Indian Journal of Thoracic and Cardiovascular Surgery最新文献

This report demonstrates the results and technical features of reconstructive operations in 15 patients with pseudoaneurysms of peripheral arteries in a military field hospital after shrapnel wounds. Localization of pseudoaneurysm: 26.7%, axillary artery; 20%, brachial artery; 13.3%, popliteal artery; 13.3%, posterior tibial artery; 13.3, superficial femoral artery; 6.7%, radial artery; 6.7%, deep femoral artery. In 53.3% of cases, autovenous grafting with a reversed great saphenous vein was performed; and 46.7%, resection of an artery section with end-to-end anastomosis. No complications were recorded in any cases. Neuropathy regressed in 7 of 12 patients 19.5 ± 2.5 days after surgery. In the presence of a shrapnel wound to the extremities, it is necessary to routinely perform ultrasound of the vessels in order to search for signs of an asymptomatic pseudoaneurysm. The choice of surgical technique should always be personalized, taking into account the topographic features of the lesion. A pronounced cicatricial process and close location of peripheral nerves create technical difficulties in isolating arteries and removing aneurysm.

Wars and crises have historically acted as powerful catalysts for advances in cardiovascular surgery. Throughout the twentieth and twenty-first centuries, periods of armed conflict and global emergencies have driven surgical innovation, accelerated technological development, and reshaped clinical priorities. This review explores how wartime conditions, with their urgent need for effective treatment of vascular and cardiac injuries, fostered the emergence of new techniques such as arterial repair, cardiopulmonary bypass, and heart valve replacement. It also examines how public health crises, including the coronavirus disease 2019 (COVID-19) pandemic, further transformed cardiovascular surgical practice by introducing new protocols, technologies, and logistical frameworks. Drawing on historical milestones, surgical breakthroughs, and lessons learned under extreme conditions, this article highlights the enduring impact of crises on the evolution of cardiovascular surgery and reflects on how these experiences continue to influence contemporary surgical strategies.

Complete heart block (CHB) is a rare complication particularly associated with primary hyperparathyroidism (PHPT). In this case report, we discuss the successful management of a 61-year-old male patient who was referred to the institute with symptomatic CHB attributed to PHPT. The patient was admitted to the center with high levels of serum calcium and parathyroid hormone (PTH). After stabilizing the patient's condition, he underwent parathyroidectomy surgery. There was an adenoma in the patient's lower left parathyroid gland, and a left lower parathyroidectomy was performed. There was also a large calcified nodule in the left lip of the thyroid, which was successfully removed. Postoperative follow-up showed improvement of CHB, modification of serum calcium levels, and PTH concentrations returned to normal. This case emphasizes the importance of timely recognition and management in patients with PHPT; early intervention in these patients can significantly improve treatment outcomes and prevent arrhythmia-related complications.

Inferior vena cava filters are commonly used in patients with venous thromboembolism who cannot tolerate anticoagulation. While retrievable filters are preferred, many remain in place long-term, increasing the risk of complications such as filter strut fracture and embolization. We present a case of a 47-year-old female with an incidentally discovered intracardiac filter strut fragment, 16 years post-implantation. Minimally invasive surgical removal was performed, while an additional embolized fragment in the pulmonary artery was managed conservatively. This case underscores the importance of timely filter retrieval to prevent complications and highlights management considerations for embolized struts.

Intramuscular hemangiomas (IMHs) are rare benign vascular tumors primarily occurring within skeletal muscle. Their incidence in the chest wall is even less common, often leading to misdiagnosis. This report discusses a case of IMH in a 51-year-old male with a history of chest trauma. It is the first case to be reported in Ethiopia. A 51-year-old male presented with a 2-year history of progressive swelling on the right lateral chest wall, accompanied by intermittent pain exacerbated by exercise. Three years prior, he sustained a chest injury in a car accident, with subsequent imaging showing no significant abnormalities other than a superficial laceration. Examination revealed a firm, smooth mass measuring 10 × 12 cm over the 8th to 10th ribs. Imaging and fine needle aspiration cytology (FNAC) identified a spindle cell neoplasm, leading to surgical excision, which confirmed the diagnosis of IMH. IMHs represent less than 1% of all hemangiomas, typically arising in individuals under 30. Although often asymptomatic, they can present as palpable masses, pain, or discomfort. Imaging such as computed tomography (CT) scans can assist in evaluation, while magnetic resonance imaging (MRI), though not performed in this case, is useful for diagnosis. Complete surgical excision remains the optimal treatment. This case underscores the importance of considering IMH in adults presenting with unexplained chest wall masses, particularly following trauma. Careful postoperative monitoring is recommended due to the risk of recurrence.

Aggressive angiomyxoma (AAM) is a rare mesenchymal tumor in males, predominantly arising in the pelvis or perineum. We report a unique case of a seventy-year-old male presenting with a progressive exophytic cardiac mass originating from the left ventricle (LV). Imaging revealed a well-circumscribed mediastinal tumor compressing the lung and involving cardiac structures. Surgical excision was performed with cardiopulmonary bypass support, including left lower lobectomy due to extensive lung adherence. Histopathological evaluation confirmed the diagnosis of angiomyxoma. The patient recovered uneventfully and was discharged on the tenth postoperative day. This case highlights the diagnostic challenges and multidisciplinary management of AAM involving the heart, emphasizing the importance of meticulous surgical planning and comprehensive follow-up to mitigate the risk of recurrence.

Supplementary information: The online version contains supplementary material available at 10.1007/s12055-025-02028-0.

Purpose: This study aims to compare the effectiveness, safety, and outcomes of trans-axillary thoracotomy and full sternotomy for surgical repair of simple congenital cardiac anomalies in children.

Methods: A cross-sectional retrospective study was conducted on 90 paediatric patients (aged 2-11 years) treated at Assiut University Heart Hospital between 2010 and 2017. Patients were randomly distributed into trans-axillary thoracotomy and full sternotomy groups. Echocardiography and physical assessments were performed. Operative and postoperative metrics (surgical time, bypass time, intensive care unit (ICU) stay, complications, and analgesic requirements) were collected from medical records and analysed using independent t-tests with statistical significance set at p < 0.05.

Results: Full sternotomy exhibited a shorter operative, bypass, and ischaemic time compared to trans-axillary thoracotomy (p < 0.001). Despite these challenges, trans-axillary thoracotomy had a lower rate of wound complications (11.1% vs. 24.4%) (p = 0.022) and required less postoperative analgesia (p = 0.027), with better pain management and cosmetic results. Trans-axillary thoracotomy was associated with marginally longer ICU (1.40 vs. 1.16 days) and hospital (5.42 vs. 4.13 days) stays postoperatively.

Conclusion: Despite longer surgical times, trans-axillary thoracotomy is a safe and effective minimally invasive alternative to full sternotomy, providing significant cosmetic and recovery benefits. Its successful adoption depends on surgeon expertise and patient selection. Further research should also be aimed at improvements in trans-axillary thoracotomy techniques, leading to reductions in surgical times and longer-term clinical outcomes.

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Purpose: Transversus thoracic muscle plane block (TTPB) is an upcoming modality for analgesia post-sternotomy. We aimed to evaluate the effect of pre-operative TTPB on post-operative analgesia in cardiac surgical patients undergoing sternotomy.

Methods: Seventy patients (18-65 years) of either gender, posted for cardiac surgery needing midline sternotomy, were prospectively enrolled and block randomized into two groups of 35 each -group T (receiving TTPB) and group C (control). Post-operative analgesia was monitored using the Numerical Rating Scale (NRS) during rest, cough, and incentive spirometry. Diaphragmatic excursion and arterial blood gases (ABG) were used to measure post-operative respiratory function, along with total opioid consumption and the duration of post-operative mechanical ventilation.

Results: NRS at rest, during cough and spirometry was significantly lower in group T at 6, 12, and 24 h post-surgery (p < 0.0001). Bilateral diaphragmatic excursion (at rest and maximal inspiration) was reduced more in group C than group T (p < 0.0001 at 12 h and 24 h post-operatively). Mean opioid consumption in the first 24 h after surgery was much lesser in group T (232.29 µg vs 373 µg, p < 0.0001), along with a lesser need for rescue analgesia in the same group. The mean duration of mechanical ventilation was 9.31 h in group T and 11.53 h in group C (p < 0.0001).

Conclusion: Administering TTPB prior to midline sternotomy in cardiac surgeries is an effective way of providing post-operative analgesia. It also improves the diaphragmatic excursion, reduces opioid consumption, and aids in faster extubation.

Trial registration: The study has been registered with the Clinical Trials Registry of India prior to patient enrolment.(CTRI/2022/10/046536).Link to webpage- https://ctri.nic.in/Clinicaltrials/regtrial.php?trialid=75409&EncHid=13705.55824&modid=1&compid=19 Date of registration: 17/10/2022.Date of first patient enrollment: 21/10/2022.

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Supplementary information: The online version contains supplementary material available at 10.1007/s12055-025-02015-5.