Indian Journal of Thoracic and Cardiovascular Surgery最新文献

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.

Graphical abstract:

The term "broncholithiasis" is defined as the presence of calcified material in the tracheobronchial tree. Broncholithiasis is usually asymptomatic when it does not cause any erosion in the airways. However, the most common symptoms of broncholithiasis include cough, hemoptysis, and wheezing due to irritation of the airways and surrounding tissues. Herein, we present a patient with chronic cough and hemoptysis due to broncholithiasis.

Purpose: Acute aortic dissection is a serious cardiovascular emergency with a high mortality rate. Its pathogenesis is complex and remains unclear. This study aimed to assess the connection between the levels of genetically predicted circulating metabolites and the risk of aortic dissection.

Methods: A two-sample Mendelian randomization (MR) approach was employed to determine the causal relationship between genetically determined metabolites and the incidence of aortic dissection. In total, 1091 specific metabolites were identified from genome-wide association study (GWAS) data and aortic dissection involving 207,011 participants. Causal inference was performed using the inverse-variance weighted (IVW) method, supplemented by extensive sensitivity analyses to ensure the validity of the results. In addition, pathway analysis was performed using the Metaconflict 5.0 platform.

Results: We found that six serum metabolites were genetically associated with an increased risk of aortic dissection, whereas eleven metabolites were associated with a decreased risk, and these associations were confirmed by rigorous sensitivity analyses. Reverse MR analysis indicated that aortic dissection could decrease the serum level of kynurenine (odds ratio (OR) = 0.9675, 95% confidence interval (CI) 0.9383-0.9976, P _IVW = 0.0344). The metabolic pathways suggested that steroid hormone biosynthesis, steroidogenesis, and bile acid biosynthesis are involved in the pathogenesis of aortic dissection.

Conclusion: This MR analysis revealed a significant association between seventeen serum metabolites and the risk of aortic dissection. Further research is needed to fully elucidate the complex mechanisms underlying these associations.

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Supplementary information: The online version contains supplementary material available at 10.1007/s12055-024-01807-5.

Anomalous brachiocephalic vein (ABCV) is a rare entity of head and neck venous channel variations and malformations. Amongst the five subtypes of ABVC, double left brachiocephalic vein (DLBCV) is the rarest. We present the case of a 1-year-11-month-old syndromic child, who had global developmental delay (GDD) with Sprengel deformity and failure to thrive (suspected Klippel Feil phenotype), who presented to us for the cardiac evaluation. Her 2D echocardiography revealed unobstructed total anomalous supra-cardiac pulmonary venous connection. However, for the delineation of individual pulmonary venous course, CT-pulmonary angiography was advised. CTPA revealed supra-cardiac total anomalous pulmonary venous connection (TAPVC) with incidentally noted DLBCV. Importance of recognition of DLBCV enables us to prevent accidental venous injury during cardiac surgery and to avoid intraoperative technical issues during transvenous pacemaker insertion.

Isolated right superior vena cava (RSVC) drainage into the left atrium (LA) is a rare congenital anomaly, presenting diagnostic and management challenges. This study presents two cases of isolated RSVC drainage into the LA alongside a comprehensive literature review to improve understanding and delineate optimal surgical approaches. The study describes two cases of isolated RSVC drainage into the LA and their surgical management. Additionally, it includes a narrative literature review summarizing existing knowledge and highlighting key clinical insights regarding this rare anomaly. Both cases exhibited diverse clinical manifestations, such as cerebral abscess and dyspnea, leading to detailed evaluation revealing RSVC drainage into the LA. Surgical correction involved intracardiac baffle surgery in one case and extracardiac re-implantation in the other, resulting in successful symptom resolution. The literature review uncovered challenges in diagnosis, embryological hypotheses, and various surgical techniques employed for correction. Isolated RSVC drainage into the LA poses a diagnostic and therapeutic challenge due to its rarity. Recognizing salient clinical features and diverse presentations underscores the importance of early identification and appropriate surgical intervention. These cases contribute to understanding this anomaly and advocate for tailored surgical approaches based on individual patient characteristics.

Background: Literature is not clear whether women experience increased mortality and adverse events after coronary artery bypass grafting (CABG). Studies have shown that women had comparative outcomes to men in off-pump CABG (OPCAB). Hence, we undertook this study to understand the short- and long-term outcomes of women compared to men after OPCAB.

Methods: Two thousand two hundred patients who underwent OPCAB from November 2014 to December 2021 were included in the study. Median follow-up period was 4.8 years. We performed propensity matching to match 404 women to 404 men.

Results: In the unmatched cohort, women had increased cardiovascular mortality and inferior major adverse cardiovascular and cerebral event (MACCE)-free survival. In the matched cohorts, there was no difference in the 30-day mortality, long-term survival, MACCE-free survival, and cardiovascular mortality between the sexes. Cox proportional hazard showed post-operative renal failure (p-value < 0.001; hazard ratio (HR) 11.469) (confidence interval (CI) 2.911-45.180), post-operative stroke (p-value 0.023, HR 6.473) (CI 1.295-32.356), EuroSCORE II > 6 (p-value 0.022, HR 3.561) (1.204-10.531), emergency surgery (p-value 0.022, HR 3.498) (CI 1.202-10.177), and ventilation hours (p-value 0.004, HR 3.327) (CI 1.455-7.607) were the risk factors associated with long-term mortality in women.

Conclusion: Our study showed that the increased risk profile of women was the reason for inferior MACCE-free survival and increased cardiovascular mortality in women in the long term after OPCAB. When the risk factors were matched, women had comparable outcomes to men.

Graphical abstract:

Autoimmune hemolytic anemia (AIHA) secondary to mediastinal teratoma is a very rare clinical entity. They can be primary or secondary to any infections, malignancy, etc. Yet at times, there could be a delay in the diagnosis. Here we present a rare presentation of mediastinal teratoma and probably this is the first from India, based on our literature review using PubMed and Scopus as search engines with MeSH (Medical Subject Headings) words "mediastinal teratoma AND India AND hemolytic anemia." A 26-year-old male with cough and effort intolerance was diagnosed with AIHA which was triggered by a mediastinal teratoma. He had difficulty in preprocedural blood transfusion due to incompatibility which needed high-dose methylprednisolone to suppress the immune system. Due to prior usage of pulse steroids, we had the challenge of ruling out hematological malignancy, which was done by bone marrow examination and positron emission tomography (PET) scan of the whole body. AIHA resolved completely with open thoracotomy and excision of the tumor.

Testing methods of detecting various cardiac biomarkers play a significant influence in determining and treating cardiac-related conditions and ultimate prognosis. With the increasing global prevalence of cardiac disease, the importance of rapid testing methods in diagnosis and management has grown tremendously. The point-of-care testing (POCT) method is a potential biochemical diagnostic technique that may overcome the issue of delayed laboratory results, particularly in regions with limited access to advanced laboratory equipment or resource-constrained. Point-of-care (POC) diagnostics are also a user-friendly method and may be easily utilised by laboratory personnel and other healthcare professionals with fundamental basic training in remote areas where specialised laboratories may be challenging to access. Another recent development is of various biosensors with incorporation of artificial intelligence (AI) technology to give early test results that may enable immediate clinical decisions, thereby enhancing the patient's health outcomes. This narrative review has been done with the aim of enhancing knowledge for current POCT methods, their diagnostic role in major cardiac ailments, comparison with other standard methods with ongoing clinical trials, and future developments. Information for this review article has been gathered and compiled by searching major databases on the internet with recent clinical trials and assessed on the Scale for the Assessment of Narrative Review Articles (SANRA) to present here.

Supplementary information: The online version contains supplementary material available at 10.1007/s12055-024-01850-2.