Indian Journal of Thoracic and Cardiovascular Surgery最新文献

The rheumatic mitral disease represents a complex progressive disorder that affects young adults and causes severe morbidity and mortality. Valve replacement with a mechanical valve has been the traditional treatment for these patients. Valve replacement increases longevity but necessitates several lifestyle changes. Improved understanding of the pathophysiology of the disease and standardization of mitral repair techniques, renewed interest is now generated in repairing these complex valves. We review the existing evidence for the repairing rheumatic mitral valve and propose a practical and systematic approach to repair the valve to ensure higher success rates.

Supplementary information: The online version contains supplementary material available at 10.1007/s12055-024-01857-9.

Ultrasound is the standard procedure for central venous catheterization, but despite its use, malposition of the catheter tip can still occur. We are reporting a case where the catheter tip was malpositioned into the left lower pulmonary vein in a patient with a total anomalous pulmonary venous connection. It is crucial to maintain a high index of clinical suspicion to promptly identify and manage malpositioned catheters. Once identified, it is important to decide on whether to retain or redirect the catheter with the appropriate clinical context.

Supplementary information: The online version contains supplementary material available at 10.1007/s12055-024-01817-3.

Kartagener's syndrome is a rare autosomal recessive disease featuring the clinical triad of chronic sinusitis, bronchiectasis, and situs inversus. Situs inversus is associated with dextrocardia wherein the cardiac apex lies over to the right. Acquired valvular lesions in this condition are rare and surgery on them is even rarer. The standard of treatment in a dextrocardiac mitral valve disease is a mitral valve replacement via a right atriotomy. Here, we present a case of mitral valve stenosis with Kartagener's syndrome, in whom a mitral valve replacement was performed via a left atriotomy.

Solitary fibrous tumors (SFTs) are uncommon mesenchymal tumors that primarily develop in the visceral pleura. The chest wall is an extremely rare site for the origin of these tumors and therefore presents unique challenges for diagnosis and management. We present a rare case of solitary fibrous tumors of the chest wall (SFTCW), necessitating extensive resection and complex reconstruction.

Background: Foreign body aspiration is a critical surgical emergency among pediatric patients, carrying a substantial risk of mortality and contributing significantly to respiratory distress in children. Timely intervention by experts is crucial to mitigating cumulative morbidity. This study aims to evaluate the efficacy of bronchotomy as a secure alternative following unsuccessful attempts at bronchoscopic foreign body retrieval.

Methods: A retrospective review of 21 instances involving bronchotomies and resections carried out following unsuccessful bronchoscopic foreign body extraction was conducted between June 2013 and March 2022. The posterolateral thoracotomy approach was employed for surgical interventions.

Results: A total of 21 cases underwent bronchotomy and resectional procedures, with a retrospective follow-up spanning 10 years. Patient ages ranged from 1 to 12 years, predominantly affecting the left lung. Bronchotomy was chosen as the intervention in 85% (18 cases) of instances. The incision was extended towards the foreign body in 8 cases involving the right bronchus and in 13 cases for the left bronchus. Late presenters commonly exhibit hemoptysis. Objects retrieved ranged from pen caps and whistles to metal balls. All enrolled cases underwent preoperative bronchoscopy.

Conclusion: This study underscores the significance of rigid bronchoscopy as the diagnostic and primary intervention for foreign body aspirations in pediatric cases. Bronchotomy emerges as a secure and effective alternative. Retained foreign bodies causing endobronchial obstruction with stasis necessitate resection, while bronchotomy is a safe procedure for non-retrievable foreign bodies without structural changes.

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Supplementary information: The online version contains supplementary material available at 10.1007/s12055-024-01845-z.

Intrathoracic subclavian artery aneurysms are very rare. They can be congenital or acquired and cause compressive symptoms like hoarseness of voice due to vocal cord palsy. Prompt diagnosis and early surgical treatment via aneurysmorrhaphy can lead to complete resolution of symptoms.

Introduction: Thoracic surgery has been conventionally performed via thoracotomy over many years. However, over the past few decades, lung surgery has evolved from open to minimally invasive surgery. Our robotic thoracic surgery programme started in October 2022. Since we were already performing uniportal video-assisted thoracic surgery (Uniportal VATS), we found it difficult to get oriented to the multi-port approach. So we decided to perform uniportal robot-assisted thoracic surgery (URATS). This article represents our initial experience in URATS.

Methods: We analysed the data of people who underwent URATS at our hospital. Twenty-one patients were included in this study. This was a retrospective study. Out of the 21 patients, 14 patients underwent surgery for benign conditions and 7 patients underwent surgery for malignancy. Thirteen patients underwent lobectomy, 1 patient underwent segmentectomy, 3 patients underwent wedge resection, 3 patients underwent mediastinal mass excision, and 1 patient underwent bronchogenic cyst excision. Out of the lobectomy group, 6 patients had benign conditions, the other 6 being operated for malignancy. All surgeries were performed by a single console surgeon using the da Vinci Xi robotic platform and the same assistant at the bedside.

Results: There was no conversion to a multiport robotic thoracic surgery or thoracotomy in our series. The average console time for the entire study group was 177.9 min. The average instrument active time for the entire study group was 130.5 min. The median instrument count per case in our study was 4. The average console time for lobectomy was 231.53 min. The average instrument active time for lobectomy was 174 min.

Conclusions: We conclude that, in appropriate patients, Uniportal RATS can be a safe and feasible alternative to other minimally invasive techniques in both benign and malignant conditions.

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Supplementary information: The online version contains supplementary material available at 10.1007/s12055-024-01862-y.

The anomalous origin of the left circumflex artery (LCx) from the right coronary sinus is one of the most common coronary anomalies. However, it presents a significant technical challenge during aortic root surgery. This case report describes a patient with a bicuspid aortic valve, anomalous circumflex artery origin, severe aortic stenosis and moderate aortic regurgitation, and aneurysms in the ascending aorta and aortic root. We addressed this through the Bentall procedure, utilizing the combined coronary button technique for a safe and successful management approach.

Supplementary information: The online version contains supplementary material available at 10.1007/s12055-024-01808-4.

We report a case of 52-year-old male with chest pain where computed tomography coronary angiography (CTCA) demonstrated rare variant of dual left anterior descending artery (LAD) with anomalous origin and intramyocardial trans septal course of long LAD and normally arising shorter LAD from left main coronary artery terminating in proximal interventricular groove. We propose that this anatomy represents a new variant of dual LAD (Type VI-B). Our case highlights the role of CTCA in identifying such variant anatomy which can attribute to patients' symptoms and guide further management.