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Khouzam MS, Jacobsen K, Boyer JH, Zeeshan A, Spurlock D, Karas TZ, Suarez-Cavelier JE, Rinewalt D, Bogar L, Silvestry S, Palmer GJ, Accola KD, Khouzam N. Fractured sternal wire causing a cardiac laceration. J Cardiothorac Surg 2023; 18:358. [PMID: 38071382 PMCID: PMC10710717 DOI: 10.1186/s13019-023-02452-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 11/04/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Hemopericardium is a serious complication that can occur after cardiac surgery. While most post-operative causes are due to inflammation and bleeding, patients with broken sternal wires and an unstable sternum may develop hemopericardium from penetrating trauma. CASE PRESENTATION We present the case of a 62-year-old male who underwent triple coronary bypass surgery and presented five months later with sudden anterior chest wall pain. Chest computed tomography revealed hemopericardium with an associated broken sternal wire that had penetrated into the pericardial space. The patient underwent a redo-sternotomy which revealed a 3.5 cm bleeding, jagged right ventricular laceration that correlated to the imaging findings of a fractured sternal wire projecting in the pericardial space. The laceration was repaired using interrupted 4 - 0 polypropylene sutures in horizontal mattress fashion between strips of bovine pericardium. The patient's recovery was uneventful and he was discharged on post-operative day four without complications. CONCLUSION Patients with broken sternal wires and an unstable sternum require careful evaluation and management as these may have potentially life-threatening complications if left untreated.
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Affiliation(s)
- Matthew S Khouzam
- Loyola University Medical Center, Stritch School of Medicine, Maywood, IL, USA.
| | - Kristina Jacobsen
- Division of Cardiothoracic Surgery, AdventHealth, Orlando, Florida, USA
| | - Joseph H Boyer
- Division of Cardiothoracic Surgery, AdventHealth, Orlando, Florida, USA
| | - Ahmad Zeeshan
- Division of Cardiothoracic Surgery, AdventHealth, Orlando, Florida, USA
| | - David Spurlock
- Division of Cardiothoracic Surgery, AdventHealth, Orlando, Florida, USA
| | - Tomer Z Karas
- Division of Cardiothoracic Surgery, AdventHealth, Orlando, Florida, USA
| | | | - Daniel Rinewalt
- Division of Cardiothoracic Surgery, AdventHealth, Orlando, Florida, USA
| | - Linda Bogar
- Division of Cardiothoracic Surgery, AdventHealth, Orlando, Florida, USA
| | - Scott Silvestry
- Division of Cardiothoracic Surgery, AdventHealth, Orlando, Florida, USA
| | - George J Palmer
- Division of Cardiothoracic Surgery, AdventHealth, Orlando, Florida, USA
| | - Kevin D Accola
- Division of Cardiothoracic Surgery, AdventHealth, Orlando, Florida, USA
| | - Nayer Khouzam
- Division of Cardiothoracic Surgery, AdventHealth, Orlando, Florida, USA
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Karas TZ, Accola KD. Commentary: Valve options for ischemic mitral regurgitation in an era of new technologies: ViV(a) la bioprosthetic. J Thorac Cardiovasc Surg 2023; 165:646-647. [PMID: 33785217 DOI: 10.1016/j.jtcvs.2021.02.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 01/18/2023]
Affiliation(s)
- Tomer Z Karas
- Cardiovascular Institute, AdventHealth Orlando, Orlando, Fla
| | - Kevin D Accola
- Cardiovascular Institute, AdventHealth Orlando, Orlando, Fla.
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Karas TZ, Accola KD. Commentary: Anticoagulation strategies: Awaiting a new paradigm. J Thorac Cardiovasc Surg 2023; 165:78. [PMID: 34340849 DOI: 10.1016/j.jtcvs.2021.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 07/08/2021] [Accepted: 07/08/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Tomer Z Karas
- Cardiovascular Institute, AdventHealth Orlando, Orlando, Fla
| | - Kevin D Accola
- Cardiovascular Institute, AdventHealth Orlando, Orlando, Fla.
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Karas TZ, Accola KD. Commentary: Business as usual: A thing of the past. J Thorac Cardiovasc Surg 2020; 160:728-729. [PMID: 32622577 PMCID: PMC9436469 DOI: 10.1016/j.jtcvs.2020.05.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/12/2020] [Accepted: 05/12/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Tomer Z Karas
- Cardiovascular Institute, AdventHealth Orlando, Orlando, Fla
| | - Kevin D Accola
- Cardiovascular Institute, AdventHealth Orlando, Orlando, Fla.
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Karas TZ, Accola KD. Reflections on 40 Years of Workforce Surveys: How the Times Have Changed. Ann Thorac Surg 2020; 110:1090-1091. [PMID: 32599052 DOI: 10.1016/j.athoracsur.2020.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Tomer Z Karas
- Cardiovascular Institute, AdventHealth Orlando, 217 Hillcrest St, Orlando, FL 32801
| | - Kevin D Accola
- Cardiovascular Institute, AdventHealth Orlando, 217 Hillcrest St, Orlando, FL 32801.
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Moghanaki D, Simone CB, Rimner A, Karas TZ, Donington J, Shirvani SM, Daly M, Videtic GM, Movsas B. The value of collaboration between thoracic surgeons and radiation oncologists while awaiting evidence in operable stage i non-small cell lung cancer. J Thorac Cardiovasc Surg 2017; 155:429-431. [PMID: 29245205 DOI: 10.1016/j.jtcvs.2017.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 08/20/2017] [Accepted: 09/02/2017] [Indexed: 12/25/2022]
Affiliation(s)
- Drew Moghanaki
- Radiation Oncology Service, Hunter Holmes McGuire VA Medical Center and Virginia Commonwealth University, Richmond, Va
| | - Charles B Simone
- Department of Radiation Oncology, University of Maryland, Baltimore, Md
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Tomer Z Karas
- Department of Cardiothoracic Surgery, Miami VA Healthcare System, Miami, Fla
| | - Jessica Donington
- Department of Cardiothoracic Surgery, New York University, New York, NY
| | - Shervin M Shirvani
- Department of Radiation Oncology, Banner MD Anderson Cancer Center, Phoenix, Ariz
| | - Megan Daly
- Department of Radiation Oncology, University of California, Davis, Sacramento, Calif
| | | | - Benjamin Movsas
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, Mich
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Videtic GMM, Donington J, Giuliani M, Heinzerling J, Karas TZ, Kelsey CR, Lally BE, Latzka K, Lo SS, Moghanaki D, Movsas B, Rimner A, Roach M, Rodrigues G, Shirvani SM, Simone CB, Timmerman R, Daly ME. Stereotactic body radiation therapy for early-stage non-small cell lung cancer: Executive Summary of an ASTRO Evidence-Based Guideline. Pract Radiat Oncol 2017; 7:295-301. [PMID: 28596092 DOI: 10.1016/j.prro.2017.04.014] [Citation(s) in RCA: 288] [Impact Index Per Article: 41.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 04/17/2017] [Indexed: 12/24/2022]
Abstract
PURPOSE This guideline presents evidence-based recommendations for stereotactic body radiation therapy (SBRT) in challenging clinical scenarios in early-stage non-small cell lung cancer (NSCLC). METHODS AND MATERIALS The American Society for Radiation Oncology convened a task force to perform a systematic literature review on 4 key questions addressing: (1) application of SBRT to operable patients; (2) appropriate use of SBRT in tumors that are centrally located, large, multifocal, or unbiopsied; (3) individual tailoring of SBRT in "high-risk" clinical scenarios; and (4) SBRT as salvage therapy after recurrence. Guideline recommendations were created using a predefined consensus-building methodology supported by American Society for Radiation Oncology-approved tools for grading evidence quality and recommendation strength. RESULTS Although few randomized trials have been completed for SBRT, strong consensus recommendations based on extensive, consistent publications were generated for several questions, including recommendations for fractionation for central tumors and surgery versus SBRT in standard-risk medically operable patients with early-stage NSCLC. Lower quality evidence led to conditional recommendations on use of SBRT for tumors >5 cm, patients with prior pneumonectomy, T3 tumors with chest wall invasion, synchronous multiple primary lung cancer, and as a salvage therapy after prior radiation therapy. These areas of moderate- and low-quality evidence highlight the importance of clinical trial enrollment as well as the role of prospective data registries. CONCLUSIONS SBRT has an important role to play in treating early-stage NSCLC, particularly for medically inoperable patients with limited other treatment options. Shared decision-making with patients should be performed in all cases to ensure the patient understands the risks related to SBRT, the side effects, and the alternative treatments available.
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Affiliation(s)
| | - Jessica Donington
- Department of Cardiothoracic Surgery, New York University, New York, New York
| | - Meredith Giuliani
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - John Heinzerling
- Department of Radiation Oncology, Southeast Radiation Oncology, Levine Cancer Institute, Charlotte, North Carolina
| | - Tomer Z Karas
- Department of Cardiothoracic Surgery, Miami VA Healthcare System, Miami, Florida
| | - Chris R Kelsey
- Department of Radiation Oncology, Duke University, Durham, North Carolina
| | - Brian E Lally
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Simon S Lo
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Drew Moghanaki
- Radiation Oncology Service, Hunter Holmes McGuire VA Medical Center and Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia
| | - Benjamin Movsas
- Department of Radiation Oncology, Henry Ford Hospital, Detroit, Michigan
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael Roach
- Department of Radiation Oncology, Washington University, St. Louis, Missouri
| | - George Rodrigues
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Shervin M Shirvani
- Department of Radiation Oncology, Banner MD Anderson Cancer Center, Phoenix, Arizona
| | - Charles B Simone
- Department of Radiation Oncology, University of Maryland, Baltimore, Maryland
| | - Robert Timmerman
- Department of Radiation Oncology, University of Texas Southwestern, Dallas, Texas
| | - Megan E Daly
- Department of Radiation Oncology, University of California, Davis, Sacramento, California
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Moghanaki D, Timmerman RD, Slatore CG, Niewoehner DE, Karas TZ. In Regard to Valle et al. Int J Radiat Oncol Biol Phys 2016; 96:482-483. [DOI: 10.1016/j.ijrobp.2016.05.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 05/27/2016] [Indexed: 11/16/2022]
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Williams CD, Salama JK, Moghanaki D, Karas TZ, Kelley MJ. Impact of Race on Treatment and Survival among U.S. Veterans with Early-Stage Lung Cancer. J Thorac Oncol 2016; 11:1672-81. [DOI: 10.1016/j.jtho.2016.05.030] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/20/2016] [Accepted: 05/29/2016] [Indexed: 01/09/2023]
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Karantalis V, DiFede DL, Gerstenblith G, Pham S, Symes J, Zambrano JP, Fishman J, Pattany P, McNiece I, Conte J, Schulman S, Wu K, Shah A, Breton E, Davis-Sproul J, Schwarz R, Feigenbaum G, Mushtaq M, Suncion VY, Lardo AC, Borrello I, Mendizabal A, Karas TZ, Byrnes J, Lowery M, Heldman AW, Hare JM. Autologous mesenchymal stem cells produce concordant improvements in regional function, tissue perfusion, and fibrotic burden when administered to patients undergoing coronary artery bypass grafting: The Prospective Randomized Study of Mesenchymal Stem Cell Therapy in Patients Undergoing Cardiac Surgery (PROMETHEUS) trial. Circ Res 2014; 114:1302-10. [PMID: 24565698 DOI: 10.1161/circresaha.114.303180] [Citation(s) in RCA: 247] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
RATIONALE Although accumulating data support the efficacy of intramyocardial cell-based therapy to improve left ventricular (LV) function in patients with chronic ischemic cardiomyopathy undergoing CABG, the underlying mechanism and impact of cell injection site remain controversial. Mesenchymal stem cells (MSCs) improve LV structure and function through several effects including reducing fibrosis, neoangiogenesis, and neomyogenesis. OBJECTIVE To test the hypothesis that the impact on cardiac structure and function after intramyocardial injections of autologous MSCs results from a concordance of prorecovery phenotypic effects. METHODS AND RESULTS Six patients were injected with autologous MSCs into akinetic/hypokinetic myocardial territories not receiving bypass graft for clinical reasons. MRI was used to measure scar, perfusion, wall thickness, and contractility at baseline, at 3, 6, and 18 months and to compare structural and functional recovery in regions that received MSC injections alone, revascularization alone, or neither. A composite score of MRI variables was used to assess concordance of antifibrotic effects, perfusion, and contraction at different regions. After 18 months, subjects receiving MSCs exhibited increased LV ejection fraction (+9.4 ± 1.7%, P=0.0002) and decreased scar mass (-47.5 ± 8.1%; P<0.0001) compared with baseline. MSC-injected segments had concordant reduction in scar size, perfusion, and contractile improvement (concordant score: 2.93 ± 0.07), whereas revascularized (0.5 ± 0.21) and nontreated segments (-0.07 ± 0.34) demonstrated nonconcordant changes (P<0.0001 versus injected segments). CONCLUSIONS Intramyocardial injection of autologous MSCs into akinetic yet nonrevascularized segments produces comprehensive regional functional restitution, which in turn drives improvement in global LV function. These findings, although inconclusive because of lack of placebo group, have important therapeutic and mechanistic hypothesis-generating implications. CLINICAL TRIAL REGISTRATION URL http://clinicaltrials.gov/show/NCT00587990. Unique identifier: NCT00587990.
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Affiliation(s)
- Vasileios Karantalis
- From the University of Miami Miller School of Medicine, Interdisciplinary Stem Cell Institute, Miami, FL (V.K., D.L.D., R.S., M.M., V.Y.S., A.W.L., J.M.H.); Johns Hopkins University, Cardiovascular Division, Baltimore, MD (G.G., S.S., E.B., J.D.-S., A.C.L.); University of Maryland, Cardiothoracic Surgery, Baltimore, MD (S.P., J.C.); Veterans Affairs Healthcare System, Cardiothoracic Surgery, Miami, FL (J.S., T.Z.K.); Jackson Health System, Cardiology, Miami, FL (J.P.Z.); University of Miami Miller School of Medicine, Radiology, Miami, FL (J.F., P.P.); University of Texas MD Anderson, Stem Cell Transplantation, Houston, TX (I.M.N.), Johns Hopkins University, Heart and Vascular Institute, Baltimore, MD (K.W.), Johns Hopkins University, Comprehensive Transplant Center (A.S.); University of Southern California, Internal Medicine, Los Angeles, CA (G.F.); Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD (I.B.); EMMES Corporation, Rockville, MD (A.M.), University of Miami Miller School of Medicine, Hematology/Oncology, Miami, FL (J.B.); and University of Miami Miller School of Medicine, Cardiology, Miami, FL (T.Z.K., M.L.)
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Bhatia SS, Karas TZ, Pereira K, King MJ, Yrizarry J. Treatment of chyle leak by percutaneous alcohol sclerosis of the cisterna chyli: a case report. Cardiovasc Intervent Radiol 2014; 38:773-5. [PMID: 24482029 DOI: 10.1007/s00270-014-0839-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 12/06/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Shivank S Bhatia
- Division of Interventional Radiology, Department of Radiology, Miami Veterans Affairs Healthcare System, Suite D300B, 1201 NW 16th Street, Miami, FL, 33125, USA,
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Karas TZ, Gregoric ID, Frazier OH, Reul RM. Delayed Left Ventricular Pseudoaneurysms After Left Ventricular Aneurysm Repairs With the CorRestore Patch. Ann Thorac Surg 2007; 84:266-9. [PMID: 17588429 DOI: 10.1016/j.athoracsur.2007.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2006] [Revised: 01/11/2007] [Accepted: 02/05/2007] [Indexed: 11/15/2022]
Abstract
We present two cases of left ventricular pseudoaneurysm that developed after left ventricular aneurysm repair with the CorRestore patch (Somanetics Corp, Troy, MI). Both patients underwent subsequent pseudoaneurysm repair with Dacron patches (Boston Scientific Corp, Natick, MA). We discuss the physiologic limitations of the CorRestore patch and the causes of pseudoaneurysms that arise after left ventricular aneurysm repair.
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Affiliation(s)
- Tomer Z Karas
- Department of Cardiovascular Surgery, The Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77225-0345, USA
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Karas TZ, Reul GJ, Cooley DA. C-ring mitral annuloplasty: 27-year follow-up. Tex Heart Inst J 2007; 34:102-4. [PMID: 17420804 PMCID: PMC1847912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
We report the long-term follow-up of a patient with rheumatic mitral valve disease who underwent annuloplasty with a specially developed C-ring (the Cooley C-ring) for mitral valve repair in 1977. The repaired valve remained competent and unobstructed for 27 years before requiring replacement.
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Affiliation(s)
- Tomer Z Karas
- Division of Cardiovascular Surgery, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77030, USA
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