Indian Journal of Thoracic and Cardiovascular Surgery最新文献

Tracheobronchial metastases from colorectal adenocarcinoma are rare but clinically significant, often with airway obstruction and severe respiratory symptoms. We report the management of a 63-year-old woman with a history of colorectal adenocarcinoma and recurrent metastatic disease, who developed a large endotracheobronchial mass with complete obstruction of the right main bronchus and partial obstruction of the left main bronchus. This case highlights the fundamental importance of a multidisciplinary approach involving interventional pulmonology, systemic therapy, and advanced thoracic surgery for the effective management of extensive respiratory metastases. Furthermore, it underscores the critical role of meticulous surgical planning and the application of innovative techniques in achieving optimal oncological control while preserving respiratory function.

Aim: To examine the risk factors for transfusion during isolated off-pump coronary artery bypass grafting (OPCAB) and investigate the differential characteristics among patients receiving single versus multiple blood transfusion units.

Methods: This retrospective cohort study evaluated patients undergoing isolated OPCAB at a tertiary care centre. Patients were grouped based on whether they received no transfusion, a single unit, or multiple units of blood. Clinical, demographic, and surgical variables were reviewed to assess associations with transfusion requirements. Predictive factors for single- and multiple-unit transfusion were identified through multivariable analysis.

Results: Compared to patients who required no transfusion, those receiving a single or multiple units were progressively older (56.21 ± 9.1 vs. 58.23 ± 9.03 vs. 60.52 ± 11.67 years, p < 0.0001) and had a higher proportion of females (5.8% vs. 7.3% vs. 19.2%, p < 0.0001). Patients who required multiple transfusions underwent more extensive grafting, as reflected by a higher mean number of grafts (2.93 ± 0.91 vs. 3.07 ± 0.90 vs. 3.22 ± 0.85; p < 0.0001), greater drain outputs (604.26 ± 256.05 ml vs. 683.02 ± 328.25 ml vs. 840.47 ± 613.52 ml; p < 0.0001), and higher rates of re-exploration (0.1% vs. 0.6% vs. 5.4%; p < 0.0001). Multivariable analysis identified number of grafts (Odds ratio (OR) 1.58, 95% Confidence interval (CI) 1.45-1.72), female sex (OR 2.95, 95% CI 2.20-3.97), peripheral vascular disease (OR 1.74, 95% CI 1.10-2.74), elevated creatinine (OR 1.34, 95% CI 1.06-1.70), low preoperative haematocrit (OR 0.85, 95% CI 0.84-0.87), and low body mass index (OR 0.93, 95% CI 0.91-0.95) as significant predictors of multiple-unit transfusion. Similar trends were observed for single-unit transfusion, with number of grafts (OR 1.20, 95% CI 1.10-1.31), low haematocrit (OR 0.95, 95% CI 0.93-0.97), and peripheral vascular disease (OR 1.76, 95% CI 1.10-2.82) emerging as significant predictors, while associations with female sex and renal function were not statistically significant.

Conclusion: A higher number of grafts, low preoperative haematocrit, low body mass index, and peripheral vascular disease were common predictors of both single- and multiple-unit transfusion during OPCAB. In addition, female sex and elevated preoperative creatinine were independently associated with an increased risk of multiple-unit transfusion.

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Supplementary information: The online version contains supplementary material available at 10.1007/s12055-025-02008-4.

Intracavitary (IC) coronary course is an anatomical variant in which a segment of the coronary artery passes inside a cardiac chamber by penetrating through the myocardium. The condition is still under-recognized by cardiac physicians and surgeons despite more frequent reporting. Although it is accidentally diagnosed, with symptoms always unrelated to the IC segment, the risk of complications during cardiac intervention is not uncommon. Percutaneous trans-catheter procedures involving the right side chambers may pose a risk of arterial injury, potentially leading to myocardial ischemia. Moreover, intra-operative dissection of the IC left anterior descending (LAD) artery may cause inadvertent right ventricular injury, with graft anastomosis being technically challenging. A systematic review of literature was conducted on case reports and case series reporting IC coronary course. A total of 200 patients were included, with the diagnosis made either by computed tomography, intraoperatively, or on autopsies. In this article, we aim to provide a structured review focusing on the role of different modalities in diagnosis, clinical hazards associated with interventions, precautions to be implemented, and the current gaps in evidence. In addition, we propose an algorithm for the surgical management of IC LAD requiring bypass graft.

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Tetralogy of Fallot with absent pulmonary valve syndrome (ToF-APVS) is a congenital heart disease with dilated pulmonary arteries causing varied degrees of bronchial compression. Double aortic arch is a complete vascular ring encasing the trachea and oesophagus causing early respiratory compromise. This unique case highlights the concurrence of double aortic arch in ToF-APVS causing respiratory compromise at the tracheal and bronchial levels detected on computed tomography angiography.

Supplementary information: The online version contains supplementary material available at 10.1007/s12055-025-02036-0.

Dilated cardiomyopathy (DCMP), a non-ischaemic heart disease involving ventricular enlargement, is the second most common cause of heart failure, with a prevalence of 1:2500. Few studies document the use of paediatric ventricular assist devices (VADs) such as the Berlin Heart EXCOR (BHE) device in those with sepsis. We report an 18-month-old patient, diagnosed with DCMP-induced refractory heart failure, causing septicaemia and thrombocytopenia. Despite this, BHE implantation was used as a last resort bridge to heart transplantation. Our case highlights the importance of carefully managing BHE in high-risk, compassionate-use patients, challenging existing guidelines and encouraging individualised assessments in VAD application.

Pericardial foreign bodies (FB) are exceptionally rare. Complications of pericardial foreign bodies include infections, pericardial effusion, arrhythmias, myocardial perforation, and constrictive pericarditis leading to heart failure. We demonstrate a case in which a pigtail catheter, which was inserted for pericardial effusion, was not completely removed, resulting in retained FB. We retrieved the FB using uniportal video-assisted thoracic surgery (u-VATS) demonstrating its feasibility. The learning point from this case was that it should be confirmed that the whole pigtail catheter had been removed by post-removal chest radiograph and an echocardiogram.

Purpose: The success of aortic surgery depends on the durability and hemostatic properties of anastomotic techniques to prevent complications such as bleeding, thromboembolic events, and anastomotic disruption. This study evaluated the tensile strength of different suturing techniques ex vivo to assess their suitability for aortic procedures.

Methods: Aortic wall specimens were obtained from porcine ascending aortae and anastomosed to vascular grafts using a 5-0 polypropylene monofilament suture. Four different suturing techniques were evaluated: simple interrupted sutures (Group A, n = 14), simple interrupted sutures with adventitial inversion and horizontal mattress sutures (Group B, n = 14), simple interrupted sutures with a Teflon-felt sandwich (TFS) (Group C, n = 14), and simple interrupted sutures with a TFS combined with horizontal mattress sutures (Group D, n = 14). The maximum tensile strength of each anastomosis was assessed.

Results: The simple interrupted suture technique incorporating a TFS with horizontal mattress sutures (Group D) demonstrated significantly superior tensile strength compared with the other techniques (P < 0.001). Notably, in this group, the fracture site was near the Teflon horizontal mattress suture, whereas in the other groups, fractures occurred adjacent to the simple interrupted sutures.

Conclusion: The TFS technique demonstrated superior tensile resilience among the studied methods, suggesting its potential advantage in aortic surgery. These findings provide a strong theoretical foundation for optimizing anastomotic techniques and warrant further in vivo investigation to validate their clinical applicability in enhancing surgical outcomes.

Graphical abstract:

Supplementary information: The online version contains supplementary material available at 10.1007/s12055-025-02043-1.

A 35-year-old female presented with heart failure. She was evaluated and found to have persistent left superior vena cava, no right superior vena cava (RSVC), coronary arteriovenous fistula into left-sided superior vena cava (LSVC) with left-to-right (L-R) shunt. She underwent closure of fistula using cardiopulmonary bypass and antegrade and retrograde cardioplegia. After opening the distal left circumflex, a coronary probe was passed through the fistula to delineate the course. The fistula was closed from both ends using a pericardial patch. This is a very rare anomaly with a single SVC.