Indian Journal of Thoracic and Cardiovascular Surgery最新文献

[This corrects the article DOI: 10.1007/s12055-021-01324-9.].

Atrial septal defect (ASD) is a congenital heart defect that can be commonly found in adults. The coexistence of ASD with pulmonary alveolar proteinosis (PAP) has not been reported. We report the case of a 35-year-old male farmer who presented with progressive shortness of breath and was diagnosed with a large ostium secundum ASD, severe pulmonary artery hypertension (PAH) and biventricular dysfunction. Despite surgical closure of the ASD and intensive postoperative support, the patient developed profound haemodynamic instability and multi-organ failure, ultimately resulting in death. Histopathological examination of lung tissue revealed secondary PAP, which likely contributed to refractoriness of pulmonary hypertension and hypoxemia, complicating management. This report underscores the need for high suspicion of coexisting lung pathology, such as PAP, in ASD patients with disproportionate PAH, and highlights the complexities of perioperative management and the importance of individualised multidisciplinary care in such rare and challenging clinical scenarios.

Diabetic foot ulcers, especially those affecting the heel, are among the most challenging and severe complications of diabetes mellitus. These ulcers are associated with high rates of morbidity, risk of limb loss, and significant healthcare costs. This comprehensive review provides an updated synthesis of the pathogenesis, classification, conventional and emerging treatment modalities, and the essential role of interdisciplinary care in the management of heel ulcers in diabetic patients. We further share our experience of the past 15 years of diabetic foot management at a tertiary care center. While established interventions like debridement, off-loading, infection control, vascular assessment, and wound closure remain foundational, novel therapies such as negative pressure wound therapy, hyperbaric oxygen, and biological products are increasingly being integrated, particularly for refractory cases. A multidisciplinary approach, incorporating patient education and preventive strategies, is indispensable for improving outcomes and reducing recurrence.

Congenital cystic adenomatoid malformation of the lung (CCAM) is a congenital lung defect characterized by the formation of cysts of varying sizes at different stages of lung morphogenesis. Due to shared causes of embryogenesis disorders, CCAM is associated with other congenital malformations (CMs) in 10-20% of cases. One such CM, an esophageal duplication cyst (EDC), originates from the foregut and accounts for 10-15% of all gastrointestinal tract duplications. The occurrence of CCAM and EDC together in children is rare, with only five documented cases identified in our research. In this report, we present a case of a 16-year-old boy in whom both CCAM and EDC were detected incidentally during a routine examination. Following further evaluation, the patient underwent simultaneous lobectomy and EDC excision using uniportal video-assisted thoracoscopic surgery (uVATS). This case report highlights that simultaneous surgery using uVATS is a safe and effective approach for the management of CMs in the pediatric population.

Oligometastatic lung lesions are often managed with curative-intent surgery, with segmentectomy serving as a parenchyma-sparing procedure that requires precise anatomical knowledge. The sub-superior (S*) segment, first described by Boyden and more recently characterized by Zhou, is an underrecognized lower lobe variant with an incidence of approximately 32%. We report the first case from India of a combined superior (S6) and sub-superior (S*) segmentectomy performed for pulmonary metastasis from a synovial sarcoma. A 38-year-old male with a right thigh synovial sarcoma underwent hip disarticulation, chemotherapy, and subsequent lung metastasectomy. Contrast-enhanced computerized tomography (CECT) with three-dimensional (3D) reconstruction revealed a pleural-based lesion in the lower lobe involving the sub-superior and superior segments, with type 1 sub-superior bronchial anatomy. Surgical resection was planned using the Optimizing the Margins with the Principles of Segmentectomy (OMPS) algorithm, and an extended segmentectomy of S6 and S* was performed via thoracotomy with the modified inflation-deflation method for delineating intersegmental planes. The patient had an uneventful recovery, and final histopathology confirmed negative margins. This case highlights the importance of recognizing the sub-superior segment in surgical planning, particularly in the Indian context where literature remains sparse. Awareness of this variant can aid in achieving oncologic clearance while preserving lung function during complex lower lobe resections.

We report a case of a 32-year-old woman with gradually worsening dyspnea on exertion, where computed tomography (CT) angiography demonstrated a right-sided superior vena cava, which was seen dividing into two channels draining into the right atrium and left atrium, respectively. The present case highlights a rare anomaly, which can be considered to represent the extreme end of the spectrum of superior sinus venosus defect, as well as the role of CT angiography in identifying this rare surgically correctable cardiac defect that may cause cyanosis or a significant left-to-right shunt.

Background: Optimal myocardial protection (MP) remains critical in complex cardiac procedures, particularly double valve replacement (DVR) operations. This study aimed to compare the safety and efficacy of Custodiol versus cold blood cardioplegia (CBCP) for MP in DVR surgeries.

Methods: A prospective, non-randomized controlled trial was conducted on 120 adult cases (aged 18-65 years) undergoing elective DVR surgery. Patients were allocated to receive either Custodiol cardioplegia (group A, n = 60) or CBCP (group B, n = 60). Primary outcomes included postoperative cardiac enzyme levels, mechanical ventilation (MV) duration, and intensive care unit (ICU) stay. Secondary outcomes encompassed postoperative complications, mortality, and hospital stay (HS).

Results: Custodiol cardioplegia demonstrated superior operative efficiency with shorter aortic cross-clamp (ACC) time (98.5 ± 36.1 versus 116.1 ± 38.0 min, p = 0.010). Creatine kinase-MB (CK-MB) levels were notably lower in the Custodiol group (11.90 ± 4.30 versus 13.60 ± 3.40 U/L, p = 0.017), while troponin I levels showed no substantial variation. Custodiol patients experienced shorter ICU stay (3.12 ± 1.10 versus 4.22 ± 1.20 days, p < 0.001) and HS (8.24 ± 1.03 versus 13.39 ± 3.09 days, p < 0.001). However, spontaneous ventricular fibrillation (VF) rates were higher with Custodiol (86.6% versus 26.6%, p < 0.001).

Conclusions: Custodiol cardioplegia provides effective MP in DVR surgery with superior clinical outcomes, including reduced ischemic time and HS, despite increased VF rates.

Graphical abstract:

Supplementary information: The online version contains supplementary material available at 10.1007/s12055-025-02126-z.

Aim: While several global bibliometric studies have examined cardiothoracic surgery research, India's contributions remain largely unquantified. This study aimed to perform a comprehensive bibliometric analysis of all PubMed-indexed publications related to cardiothoracic surgery from India.

Methods: A retrospective review of PubMed was conducted for the period 1948-2024 using six predefined search strategies. Manuscripts were screened using strict inclusion and exclusion criteria and categorized by year, subspecialty, institution, and journal of publication.

Results: A total of 8025 publications across 1014 journals were identified. The publication trajectory revealed three distinct phases: an early phase (1948-1986) with only 106 publications; an acceleration phase (1987-2019) with 5472 publications; and a recent phase (2020-2024) with an average of 489 publications per year, peaking at 566 in 2022. Adult cardiac surgery-including coronary artery bypass grafting, valve surgery, and aortic procedures-accounted for 33.1% of publications, followed by congenital (27.1%) and thoracic surgery (20.8%). The All India Institute(s) of Medical Sciences contributed the highest overall output. The Indian Journal of Thoracic and Cardiovascular Surgery (IJTC) emerged as the most frequently chosen journal in the last 5 years, accounting for 12.3% of all recent publications.

Conclusion: This bibliometric analysis highlights India's expanding academic footprint in cardiothoracic surgery, reflecting evolving research priorities, increasing subspecialization, and a growing preference for domestic specialty journals.

Graphical abstract:

Supplementary information: The online version contains supplementary material available at 10.1007/s12055-025-02087-3.

Peripheral arterial disease (PAD) is a chronic vascular condition characterized by narrowing or obstruction of arteries to the extremities, leading to symptoms such as intermittent claudication, rest pain, foot ulcers, and gangrene. Its severe form is known as critical limb ischaemia (CLI), which is characterized by rest pain, tissue loss, and reduced perfusion pressures. Most CLI patients have multiple medical comorbidities ranging from diabetes, hypertension, hypercholesterolemia, to ischaemic heart disease, chronic lung disease, and previous strokes. The most effective management of CLI requires a multidisciplinary approach that integrates expertise from vascular surgeons, endocrinologists, podiatrists, interventional radiologists, microbiologists, plastic surgeons, primary care physicians, and specialist nurses. This article explores the pivotal role of multidisciplinary team foot clinics (MDT foot clinics) in the holistic management of CLI, emphasizing their benefits in providing patient-centric care and better clinical outcomes with cost-effectiveness. The MDT foot clinics are the best approach to CLI management, as they provide diagnostic evaluations, wound care, infection control, long-term medical therapy, and referrals for any revascularization procedure, all in a single coordinated setup. These clinics also address barriers such as transportation challenges, high-frequency visits made by patients, distrust of healthcare systems, and expensive treatment options hence, providing a more patient-centered approach. Multiple studies have demonstrated that the introduction of these clinics has significantly reduced the rates of amputation and inpatient admissions and has improved treatment outcomes and limb salvage rates. In conclusion, the multidisciplinary approach is indeed the gold standard approach that paves a path to better outcomes in patients with CLI by delivering superior outcomes through comprehensive, integrated, and patient-centric care. This approach focusses on most, if not all, aspects of management, starting from treating the active disease symptoms, preventing the disease progression, and also enhancing the quality of life with regular follow-ups and continuous monitoring of patients, all in a community setup.