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Article ; Online: No cupid, just an arrow: a penetrating injury into the interventricular septum.

Lehtinen, Miia / Nykänen, Antti / Raivio, Peter

2024 Volume 19, Issue 1, Page(s) 48

Abstract: Background: Penetrating cardiac injuries are rare but often fatal, with 16-55% mortality. We report a patient who suffered a non-fatal occupational cardiac injury.: Case presentation: A 47-year-old man was operating an ironworker machine. A thin 3-cm ...

Abstract	Background: Penetrating cardiac injuries are rare but often fatal, with 16-55% mortality. We report a patient who suffered a non-fatal occupational cardiac injury. Case presentation: A 47-year-old man was operating an ironworker machine. A thin 3-cm metal fragment catapulted from the machine piercing the chest wall and the right ventricular outflow tract (RVOT), burrowing into the interventricular septum (IVS). The patient remained hemodynamically stable and walked to the nearest hospital. ECG-gated computed tomography revealed the exact location of the fragment within the IVS, allowing for detailed preoperative planning. The fragment was removed through a sternotomy and an incision through the RVOT. The postoperative course was uneventful. Conclusions: This case underscores the value of detailed preoperative imaging and the wide spectrum of clinical scenarios of penetrating cardiac injuries.
MeSH term(s)	Male ; Humans ; Middle Aged ; Ventricular Septum/surgery ; Wounds, Penetrating/diagnosis ; Wounds, Penetrating/surgery ; Heart Ventricles/surgery ; Heart Ventricles/injuries ; Heart Injuries/diagnosis ; Heart Injuries/etiology ; Heart Injuries/surgery ; Foreign Bodies/diagnostic imaging ; Foreign Bodies/surgery
Language	English
Publishing date	2024-02-03
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	2227224-0
ISSN	1749-8090 ; 1749-8090
ISSN (online)	1749-8090
ISSN	1749-8090
DOI	10.1186/s13019-024-02512-5
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Article ; Online: Reconstruction of Donor Anomalous Pulmonary Vein During Lung Transplantation.

Nykänen, Antti I / Raivio, Peter

The Annals of thoracic surgery

2021 Volume 114, Issue 2, Page(s) e83–e84

Abstract: Pulmonary vein anomalies are rare but can complicate lung transplantation, especially if unrecognized during the lung procurement operation. We describe a case of a partial anomalous pulmonary venous return of a donor lung detected at the time of ... ...

Abstract	Pulmonary vein anomalies are rare but can complicate lung transplantation, especially if unrecognized during the lung procurement operation. We describe a case of a partial anomalous pulmonary venous return of a donor lung detected at the time of transplant reperfusion. The anomalous donor right upper pulmonary vein was successfully connected to the recipient atrial cuff using a bovine pericardium conduit constructed with a vascular stapler. This reconstruction has been durable and has remained patent for over 5 years.
MeSH term(s)	Animals ; Cattle ; Heart Defects, Congenital ; Humans ; Lung Transplantation ; Pulmonary Veins/abnormalities ; Pulmonary Veins/surgery ; Scimitar Syndrome ; Tissue Donors ; Vascular Malformations
Language	English
Publishing date	2021-12-14
Publishing country	Netherlands
Document type	Case Reports
ZDB-ID	211007-6
ISSN	1552-6259 ; 0003-4975
ISSN (online)	1552-6259
ISSN	0003-4975
DOI	10.1016/j.athoracsur.2021.10.066
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Article ; Online: Impact of high-risk features on outcome of acute type B aortic dissection.

Herajärvi, Johanna / Mustonen, Caius / Kesävuori, Risto / Raivio, Peter / Biancari, Fausto / Jormalainen, Mikko / Juvonen, Tatu

JTCVS open

2023 Volume 13, Page(s) 20–31

Abstract: Background: Acute type B aortic dissection (TBAD) is a severe condition associated with significant morbidity and mortality. The optimal classification and treatment strategy of TBAD remain controversial and inconsistent.: Methods: This analysis ... ...

Abstract	Background: Acute type B aortic dissection (TBAD) is a severe condition associated with significant morbidity and mortality. The optimal classification and treatment strategy of TBAD remain controversial and inconsistent. Methods: This analysis includes patients treated for acute TBAD at the Helsinki University Hospital, Finland between 2007 and 2019. The endpoints were early and late mortality, intervention of the aorta, and a composite of death and aortic intervention in uncomplicated patients and high-risk patients. Results: This study included 162 consecutive TBAD patients (27.8% females), 114 in the high-risk group and 48 in the uncomplicated group, with a mean age of 67.6 ± 13.9 years. Intramural hematoma was reported in 63 cases (38.9%). The mean follow-up was 5.1 ± 3.9 years. In-hospital/30-day mortality (n = 4; 3.5%) occurred solely in the high-risk group ( Conclusions: Recognition of risk factors underlying adverse events related to TBAD is essential because the disease progression impacts both early and late outcomes. Early aortic repair in high-risk TBAD may reduce long-term morbidity and mortality.
Language	English
Publishing date	2023-01-16
Publishing country	Netherlands
Document type	Journal Article
ISSN	2666-2736
ISSN (online)	2666-2736
DOI	10.1016/j.xjon.2023.01.005
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Article ; Online: Deep learning-aided extraction of outer aortic surface from CT angiography scans of patients with Stanford type B aortic dissection.

Kesävuori, Risto / Kaseva, Tuomas / Salli, Eero / Raivio, Peter / Savolainen, Sauli / Kangasniemi, Marko

European radiology experimental

2023 Volume 7, Issue 1, Page(s) 35

Abstract: Background: Guidelines recommend that aortic dimension measurements in aortic dissection should include the aortic wall. This study aimed to evaluate two-dimensional (2D)- and three-dimensional (3D)-based deep learning approaches for extraction of outer ...

Abstract	Background: Guidelines recommend that aortic dimension measurements in aortic dissection should include the aortic wall. This study aimed to evaluate two-dimensional (2D)- and three-dimensional (3D)-based deep learning approaches for extraction of outer aortic surface in computed tomography angiography (CTA) scans of Stanford type B aortic dissection (TBAD) patients and assess the speed of different whole aorta (WA) segmentation approaches. Methods: A total of 240 patients diagnosed with TBAD between January 2007 and December 2019 were retrospectively reviewed for this study; 206 CTA scans from 206 patients with acute, subacute, or chronic TBAD acquired with various scanners in multiple different hospital units were included. Ground truth (GT) WAs for 80 scans were segmented by a radiologist using an open-source software. The remaining 126 GT WAs were generated via semi-automatic segmentation process in which an ensemble of 3D convolutional neural networks (CNNs) aided the radiologist. Using 136 scans for training, 30 for validation, and 40 for testing, 2D and 3D CNNs were trained to automatically segment WA. Main evaluation metrics for outer surface extraction and segmentation accuracy were normalized surface Dice (NSD) and Dice coefficient score (DCS), respectively. Results: 2D CNN outperformed 3D CNN in NSD score (0.92 versus 0.90, p = 0.009), and both CNNs had equal DCS (0.96 versus 0.96, p = 0.110). Manual and semi-automatic segmentation times of one CTA scan were approximately 1 and 0.5 h, respectively. Conclusions: Both CNNs segmented WA with high DCS, but based on NSD, better accuracy may be required before clinical application. CNN-based semi-automatic segmentation methods can expedite the generation of GTs. Relevance statement: Deep learning can speeds up the creation of ground truth segmentations. CNNs can extract the outer aortic surface in patients with type B aortic dissection. Key points: • 2D and 3D convolutional neural networks (CNNs) can extract the outer aortic surface accurately. • Equal Dice coefficient score (0.96) was reached with 2D and 3D CNNs. • Deep learning can expedite the creation of ground truth segmentations.
MeSH term(s)	Humans ; Computed Tomography Angiography ; Deep Learning ; Retrospective Studies ; Aorta ; Aortic Dissection/diagnostic imaging
Language	English
Publishing date	2023-06-29
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2509-9280
ISSN (online)	2509-9280
DOI	10.1186/s41747-023-00342-z
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Article ; Online: Outcomes after Surgery for Endocarditis among Intravenous Drug Users and Nonusers.

Huuskonen, Antti / Kesävuori, Risto / Raivio, Peter

The Thoracic and cardiovascular surgeon

2021

Abstract: Background: The optimal treatment strategy for intravenous drug users (IVDU) with infective endocarditis (IE) is controversial. We therefore sought to investigate outcomes among IVDUs after surgery for IE.: Methods: We retrospectively reviewed all ... ...

Abstract	Background: The optimal treatment strategy for intravenous drug users (IVDU) with infective endocarditis (IE) is controversial. We therefore sought to investigate outcomes among IVDUs after surgery for IE. Methods: We retrospectively reviewed all 192 consecutive patients who underwent an operation for IE between 2005 and 2016 in the Helsinki University Hospital. Forty-seven patients (24.5%) were IVDUs and 145 (75.5%) were non-IVDUs. Mortality and reinfection and reoperation rates were evaluated. Results: IVDUs were younger (29.9 vs. 63.8 years, Conclusions: IVDUs and non-IVDUs had comparable survival at 5 years, but IVDUs had a very significantly increased risk of death in comparison to an age- and sex-matched general population. IVDUs had higher reinfection and early reoperation rates. Survival was poor after medically treated reinfection.
Language	English
Publishing date	2021-06-27
Publishing country	Germany
Document type	Journal Article
ZDB-ID	800050-5
ISSN	1439-1902 ; 0171-6425 ; 0946-4778 ; 0172-6137
ISSN (online)	1439-1902
ISSN	0171-6425 ; 0946-4778 ; 0172-6137
DOI	10.1055/s-0041-1727231
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Article ; Online: Outcomes of surgery for extensive infective endocarditis.

Huuskonen, Antti / Kaarne, Markku / Vento, Antti / Juvonen, Tatu / Raivio, Peter

Journal of cardiac surgery

2021 Volume 36, Issue 12, Page(s) 4675–4681

Abstract: Objective: Extensive infective endocarditis (EIE) involving the valve annulus or the intervalvular fibrous body (IFB) is a treatment challenge. We sought to clarify the outcomes of patients undergoing surgery for EIE.: Methods: We retrospectively ... ...

Abstract	Objective: Extensive infective endocarditis (EIE) involving the valve annulus or the intervalvular fibrous body (IFB) is a treatment challenge. We sought to clarify the outcomes of patients undergoing surgery for EIE. Methods: We retrospectively reviewed all 197 consecutive patients who underwent an operation for infective endocarditis (IE) between 2005 and 2016 in the Helsinki University Hospital. Thirty-five (18%) patients had EIE, of which 17 (9%) infection extended to IFB. Results: Patients with EIE had higher EuroSCORE II (24.4% vs. 12.4% p < .001), higher frequency of diabetes (29% vs. 13% p = .017), more often NYHA Class IV (83% vs. 56% p = .02), aortic (97% vs. 45% p < .001), multivalve (40% vs. 11% p < .001), and prosthetic valve IE (37% vs. 9% p < .001), and underwent more often emergency surgery (46% vs. 29% p = .042). Thirty-day mortality was 9% in the EIE group and 7% in the non-EIE group (p = .720). Survival of patients with EIE at 5 years was 60% and with non-EIE 71% (p = .029). The frequency of complications was higher in EIE (54%) than in non-EIE patients (25%) (p < .001), due to the higher need for permanent pacemaker implantations (34% vs. 4% p < .001). Freedom from re-operations at 5 years was 91% in the EIE group and 97% in the non-EIE group (p = .203). Conclusions: Early mortality of surgery for EIE was comparable with non-EIE. Midterm survival was lower after surgery for EIE than after surgery for non-EIE but there was no difference in survival of patients with IE limited to the valve annulus amenable to patch repair and patients with endocarditis requiring IFB reconstruction.
MeSH term(s)	Aortic Valve/surgery ; Endocarditis/surgery ; Endocarditis, Bacterial/surgery ; Heart Valve Prosthesis ; Heart Valve Prosthesis Implantation ; Humans ; Reoperation ; Retrospective Studies ; Treatment Outcome
Language	English
Publishing date	2021-09-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	639059-6
ISSN	1540-8191 ; 0886-0440
ISSN (online)	1540-8191
ISSN	0886-0440
DOI	10.1111/jocs.16005
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Article ; Online: Transition from BOS to RAS impairs prognosis after lung transplantation-CLAD subtype analysis by CT volumetry.

Peräkylä, Laura / Nykänen, Antti / Piilonen, Anneli / Kesävuori, Risto / Halme, Maija / Raivio, Peter

PloS one

2022 Volume 17, Issue 10, Page(s) e0275563

Abstract: Background: Chronic lung allograft dysfunction (CLAD), subclassified into bronchiolitis obliterans syndrome (BOS) or restrictive allograft syndrome (RAS), limits survival after lung transplantation. Information concerning transition from BOS to RAS is ... ...

Abstract	Background: Chronic lung allograft dysfunction (CLAD), subclassified into bronchiolitis obliterans syndrome (BOS) or restrictive allograft syndrome (RAS), limits survival after lung transplantation. Information concerning transition from BOS to RAS is limited. We aimed to characterize the lung volume change after BOS diagnosis by computed tomography (CT) volumetry and to determine the incidence, risk factors and clinical significance of BOS to RAS transition. Methods: CT volumetry measurements were performed from 63 patients with CLAD initially classified as BOS by CT volumetry. BOS patients with lung volume remaining >85% of baseline were classified as persistent BOS, whereas BOS patients whose lung volume permanently decreased to ≤85% of baseline were classified as BOS to RAS transition. Results: During follow-up (median 9.8 years) eight patients (12.7%) were classified as BOS to RAS transition, which decreased recipient (p = 0.004) and graft survival (p = 0.020) in comparison to patients with persistent BOS. Opacities on chest imaging preceded BOS to RAS transition in 88% of patients. Opacities on chest imaging at BOS diagnosis and early CLAD diagnosis after transplantation were risk factors for transition. Conclusion: Based on lung volume decrease measured by CT volumetry, a small proportion of BOS patients transitioned to RAS which had an adverse effect on recipient and graft survival.
MeSH term(s)	Allografts ; Bronchiolitis Obliterans/diagnostic imaging ; Bronchiolitis Obliterans/etiology ; Graft vs Host Disease/etiology ; Humans ; Lung/diagnostic imaging ; Lung Transplantation/adverse effects ; Prognosis ; Retrospective Studies ; Syndrome ; Tomography, X-Ray Computed/adverse effects
Language	English
Publishing date	2022-10-12
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0275563
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Article ; Online: 13-year single-center experience with the treatment of acute type B aortic dissection.

Herajärvi, Johanna / Jormalainen, Mikko / Mustonen, Caius / Kesävuori, Risto / Raivio, Peter / Biancari, Fausto / Juvonen, Tatu

Scandinavian cardiovascular journal : SCJ

2022 Volume 56, Issue 1, Page(s) 360–367

Abstract: ... Background ... Acute type B aortic dissection (TBAD) is catastrophic event associated with significant mortality and lifelong morbidity. The optimal treatment strategy of TBAD is still controversial. ... Methods ... This analysis includes patients ... ...

Abstract	Background. Acute type B aortic dissection (TBAD) is catastrophic event associated with significant mortality and lifelong morbidity. The optimal treatment strategy of TBAD is still controversial. Methods. This analysis includes patients treated for TBAD at the Helsinki University Hospital, Finland in 2007-2019. The endpoints were early and late mortality, and intervention of the aorta. Results. There were 205 consecutive TBAD patients, 59 complicated and 146 uncomplicated patients (mean age of 66 ± 14, females 27.8%). In-hospital and 30-day mortality rates were higher in complicated patients compared with uncomplicated patients with a statistically significant difference (p = 0.035 and p = 0.015, respectively). After a mean follow-up of 4.9 ± 3.8 years, 36 (25.0%) and 22 (37.9%) TBAD -related adverse events occurred in the uncomplicated and complicated groups, respectively (p = 0.066). Freedom from composite outcome was 83 ± 3% and 69 ± 6% at 1 year, 75 ± 4% and 63 ± 7% at 5 years, 70 ± 5% and 59 ± 7% at 10 years in the uncomplicated group and in the complicated group, respectively (p = 0.052). There were 25 (39.1%) TBAD-related deaths in the overall series and prior aortic aneurysm was the only risk factor for adverse aortic-related events in multivariate analysis (HR 3.46, 95% CI 1.72-6.96, p < 0.001). Conclusion. TBAD is associated with a significant risk of early and late adverse events. Such a risk tends to be lower among patients with uncomplicated dissection, still one fourth of them experience TBAD-related event. Recognition of risk factors in the uncomplicated group who may benefit from early aortic repair would be beneficial.
MeSH term(s)	Aged ; Aged, 80 and over ; Aneurysm, Dissecting/diagnostic imaging ; Aneurysm, Dissecting/surgery ; Aortic Aneurysm, Thoracic/diagnostic imaging ; Aortic Aneurysm, Thoracic/surgery ; Blood Vessel Prosthesis Implantation/adverse effects ; Endovascular Procedures/adverse effects ; Female ; Humans ; Middle Aged ; Retrospective Studies ; Risk Factors ; Time Factors ; Treatment Outcome
Language	English
Publishing date	2022-10-02
Publishing country	England
Document type	Journal Article
ZDB-ID	1379906-x
ISSN	1651-2006 ; 1401-7431
ISSN (online)	1651-2006
ISSN	1401-7431
DOI	10.1080/14017431.2022.2127873
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Article: The Presence of Residual Vascular and Adipose Tissue Inflammation on

Toivonen, Sini / Lehtinen, Miia / Raivio, Peter / Sinisalo, Juha / Loimaala, Antti / Uusitalo, Valtteri

Nuclear medicine and molecular imaging

2022 Volume 57, Issue 3, Page(s) 117–125

Abstract: Purpose: We evaluated the residual vascular and adipose tissue inflammation in patients with chronic coronary artery disease (CAD) using positron emission tomography (PET).: Methods: Our study population consisted of 98 patients with known CAD and 94 ...

Abstract	Purpose: We evaluated the residual vascular and adipose tissue inflammation in patients with chronic coronary artery disease (CAD) using positron emission tomography (PET). Methods: Our study population consisted of 98 patients with known CAD and 94 control subjects who had undergone Results: The aortic root TBR was higher in CAD patients compared to control subjects, 1.68 (1.55-1.81) vs. 1.53 (1.43-1.64), Conclusion: Patients with a chronic CAD had a higher aortic root and subcutaneous adipose tissue
Language	English
Publishing date	2022-12-26
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2541855-5
ISSN	1869-3482 ; 1869-3474
ISSN (online)	1869-3482
ISSN	1869-3474
DOI	10.1007/s13139-022-00785-z
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Article: Outcomes after Surgery for Endocarditis among Intravenous Drug Users and Nonusers

Huuskonen, Antti / Kesävuori, Risto / Raivio, Peter

The Thoracic and Cardiovascular Surgeon

2021 Volume 71, Issue 01, Page(s) 38–45

Abstract	Background: The optimal treatment strategy for intravenous drug users (IVDU) with infective endocarditis (IE) is controversial. We therefore sought to investigate outcomes among IVDUs after surgery for IE. Methods: We retrospectively reviewed all 192 consecutive patients who underwent an operation for IE between 2005 and 2016 in the Helsinki University Hospital. Forty-seven patients (24.5%) were IVDUs and 145 (75.5%) were non-IVDUs. Mortality and reinfection and reoperation rates were evaluated. Results: IVDUs were younger (29.9 vs. 63.8 years, p < 0.001) and had less cardiovascular risk factors and lower EuroSCORE II (4.3 vs. 7.3%, p < 0.001), but Staphylococcus aureus infection (66.0 vs. 23.4%, p < 0.001), tricuspid valve endocarditis (34.0 vs. 2.8%, p < 0.001), and liver disease (63.8 vs. 2.8%, p < 0.001) occurred more often in IVDUs than in non-IVDUs. Thirty-day mortality of IVDUs was 8.5% and that of non-IVDUs was 6.9% ( p = 0.711). Survival of IVDUs at 5 years was 70.8 ± 7.4% and survival of non-IVDUs was 67.9 ± 4.7% ( p = 0.678). Relative to an age- and sex-matched general population, IVDUs had 58.6 (95% confidence interval [CI]: 33.7–101.9; p < 0.001) and non-IVUD 4.4 (95% CI: 3.1–6.2; p < 0.001) standardized mortality ratio. IVDUs had a higher reinfection rate at 5 years (25.8 ± 7.7% vs. 3.0 ± 1.7%, p < 0.001) and a higher early reoperation rate than non-IVDUs (10.6 vs. 1.4%, p = 0.003). Conclusions: IVDUs and non-IVDUs had comparable survival at 5 years, but IVDUs had a very significantly increased risk of death in comparison to an age- and sex-matched general population. IVDUs had higher reinfection and early reoperation rates. Survival was poor after medically treated reinfection.
Keywords	endocarditis ; heart valve surgery ; outcomes (includes mortality and morbidity)
Language	English
Publishing date	2021-06-27
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	800050-5
ISSN	1439-1902 ; 0171-6425 ; 0946-4778 ; 0172-6137
ISSN (online)	1439-1902
ISSN	0171-6425 ; 0946-4778 ; 0172-6137
DOI	10.1055/s-0041-1727231
Database	Thieme publisher's database

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