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Saad EA, Mukherjee T, Gandour G, Fatayerji N, Rammal A, Samuel P, Abdallah N, Ashok T. Cardiac myxomas: causes, presentations, diagnosis, and management. Ir J Med Sci 2024; 193:677-688. [PMID: 37737916 DOI: 10.1007/s11845-023-03531-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/14/2023] [Indexed: 09/23/2023]
Abstract
Cardiac myxomas (CM) are one of the most common benign tumors which are typical in adults with a yearly incidence of 0.5-1 case per million individuals. This review article includes discussions based on existing literature on the role of interleukin interactions in the pathophysiology of cardiac myxoma which can lead to embolic complications, aneurysms, and CNS involvement. The objective of this narrative review was to study the variable clinical presentations of cardiac myxoma, its detection and diagnosis involving multiple modalities like genetic and hematological testing, echocardiography, CT, and MRI, of which transoesophageal echocardiogram shows excellent precision with a 90% to 96% accuracy in diagnosing CM. Individuals with the Carney complex are prone to such neoplasia. Cardiac myxomas are challenging to diagnose due to the ambiguity of their differential with thrombi. Myxomas can also be diagnosed by tumor markers like interleukin-6 and endothelial growth factors. The management of CM includes surgical excision like median sternotomy and robotic minimally invasive surgery. The use of robotic surgery in CM increased from 1.8% in 2012 to 15.1% in 2018. Tumor recurrences are uncommon but can occur due to inadequate surgical resection.
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Affiliation(s)
- Elio Assaad Saad
- Faculty of Medicine and Medical Sciences, University of Balamand, Al Koura, Lebanon
| | - Tishya Mukherjee
- Faculty of Medicine, Nicolae Testemițanu State University of Medicine and Pharmacy, Chișinău, Moldova
| | - Georges Gandour
- Faculty of Medicine and Medical Sciences, University of Balamand, Al Koura, Lebanon
| | - Nora Fatayerji
- Faculty of Medicine and Medical Sciences, Poznan University of Medical Sciences, Poznan, Poland
| | - Aya Rammal
- Faculty of Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Peter Samuel
- International Faculty of Medicine, Tbilisi State Medical University, Tbilisi, Georgia.
| | - Nicolas Abdallah
- Faculty of Medicine and Medical Sciences, University of Balamand, Al Koura, Lebanon
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Shetty RS, Prakash N, Krishna V, Verma RK, Patel GP, Moharana A, Siddabasavaiah D. Evaluating the Clinical Equivalence of Truwax® and Ethicon® Bone Waxes for Sternal Wound Hemostasis: A Prospective Randomized Study. Cureus 2024; 16:e55141. [PMID: 38558664 PMCID: PMC10979720 DOI: 10.7759/cureus.55141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Incidence of sternal dehiscence, wound infection, and mortality are prevalent following sternotomy. Bone wax is widely used over the sternal edges for augmenting hemostasis. This study evaluated the clinical equivalence of Truwax® (Healthium Medtech Limited, Bengaluru, India) with Ethicon® (Johnson & Johnson, New Brunswick, New Jersey, United States) bone wax for sternal wound hemostasis in subjects undergoing surgical procedures by sternotomy. METHODS The primary endpoint of this prospective (May 2022-April 2023), parallel-group, two-arm, randomized, single-blind, multicenter study was to evaluate the proportion of subjects having sternal dehiscence within 26 weeks of median sternotomy closure. Secondary endpoints assessed the average time to hemostasis on sternum sides, bone wax properties, number of dressing changes, sternal bone instability (clinically/chest radiography), pain, perioperative/postoperative complications, blood and blood products used, duration of intensive care unit (ICU)/hospital stay, reoperations, time taken to return back to work and normal day-to-day activities, subject satisfaction and quality of life (QoL), and adverse events. A probability of <0.05 was considered significant. RESULTS No incidence of sternal dehiscence or postoperative complications was witnessed. Time to hemostasis, bone wax properties, number of dressing changes, sternal stability, pain, blood and blood products used, duration of ICU/hospital stay, reoperations, time taken to return back to normal day-to-day activities and to work, and subject satisfaction and QoL were comparable between Truwax® and Ethicon® bone wax groups. CONCLUSION Truwax® and Ethicon® bone waxes are safe and effective and provide sternal wound hemostasis in people undergoing sternotomy.
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Affiliation(s)
- Ravi S Shetty
- Cardiothoracic Surgery, Mathikere Sampangi (MS) Ramaiah Medical College and Hospitals, Bengaluru, IND
| | - Neeraj Prakash
- Cardiothoracic and Vascular Surgery, Laxmipat Singhania (LPS) Institute of Cardiology and Cardiac Surgery, Ganesh Shankar Vidyarthi Memorial (GSVM) Medical College, Kanpur, IND
| | - Vinay Krishna
- Cardiothoracic and Vascular Surgery, Laxmipat Singhania (LPS) Institute of Cardiology and Cardiac Surgery, Ganesh Shankar Vidyarthi Memorial (GSVM) Medical College, Kanpur, IND
| | - Rakesh K Verma
- Cardiothoracic and Vascular Surgery, Laxmipat Singhania (LPS) Institute of Cardiology and Cardiac Surgery, Ganesh Shankar Vidyarthi Memorial (GSVM) Medical College, Kanpur, IND
| | - Guru P Patel
- Cardiothoracic Surgery, Mathikere Sampangi (MS) Ramaiah Medical College and Hospitals, Bengaluru, IND
| | - Ashok Moharana
- Clinical Affairs, Healthium Medtech Limited, Bengaluru, IND
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Sudin A, Chong C, Hassan R. Incidence and Factors Associated With Post-Sternotomy Pain Syndrome in the National Heart Institute, Malaysia. J Cardiothorac Vasc Anesth 2024; 38:466-474. [PMID: 38114372 DOI: 10.1053/j.jvca.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/09/2023] [Accepted: 11/03/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVE To determine the incidence of poststernotomy pain syndrome (PSPS) after open cardiac surgery in 2021. To determine characteristics and assess the severity of symptoms in patients diagnosed with PSPS. To identify factors that can be associated with patients who were positive for PSPS. DESIGN AND METHODOLOGY This study used a retrospective observational approach. Logistic regression analysis was employed to identify factors associated with the positive group. SETTING This study included all adult patients who underwent open cardiac surgery at the National Heart Institute, Malaysia, in 2021. PARTICIPANTS A total of 1,395 patients were enrolled. INTERVENTIONS The study involved conducting phone interviews to assess the presence of PSPS, followed by administering the Brief Pain Inventory questionnaire in the positive group to identify characteristics and severity of chronic pain. MEASUREMENTS AND MAIN RESULTS The incidence of PSPS after open cardiac surgery in 2021 was 20.35%. A total of 17.7% of patients reported that pain affected their daily activities, sleep, or emotions. Univariate analysis identified factors associated with PSPS, including age <60 years old, body mass index >30 kg/m2, history of previous percutaneous coronary intervention, ejection fraction <50%, the absence of chronic kidney disease (CKD), and internal mammary artery harvesting (p < 0.05). Multivariate analysis revealed that 4 independent factors were associated with PSPS: age <60 years old, history of previous percutaneous coronary intervention, ejection fraction <50%, and the absence of CKD (as compared with CKD) (p < 0.05). CONCLUSIONS Poststernotomy pain syndrome is a complex issue affected by various factors. Although the pain score may not be as severe as previously believed, it remains crucial to recognize PSPS because a significant proportion of patients are affected.
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Affiliation(s)
- Arif Sudin
- Anesthesia & Intensive Care department, National Heart Institute (IJN), Kuala Lumpur, Malaysia.
| | - Collins Chong
- Department of Anaesthesia & Intensive Care, Faculty of Medicine & Health Science, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Rozaini Hassan
- Anesthesia & Intensive Care department, National Heart Institute (IJN), Kuala Lumpur, Malaysia
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Krauze A, Fus-Kujawa A, Bajdak-Rusinek K, Żyła-Uklejewicz D, Fernandez C, Bednarek I, Gałka S, Sieroń Ł, Bogunia E, Hermyt M, Nożyński J, Milewski K, Czekaj P, Wojakowski W. Impact of local delivery of allogeneic chondrocytes on the biological response and healing of the sternum bones after sternotomy. Sci Rep 2023; 13:15971. [PMID: 37749290 PMCID: PMC10520054 DOI: 10.1038/s41598-023-43255-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 09/21/2023] [Indexed: 09/27/2023] Open
Abstract
Median sternotomy is the surgical method of choice for many procedures where one of the main problems is the long post-operative wound healing process leading to sternal dehiscence and the development of infection. This leads to prolonged hospital stay and increased mortality due to post-operative complications. A promising solution seems to be the use of allogeneic chondrocytes for wound treatment, whose properties in the field of cartilage reconstruction are widely used in medicine, mainly in orthopedics. In the present study, we investigated the effect of local delivery of allogeneic chondrocytes on the biological response and healing of the sternum after sternotomy. We optimized the culture conditions for the isolated chondrocytes, which were then applied to the sternal incision wound. Chondrocytes in the culture were assessed on the basis of the presence of chondrocyte-specific genes: Sox9, Aggrecan and Collagen II. In turn, the histopathological and immunohistochemical evaluation was used to assess the safety of implantation. In our work, we demonstrated the possibility of obtaining a viable culture of chondrocytes, which were successfully introduced into the sternal wound after sternotomy. Importantly, implantation of allogeneic chondrocytes showed no significant side effects. The obtained results open new possibilities for research on the use of allogeneic chondrocytes in the process of accelerating wound healing after median sternotomy.
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Affiliation(s)
- Agata Krauze
- Center for Cardiovascular Research and Development, American Heart of Poland SA, 43-450, Ustroń 1, Poland
| | - Agnieszka Fus-Kujawa
- Department of Medical Genetics, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medykow 18 Street, 40-752, Katowice, Poland
| | - Karolina Bajdak-Rusinek
- Department of Medical Genetics, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medykow 18 Street, 40-752, Katowice, Poland.
| | - Dorota Żyła-Uklejewicz
- Center for Cardiovascular Research and Development, American Heart of Poland SA, 43-450, Ustroń 1, Poland
| | - Carlos Fernandez
- Center for Cardiovascular Research and Development, American Heart of Poland SA, 43-450, Ustroń 1, Poland
| | - Ilona Bednarek
- Department of Biotechnology and Genetic Engineering, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, 40-055, Katowice, Poland
| | - Sabina Gałka
- Department of Biotechnology and Genetic Engineering, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, 40-055, Katowice, Poland
| | - Łukasz Sieroń
- Department of Medical Genetics, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medykow 18 Street, 40-752, Katowice, Poland
| | - Edyta Bogunia
- Department of Cytophysiology, Chair of Histology and Embryology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medykow 18 Street, 40-752, Katowice, Poland
| | - Mateusz Hermyt
- Department of Cytophysiology, Chair of Histology and Embryology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medykow 18 Street, 40-752, Katowice, Poland
| | - Jerzy Nożyński
- Department of Histopathology, Silesian Centre for Heart Diseases, 41-800, Zabrze, Poland
| | - Krzysztof Milewski
- Center for Cardiovascular Research and Development, American Heart of Poland SA, 43-450, Ustroń 1, Poland
| | - Piotr Czekaj
- Department of Cytophysiology, Chair of Histology and Embryology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Medykow 18 Street, 40-752, Katowice, Poland
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
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