Research Articles (Cardiothoracic Surgery)

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    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.
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    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.
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    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.
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    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.
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    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.