Indian Journal of Thoracic and Cardiovascular Surgery最新文献

Inferential statistics enable researchers to make predictions about a population based on sample data. This involves hypothesis testing where the null hypothesis assumes no effect, and the alternative hypothesis suggests a significant effect. Testing requires assumptions like normality and independence to be validated using tests like Shapiro-Wilk or Levene's for normality and variance. Significant findings are determined by p-values, with values under 0.05 typically indicating non-random effects. Choosing between parametric and non-parametric tests depends on data normality and variance homogeneity. Tools such as t-tests, analysis of variance (ANOVA), and their non-parametric counterparts like Mann-Whitney or Kruskal-Wallis are used based on these criteria, ensuring appropriate conclusions about clinical effects and interventions.

Aspiration pneumonia is a serious problem in the elderly due to weakened swallowing reflexes or underlying gastroesophageal reflux disease (GERD). This can lead to acute respiratory distress syndrome (ARDS), which can become life-threatening, sometimes requiring extra corporeal membrane oxygenation (ECMO) support. Lung transplantation is a possible therapeutic option for patients with no signs of lung recovery despite prolonged ECMO support. However, this can be a particularly challenging situation in a geriatric population. We report the case of a 79-year-old male with aspiration pneumonia leading to severe ARDS who underwent successful bilateral lung transplantation after 60 days of ECMO support.

We report a case of a 14-year-old girl with complex congenital heart disease where computed tomography (CT) angiography demonstrated a giant aneurysm of the right inferior pulmonary vein, in the absence of any downstream obstruction. The case highlights the developmental aspects of this rare anomaly in addition to the role of CT angiography in anatomical depiction of structures which are difficult to visualize on transthoracic echocardiography.

In congenital heart surgery, redo-sternotomies are very common. In most cases, sternal re-entry is achieved without serious complications. However, sometimes elective institution of peripheral cardiopulmonary bypass is needed for safe sternotomy, albeit with a long cardio-pulmonary bypass time. We report our initial experience of three-dimensional reconstruction and virtual dissection of the retrosternal space, using Horos®, an open-source software, which uses the computed tomography (CT) scan dataset from a 64-slice CT pulmonary angiogram. We reconstructed three-dimensional images to help us conceptualize the retrosternal space for safer re-entry, which could be viewed in stereo with depth perception using anaglyph glasses. Once reconstructed, the substernal space could be viewed from multiple angles and this helped us better understand the anatomy for re-entry. The CT scans, though being the age-old imaging modality for assessment of the anatomy, leave room for assessment of the sub-sternal space. Recently, we encountered three patients in whom the sternal re-entry was deemed to be difficult. The CT scan left ambiguity in assessment of the substernal space and all three patients were assessed with 3-dimensional (3D) reconstruction and virtual dissection prior to sternotomy. All three patients underwent a safe redo-sternotomy without institution of cardiopulmonary bypass. Three-dimensional rendering of CT dataset as a novel technique has the potential to help surgeons visualize the retrosternal space in three dimensions and better understand the spatial relation of the heart with the inner table of the sternum.

Supplementary information: The online version contains supplementary material available at 10.1007/s12055-024-01879-3.

Infective endocarditis (IE) in children is a rare entity which presents a high rate of events during follow-up. Congenital heart disease, i particular ventricular septal defect (VSD), is the main predisposing condition to IE at those ages. The long-term risk of IE is of concern and whose follow-up can be complicated by a relapse of IE and reintervention. The endocarditis can affect the aortic valve (AV) and induce destructive lesions such as perforation of the valve making it leaky. We report an uncommon case of recurrent endocarditis on restrictive perimembranous VSD, and onset of severe aortic regurgitation after surgical closure, requiring a reoperation.

Minimally invasive mitral valve surgery (MIMVS) is revolutionizing the field of cardiothoracic surgery by offering patients less invasive alternatives to conventional sternotomy. This article reviews recent research and studies on the outcomes, challenges, and considerations surrounding MIMVS. Comparative studies reveal that while MIMVS offers advantages such as shorter hospital stays and reduced recovery times, it shows no significant differences in mortality or long-term quality-of-life outcomes compared to traditional methods. Techniques like mini-thoracotomy and artificial chordae have demonstrated safety and efficacy, although specific challenges such as higher rates of recurrent mitral regurgitation and the need for extensive postoperative monitoring persist. The learning curve for MIMVS emphasizes the importance of surgical expertise, with improved outcomes observed after mastering the procedure. Furthermore, complex degenerative mitral regurgitation presents unique challenges but can be effectively managed with tailored approaches. Patient selection, surgeon experience, and individualized treatment strategies are pivotal factors in achieving optimal results. While promising, the overall benefits of MIMVS require further exploration through large-scale randomized trials focusing on patient-reported outcomes and long-term success.

Purpose: Despite significant improvements in the design and performance of continuous flow left ventricular assist devices (CFLVADs), one of the most important reasons hampering further penetration of this technology is the occurrence of adverse events, especially strokes. One of the well-known risk factors for strokes is hypertension which is particularly common in patients undergoing a CFLVAD implant. While the device is implanted in the heart, strokes happen due to pathology in the brain and we hypothesised that modelling the blood flow in the circle of Willis might shed light on the causation of strokes in this situation.The aim of the study was two-fold:1. What is the reason for hypertension in CFLVADs? Are there physical factors at play, besides neurohumoral mechanisms?2. Do anatomical factors in the circle of Willis play a role in the causation of strokes in these patients?

Methods: The circle of Willis is often incomplete and has a number of anatomical variations, the commonest being the absence of the posterior communicating artery. Hypertension is common after CFLVAD implantation and is also a well-known risk factor for strokes. We examined the blood pressure in the cerebral circulation with pulsatile and non-pulsatile flow for identical conditions and the effect of the absence of the posterior communicating artery on regional cerebral blood flow and pressure. One-dimensional blood flow model was used, taking into account wave propagation and reflections and physiological data obtained from anatomically detailed arterial network (ADAN86) which has data from 86 arteries including detailed cerebral network.

Results: The mean arterial pressure was significantly higher in the non-pulsatile blood flow of CFLVADs compared to pulsatile flow, for identical conditions, across all arteries. With increasing imparted pulsatility to CFLVAD flow, the mean arterial pressure progressively decreased. Isolated absence of the posterior communicating artery had no effect on the flow as well as pressure in the middle cerebral artery. However, when combined with the absence of flow in the ipsilateral carotid artery, the flow as well as the pressure decreased very significantly in both continuous and pulsatile flow situations.

Conclusions: Physiologically significant pulsatility in CFLVADs can have important clinical advantages in lowering of blood pressure which can lead to lower incidence of strokes, pump thrombosis, gastrointestinal (GI) bleeds, and aortic incompetence. Patient-specific anatomical variations in the circle of Willis, especially the absence of the posterior communicating artery, can have important consequences in regional cerebral perfusion under some circumstances.

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