) Reddy, Darshan; Kleinloog, Robert; Janson, Jacques; Manganyi, Rogers; Brink, Johan; Zilla, Peter; ns202102
ENGLISH ABSTRACT: In the face of the novel coronavirus pandemic, the impact of COVID-19 infection has disrupted cardiothoracic surgical services globally. A risk-adjusted approach to restructuring the delivery of cardiothoracic surgical services has been proposed in accordance with international guidance to ensure that the surgical standard of care is maintained in the practice of adult and paediatric cardiac surgery, as well as thoracic surgery. The potential influx of COVID-19 patients with cardio-respiratory complications requiring intensive care management and associated surgical procedures falling within the gamut of the thoracic surgeon, is considered. Finally, the protection of healthcare workers, in particular the surgical team exposed to aerosolising procedures, is outlined.
Ewart's sign in tuberculous pericarditis
(Health & Medical Publishing Group, 2000) Smedema, J. P.; Katjitae, I.; Reuter, H.; Doubell, A. F.
[No abstract available]
Lungresection and the cardiopulmonary reserve
(Stellenbosch : Stellenbosch University, 1996) Basson, Elizabeth; Coetzee, A. R.; Stewart, R. I.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Surgery.
ENGLISH ABSTRACT: Concomitant pulmonary dysfunction such as airway obstruction, lung fibrosis and/ or pulmonary hypertension limits a patient's cardiopulmonary reserve. It is clear from the literature that the presence of co-existing disease and cardiopulmonary dysfunction places patients undergoing lung resection at increased risk for the development of postoperative complications, prolonged disability and death (Olsen et al, 1989). In the course of the past 36 years numerous attempts have been to clarify the issue of reliable predictions of post-lung resection morbidity and mortality (Olsen et al, 1989). The goal of the present study was to devise a method to predict the success of lung resection in terms of postoperative exercise capacity.
Lysosomal disruption during the development of endotoxic shock in the baboon
(Health and Medical Publishing Group (HMPG), 1975-06) Janson, P. M. C.; Kuhn, S. H.; Geldenhuys, J. J.
Lysosomal disruption with release of lysosomal enzymes has been described in shock. This study was designed to demonstrate the release of lysosomal enzymes in the liver and lung in addition to determining circulating serum lysosomal enzyme values. Therapeutic means of reducing or inhibiting lysosomal disruption were also investigated. Five groups of baboons were investigated: Group A: (control group) - no endotoxin or treatment administered. Group B: (endotoxin only) - liver and lung tissues showed an increase in free lysosomal enzymes, and a similar increase in circulating serum lysosomal enzymes was demonstrated. Group C: (chloroquine treatment (lysosomal stabiliser) following endotoxin administration) - the liver and lung tissues showed a smaller increase in free lysosomal enzymes and a corresponding lesser increase in circulating serum lysosomal enzymes was demonstrated. Group D: (dexamethasone treatment (lysosomal membrane stabiliser) following endotoxin administration) - the rise in lysosomal tissue and serum enzyme values was less than that in group B. Group E: (combination of chloroquine and dexamethasone treatment following endotoxin administration) - the rise in lysosomal tissue and serum values was less than that demonstrated in group B. The survival of the animals in the various groups correlated well with the lysosomal enzyme tissue and serum values, as did the monitored haemodynamic, haematological and other parameters.
'n Nuwe metode vir die bepaliog van serotonien in bloed en serebrospinale vloeistof
(Health & Medical Publishing Group, 1979) Kriek, J. A.; Bester, A. J.; Rossouw, J. J.
A new rapid method for the microdetermination of serotonin (5-hydroxytryptamine) in plasma and cerebrospinal fluid is described. A recovery coefficient of 98% was obtained in the present method, with the use of [3H]-hydroxytryptamine creatinine sulphate as an internal standard, compared with recovery coefficients of 31% and 66% for the two existing methods generally used for serotonin determination. This method involves a one-step sample deproteinization by perchloric acid, resulting in a high stability of serotonin.
Penetrating traumatic cardiac injury : experience in the current era from a high-volume tertiary hospital.
(Stellenbosch : Stellenbosch University, 2024-03) Koen, Johan Gerhard; Janson, Jacques Teran; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Cardiothoracic Surgery.
ENGLISH ABSTRACT: Objectives Penetrating Cardiac Injury is encountered by most surgeons at some point in their career. Prehospital and emergency department risk factors for mortality have been well established. Perioperative predictive risk factors for mortality in patients undergoing operative room surgery has not been well established. The incidence of post-operative intra-cardiac defects is not known. Early and late mortality outcomes in this patient population in the recent era is not known. Methods All suspected penetrating cardiac injuries patients who were admitted to our Trauma Unit and underwent median sternotomy between January 2014 and December 2019 were reviewed. Demographics, mechanism, and mortality, presence of intra-cardiac injuries and surgical management were assessed. Stratification and inter-variable comparison were performed. Results A total of 233 patients were identified. Mean age was 30 years with a male predominance (95%). Most were acute injuries (1 injury in 18% of cases. The presence of cardiac tamponade is highly sensitive for underlying cardiac injuries. Penetrating Zone 1 neck injuries with tamponade may avoid missing potential underlying aortic injuries. Post-operative echocardiography is advised as 23% of Ventricular Septal Defects are clinically missed on admission. We provide our algorithmic approach and surgical management of penetrating cardiac trauma.
Penetrating wounds of the heart and great vessels : a new therapeutic approach
(Health and Medical Publishing Group -- HMPG, 1982-08) Knott-Craig, C. J.; Przybojewski, J. Z.; Barnard, P. M.
A series of 36 Black and Coloured patients, presenting during a 1-year period with life-endangering intrathoracic trauma secondary to assault, is presented. Penetrating wounds of the heart were documented in 32 of these patients, 6 of whom died almost immediately after having been brought into the Resuscitation Unit of Tygerberg Hospital, Parowvallei, CP. The remaining 26 patients had clinical features of cardiac tamponade and circulatory collapse, and in 4 of these patients an emergency thoracotomy was performed in the Resuscitation Unit as it was considered inadvisable to delay surgery until theatre had been arranged. Three of the latter 4 were discharged home completely recovered. Total peri-operative mortality was 13.3%, most deaths being due to lacerations of the left ventricle. Penetrating wounds of the ventricles accounted for some 85% of the total cardiac lacerations; other lacerations affected the pulmonary artery and its branches, the aorta, left atrium and internal thoracic artery. The incision most frequently employed at surgery was a median sternotomy (53%), followed by left thoracotomy (40%) and right thoracotomy (7%). Pre-operative emergency management based on pathophysiological principles is discussed. The fact that relatively inexperienced surgical registrars performed many of these operations with good results emphasizes the need for the establishment of resuscitation units in more peripheral hospitals where many of these patients could primarily be treated. These units would then be able to manage many of these patients, probably at an earlier stage than if they were referred to a teaching hospital such as Tygerberg.
Penetrating wounds of the heart and great vessels : experience with 24 cases including 3 with intracardiac defects
(Health and Medical Publishing Group (HMPG), 1975-03) De Wet Lubbe, J. J.; Janson, P. M. C.; Barnard, P. M.
Twenty four cases of penetrating cardiac injuries due to stab wounds, which were seen over a 3 yr period, are reviewed. Ten patients were treated by aspiration alone because tamponade was mild, or because they were seen more than 12 hr after injury. One patient with multiple stab wounds in the ventricles and left atrium died during emergency thoracotomy in the admission room. The mortality rate of 4.2% is considerably lower than rates reported in other series. Two cases of traumatic ventricular septal defects, one case of traumatic aortic incompetence and sinus of Valsalva fistulae with rupture into the right ventricle and right atrium, and one case of ascending aorta innominate vein fistula are discussed. A plan of management is outlined.
Post-infarction ventricular septal defect and aneurysm formation : a case presentation with successful surgical correction and review of the literature
(HMPG, 1981-02) Przybojewski, J. Z.; Barnard, P. M.
A fairly young man suddenly developed a large ventricular septal defect (VSD) after an extensive anterolateral and anteroseptal myocardial infarction. Because of congestive cardiac failure refractory to medical treatment he underwent simultaneous closure of the VSD and left ventricular aneurysmectomy 6 weeks after the myocardial infarction. Some 14 months after operation the patient is completely asymptomatic on the minimum of medical therapy and is able to live normally. The literature on these two combined lesions complicating acute myocardial infarction and their surgical correction is reviewed. It is postulated that this patient's infarction was caused by coronary spasm of the Prinzmetal variety with underlying normal coronary arteries.
Severe isolated left mainstem coronary artery stenosis : a case report
(Health and Medical Publishing Group (HMPG), 1986-01) Przybojewski, J. Z.; Rossouw, J.
A 33-year-old white man had exertional angina pectoris, followed by angina pectoris at rest, and then episodes of ischaemic acute pulmonary oedema associated with angina pectoris. Selective coronary angiography delineated an isolated long-segment stenosis of the left brainstem coronary artery with no other lesions. We believe that the mainstem obstruction was due to coronary artery fibromuscular hyperplasia, a condition rarely affecting the coronary artery circulation. At operation three coronary artery bypass grafts were inserted, one to the left anterior descending artery and two to the left circumflex coronary artery, with a most successful result. The patient's recurrent acute pulmonary oedema was due to severe myocardial ischaemia; the possibility of superadded coronary vasospasm aggravating the obstruction cannot be entirely discounted.
Spontaneous contained transmural oesophageal rupture clinically resembling intramural rupture : a case report
(Health and Medical Publishing Group (HMPG), 1985-09) Keet, A. D.; Waters, G. A.; MacGregor, L. A.
[No abstract available]
Ventrikulere aneurismektomie en infarktektomie
(Health and Medical Publishing Group (HMPG), 1975-03) Barnard, P. M.; De Wet Lubbe, J. J.; Janson, P. M. C.
Four patients underwent ventricular aneurysmectomy for congestive cardiac failure. In addition, 1 patient with an aneurysm and 3 patients with acute myocardial infarcts, ranging from 16 to 28 days postinfarction, underwent emergency surgery for recurrent malignant arrhythmias. The preoperative treatment, cardiac catheterization data and surgical findings are outlined. The overall survival rate is 75% for a mean followup period of 12.5 mth (range 8-22 mth). It is concluded that aneurysmectomy, for congestive cardiac failure, and infarctectomy, for life threatening ventricular arrhythmias, are gratifying and worthwhile procedures.

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