Indian Journal of Thoracic and Cardiovascular Surgery最新文献

Background: Alternative access approaches are required for transcatheter aortic valve replacement (TAVR) cases wherein the transfemoral approach is restrictive with severe calcification. We aimed to examine the safety of the external iliac artery (EIA) as an alternative access site by evaluating the calcification distributions from the common iliac artery (CIA) to the common femoral arteries (CFA).

Methods: We retrospectively enrolled 402 patients who underwent TAVR. Using computed tomography, calcification was visually assessed based on the maximal circumferential involvement, length, and morphology, and its volumes were quantitatively measured using a minimum threshold of 600 Hounsfield units in 804 arteries.

Results: The calcification volumes were 0.301 (interquartile range, 0.114-0.624) cc in the CIA, 0.0 (0.0-0.041) cc in the EIA, and 0.047 (0.002-0.158) cc in the CFA (p < 0.01). Maximum calcification of >50% of the arterial circumference was observed in only 7.3% of the EIA, compared to 35.2% and 10.8% of the CIA and CFA, respectively. Almost 55% of the EIA had no calcification, compared with only <5% and 22.7% of the CIA and CFA, respectively. In a subgroup analysis of patients on dialysis, the calcification volume was smallest in the EIA at 0.011 (0.0-0.127) cc (p < 0.01). In all, 33.3% of EIAs had no calcification, while 2.0% of CIAs and 19.6% of CFAs were calcification-free.

Conclusions: Calcification rarely presents qualitatively and quantitatively in the EIA, suggesting that it could be an option for TAVR when the transfemoral access is unsuitable.

Graphical abstract: We qualitatively and quantitatively evaluated the distribution of calcification in the iliofemoral arteries of patients who underwent TAVR. The calcification was more rarely present in the EIA than in the CIA or CFA.

Supplementary information: The online version contains supplementary material available at 10.1007/s12055-024-01841-3.

We report a case of a 73-year-old male, presenting with persistent cough and shortness of breath. He was diagnosed with an anterior mediastinal mass with significant recurrent loculated pleural effusion. The pre-operative biopsy from the mass was inconclusive. The patient underwent video-assisted thoracoscopic decortication on the left side followed by anterolateral thoracotomy for radical mediastinal mass excision, with notable challenges including mass being densely adherent to critical mediastinal structures intra-operatively and atrial fibrillation postoperatively. Final histopathology was suggestive of "capillary hemangioma." This case highlights the complexity of diagnosing and managing such rare mediastinal mass and the importance of a multidisciplinary approach.

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.