Indian Journal of Thoracic and Cardiovascular Surgery最新文献

We report a rare case of aortic dissection with radiologically documented rupture. A 65-year-old man presented with sudden loss of consciousness. Sequential computed tomography (CT), first non-contrast, then contrast-enhanced- captured the transition from dissection to rupture, revealing the intimal tear at the dorsal aspect of aortic root and increase of pericardial sac perforation. This case demonstrates the power of imaging to anatomically pinpoint rupture intermittently, with potential implications for emergent diagnosis.

Primary cardiac lymphoma (PCL) is a rare malignancy, representing less than 1% of primary cardiac tumors. While benign tumors like myxomas more commonly affect the left atrium, malignant lesions-particularly lymphomas and angiosarcomas-typically involve the right atrium. The nonspecific presentation often delays diagnosis and treatment. A 40-year-old male presented with progressive dyspnea, chest pain, fatigue, and pedal edema. Transthoracic and transesophageal echocardiography revealed a large right atrial mass with pericardial effusion. Cardiac magnetic resonance imaging (MRI) showed a heterogeneous mass with peripheral enhancement and central necrosis, initially suggestive of angiosarcoma. Due to inconclusive biopsy findings, the patient underwent surgical debulking. Histopathological analysis confirmed diffuse large B-cell lymphoma (DLBCL) (non-germinal center type) with CD20 positivity and a high Ki-67 index. Postoperative positron emission tomography (PET) scan showed residual mediastinal involvement. The patient received six cycles of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) chemotherapy with intrathecal methotrexate. Follow-up positron emission tomography-computed tomography (PET CT) demonstrated complete metabolic remission, corroborated by echocardiography. This case underscores the importance of including PCL in the differential diagnosis of right atrial masses. Early imaging, prompt tissue diagnosis, and chemotherapy can lead to excellent outcomes even in aggressive disease presentations.

Hemolytic anemia caused by kinking of a prosthetic graft after total arch replacement (TAR) is rare. While many reported cases involve a single angulated ("L-shaped") kink, clinically significant hemolysis is not always observed. We report a unique case of a 68-year-old man who developed progressive aortic regurgitation (AR) and subsequent severe hemolytic anemia ten years after TAR with an elephant trunk using a Triplex® graft for acute type A aortic dissection. Early postoperative imaging showed a mild, single curvature of the ascending graft without evidence of hemolysis. Over time, the graft progressively deformed into a distinct S-shaped kink, accompanied by worsening AR and eventual onset of severe hemolysis. Laboratory findings confirmed hemolysis, and surgical intervention with a Bentall procedure and redo TAR led to prompt resolution of symptoms and laboratory abnormalities. This case highlights that not all graft kinking result in hemolysis, but the evolution to a double-kink (S-shaped) configuration may critically alter hemodynamics, particularly when compounded by progressive AR. Awareness of this progression and careful morphological surveillance of the graft are essential for early detection and timely management. To our knowledge, this is the first report documenting the evolution from a single to S-shaped graft kink as a key trigger for late-onset hemolysis.

Germ cell tumors (GCTs) of the anterior mediastinum are relatively uncommon, with mature teratomas being the most frequent subtype. Although typically benign, mature teratomas may rarely undergo somatic-type malignant transformation, significantly worsening prognosis and posing diagnostic challenges. We report a case of a young female presenting with chest heaviness and exertional dyspnea. Imaging revealed a well-defined anterior mediastinal mass suggestive of a mature teratoma. Thoracoscopic excision was performed, and the mass was found adherent to surrounding vital structures, including the lung, pericardium, and major vessels. Complete resection was achieved through meticulous adhesiolysis. Histopathological evaluation revealed a focus of somatic-type adenocarcinoma arising within a mature mediastinal teratoma, confirming malignant transformation. This case highlights the importance of thorough tissue sampling and histopathological evaluation, crucial for establishing the diagnosis. Given the rarity of such transformations, standardized treatment protocols remain undefined. This case underscores the diagnostic and therapeutic challenges associated with malignant transformation in mediastinal teratomas.

Aberrant right subclavian artery (ARSCA) is a congenital anomaly of the aortic arch where the aberrant artery arises from the descending aorta and traverses the mediastinum, compressing the esophagus in the process. We present a case of a 16-year-old boy who presented with worsening dysphagia of 1 year duration. He was diagnosed with ARSCA causing mass effect on the esophagus. He underwent a simultaneous right common carotid (RCC) to right subclavian artery (RSCA) bypass with an 8-mm polytetrafluoroethylene (PTFE) ringed graft and robot (Da Vinci system)-assisted division of the aberrant artery. He had an uneventful postoperative period, without any complications, and was discharged after 4 days with complete resolution of his symptoms. This case report highlights that the robotic approach is safe and effective, with benefits of minimally invasive surgery like better precision, faster recovery, and return to daily activity post-surgery.

We present a 52-year-old male with end-stage systolic heart failure secondary to dilated non-ischemic cardiomyopathy and recurrent ventricular tachycardia, requiring cardiac resynchronization therapy defibrillator (CRT-D) and intra-aortic balloon pump (IABP) support for cardiogenic shock. Initially supported with a percutaneous femoral IABP, the patient developed significant lower limb deconditioning. To mitigate this, a surgically placed tunneled Dacron graft IABP was introduced to improve mobility and reduce atrophy, enabling structured prehabilitation while awaiting orthotopic heart transplantation (OHT). This approach allowed for safe ambulation and physical therapy without compromising device function, ultimately enhancing functional status pre-OHT. Post-transplant, he required temporary veno-arterial extracorporeal membrane oxygenation (ECMO) and IABP support for primary graft dysfunction and was eventually weaned off devices. Another case involved a 63-year-old male transferred from an outside hospital (OSH) with 95% left mainstem stenosis and diffuse triple vessel coronary artery disease (preoperative right femoral IABP was placed). After emergency triple vessel coronary artery bypass grafting (CABG), he required left femoral veno-arterial ECMO for poor right ventricular (RV) function. He recovered postoperatively, had subsequent ECMO decannulation and IABP replacement with tunneled graft, and was able to engage in physical therapy, with improvement in upright tolerance. Further research is needed to assess infection risks and validate the promising tunneled Dacron graft technique.

Objective: To determine the outcomes of endovascular thoracoabdominal aortic aneurysm (TAAA) repair using t-branch stent graft.

Methods: We performed a systematic search for relevant studies published after 2012 in MEDLINE, Embase, Web of Science, and Cochrane CENTRAL registry. This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement (protocol CRD42022378654). Validity and risk of bias were assessed using the National Heart, Lung, and Blood Institute Quality Assessment Tool. Both random- and fixed-effects models were used to calculate the pooled effect sizes, where appropriate. Sensitivity and subgroup analyses were performed to explore sources of heterogeneity.

Results: Eleven reports from 10 retrospective observational studies, comprising 997 patients, were included. Regarding the perioperative outcomes, the overall technical success rate was 94.2% (95% confidence interval (CI) 90.1-96.6), 30-day mortality 9.0% (95% CI 5.0-13.4), spinal cord ischemia (SCI) 6.7% (95% CI 5.4-8.2), early endoleak 3.5% (95% CI 2.7-4.5), acute kidney injury (AKI) 13.8% (95% CI 8.7-21.3), permanent dialysis 2.5% (95% CI 1.2-5.4), and early reintervention 110 per 1000 person-years (95% CI 68-174). Negative regression coefficients were observed between the number of elective cases and 30-day mortality, AKI, and permanent dialysis. There was a positive regression coefficient between permanent dialysis and American Society of Anesthesiologists (ASA) class 4-5, the number of ruptured aneurysms, and Crawford class I-II-III. The overall mortality beyond the first 30 days was 138 per 1000 person-years.

Conclusion: T-branch stent graft is a safe and effective option to use in endovascular TAAA repair with a good technical success rate and acceptable rate of mortality and complications.

Supplementary information: The online version contains supplementary material available at 10.1007/s12055-025-02044-0.

We report a case of an 60-year-old frail female presenting to us with anterolateral wall myocardial infarction (MI). She had a history of hypothyroidism for the last 10 years and was on Thyroxine 25 µg daily (mcg). A coronary angiogram revealed a distal left main coronary artery having 40-50% occlusion with proximal left anterior descending artery (LAD) and circumflex artery critical stenosis and the lesions were not suitable for percutaneous coronary intervention (PCI). In view of ongoing chest pain with ST elevation in the anterior chest leads, an intraaortic balloon pump (IABP) was inserted. At admission, her thyroid function tests were severely deranged: Thyroid Stimulating Hormone (TSH) was 89.57 mIU/L. Endocrinology consultation prompted an increase in Thyroxine dosage from 25 to 75 mcg per day, with the addition of Triiodothyronine (T3) 20 mcg/day, as intravenous thyroxine was unavailable at our centre. After five days of optimization with thyroid medications and IABP support, emergency On Pump coronary artery bypass graft (CABG) surgery was performed with two grafts. As anticipated, the patient's postoperative course was prolonged due to congestive heart failure and recurrent bilateral pleural effusion, which was managed medically. On literature search at Google and PubMed, regarding Successful CABG surgery with such a high level of TSH, we did not find any study. This case demonstrates that emergency CABG can be successful in severe hypothyroidism with meticulous preoperative optimization and multidisciplinary care.

Renal artery aneurysm (RAA), a type of visceral aneurysm often presenting with nonspecific symptoms, is challenging to diagnose and is typically detected incidentally during imaging examinations. Saccular aneurysms of the renal artery can cause significant compression of the renal parenchyma. In this case, we report a 23-year-old woman diagnosed with a giant saccular left RAA measuring 13 cm × 11 cm × 11 cm. She successfully underwent endovascular treatment involving covered balloon-expandable stent implantation followed by occlusion of the left renal artery branch supplying the aneurysm. The patient was discharged without any complications. This case is notable for the aneurysm's unusually large size in the left renal artery compressing the renal parenchyma, posing a challenge in maintaining adequate blood flow to the left kidney. The innovative endovascular approach not only resolved the aneurysm but also preserved the blood supply to the affected kidney. Endovascular therapy proves to be an effective strategy for managing a giant RAA.