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Different ascending aortic phenotypes with similar mutations in 2 patients with Loeys-Dietz syndrome type 2 2例2型Loeys-Dietz综合征升主动脉表型相似突变的分析
4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-06-11 DOI: 10.1093/icvts/ivac159
R. Heck, Björn Fischer-Zirnsak, J. Photiadis, D. Horn, P. Gehle
Abstract Our goal was to present 2 infants with confirmed Loeys-Dietz syndrome. The missense mutations in exon 7 of the TGFBR2 gene are only 5 codons apart (c.1597T>C and c.1582C>G). Phenotypically, the aneurysms of the ascending aorta were restricted to different segments of the aorta: the suprajunctional segment in 1 patient and the aortic root in another. These cases highlight the complexity of signaling pathways and gene expression in the pathogenesis of aortic aneurysms.
我们的目的是介绍2例确诊的Loeys-Dietz综合征的婴儿。TGFBR2基因外显子7错义突变仅相隔5个密码子(C . 1597t >C和C . 1582c >G)。在表型上,升主动脉的动脉瘤局限于不同的主动脉段:1例为结上段,另1例为主动脉根。这些病例突出了信号通路和基因表达在主动脉瘤发病机制中的复杂性。
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引用次数: 0
Press tack needle stimulation for blunt chest trauma: a randomized double-blind control trial 按压针刺激治疗钝性胸外伤:随机双盲对照试验
4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-06-07 DOI: 10.1093/icvts/ivac158
P. Kao, Bernice Lottering, Ting-Yu Lu, W. Ho, Yu-sen Lin, Tzu-Min Huang, Chien-Kuang Chen, Jian‐Xun Chen, Yu-Chen Lee, Fang-Pey Chen, E. Ben-Arie
Abstract OBJECTIVES Blunt chest trauma is often associated with severe pain, reduced lung function and decreased sleep quality. This study aims to investigate the immediate and long-term effect of acupuncture on these factors using a randomized control double-blind design. METHODS A total of 72 patients were randomized into 2 groups: treatment group (press tack acupuncture) and control group (press tack placebo). The face rating scale, numerical rating scale (NRS), portable incentive spirometer and Verran Snyder-Halpern sleep scale were measured at baseline, immediately after the intervention, and at the 4th day, with 2-weeks and 3-months follow-ups. RESULTS There were no significant changes between the groups at the baseline measurements, with the exception of hypertension comorbidity. Immediately after the intervention and on the 4th day follow-up, the patients in the treatment group showed a significantly lower face rating scale when compared to the control (P < 0.05). There were no significant changes in any of the other measurements between the groups (P > 0.05). Subgroup analysis revealed that the NRS for turn over on the 4th day was reduced significantly in the treatment group of patients without lung contusion (P < 0.05). For patients without pleural drainage, cough NRS in the treatment group was significantly reduced in the 2-week follow-up (P < 0.05). CONCLUSIONS This study showed that press tack acupuncture effects on pain reduction were inconclusive. However, future studies on the effect of acupuncture on blunt chest trauma patients are needed. Clinical trial registration clinicaltirl.gov: NCT04318496.
钝性胸部创伤常伴有剧烈疼痛、肺功能下降和睡眠质量下降。本研究采用随机对照双盲设计,旨在探讨针刺对这些因素的即时和长期影响。方法将72例患者随机分为治疗组(按钉针刺)和对照组(按钉安慰剂)。面部评分量表、数值评分量表(NRS)、便携式激励肺活量计和Verran Snyder-Halpern睡眠量表分别在基线、干预后立即和第4天进行测量,随访2周和3个月。结果:除了高血压合并症外,两组在基线测量时无显著变化。干预后即刻及随访第4天,治疗组患者面部评分量表明显低于对照组(P < 0.05)。亚组分析显示,无肺挫伤治疗组第4天翻身NRS显著降低(P < 0.05)。对于无胸腔引流的患者,治疗组在随访2周后咳嗽NRS明显降低(P < 0.05)。结论:本研究显示按钉针刺对减轻疼痛的作用尚无定论。然而,针刺对钝性胸外伤患者的疗效有待进一步研究。临床试验注册:clinicaltir.com: NCT04318496。
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引用次数: 1
Do we need new devices for surgical mitral valve repair? 外科二尖瓣修复需要新器械吗?
4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-06-07 DOI: 10.1093/icvts/ivac140
L. Müller
In their article ‘Usability, performance and safety of a new device for degenerative mitral regurgitation: in vivo chronic evaluation’, Zeitani et al. [1] present 3-month results of a chronic sheep model using a novel annuloplasty device with an intraventricular bridge for anchoring premeasured artificial chordae to facilitate mitral valve repair. The authors are to be congratulated for their innovative work and the promising shortto mid-term results of the new device.
Zeitani等人在他们的文章《一种用于退行性二尖瓣反流的新装置的可用性、性能和安全性:体内慢性评估》中,介绍了一种新型环成形术装置在慢性绵羊模型中使用3个月的结果,该装置带有心室桥,用于锚定预先测量的人工索,以促进二尖瓣修复。值得祝贺的是,作者们的创新工作以及新设备有望在短期到中期取得的成果。
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引用次数: 0
Extracorporeal membrane oxygenation support in carinal resection for recurrent chondrosarcoma after previous distal tracheal resection 气管远端切除术后复发软骨肉瘤隆突切除术的体外膜氧合支持
4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-06-02 DOI: 10.1093/icvts/ivac148
L. Voltolini, A. Salvicchi, G. Cianchi, S. Bongiolatti
Abstract Carinal re-resection for tumour recurrence is rarely performed due to increased difficulty in airway reconstruction. We reported a successful case of carinal resection and reconstruction for recurrent chondrosarcoma after previous distal tracheal resection. Due to the technical complexity of the reconstruction and the poor respiratory reserve of the patient, the veno-venous extracorporeal membrane oxygenation support was used.
由于气道重建的难度增加,隆突再切除治疗肿瘤复发的病例很少。我们报告了一例成功的隆突切除和重建复发软骨肉瘤前远端气管切除术。由于重建的技术复杂性和患者呼吸储备较差,采用静脉-静脉体外膜氧合支持。
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引用次数: 0
Bend relief fenestration might prevent outflow graft obstruction in patients with left ventricular assist device 弯曲缓解开窗可预防左室辅助装置患者移植物流出梗阻
4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-06-01 DOI: 10.1093/icvts/ivac149
G. Färber, H. Kirov, I. Schwan, Stephanie Gräger, M. Diab, S. Tkebuchava, T. Doenst
Abstract OBJECTIVES Patients with left ventricular assist devices may experience external obstruction of the outflow graft through a gelatinous substance within the bend relief (BR; a stiff tube graft guiding the outflow graft). Preventative strategies have been missing. Having faced this problem, we decided to fenestrate the BR to avoid outflow graft obstruction (OGO). METHODS Since December 2010, 167 patients underwent left ventricular assist device implantation using HeartMate II or 3. BR fenestration was introduced on July 2018 (108 patients before, 59 after the introduction of BR fenestration). Follow-up computed tomography scans were obtained from all patients and were screened for OGO by 3 independent investigators. Results were correlated with log file history, echocardiographic and clinical outcomes. RESULTS Demographic data were comparable between groups, with mostly male patients. Patients with BR fenestration were older [63 (standard deviation (SD):10.6) vs 58 (SD: 10.7) years] and had shorter support duration [494 (SD: 383) vs 951 (SD: 875) days]. OGO was observed in 5 patients and occurred only in patients without fenestration. Importantly, it occurred late on postoperative Days 412, 462, 1043, 1184 and 1506. Three patients are still asymptomatic. Surgical revision was required in the other 2 patients for pump thrombosis or continuous low flow. One of them died 36 days after revision due to right heart failure. CONCLUSIONS Our results suggest that fenestration of the BR may be a preventative strategy to avoid external OGO. OGO occurred late, which suggests a careful long-term follow-up.
【摘要】目的:使用左心室辅助装置的患者可能会经历通过弯曲缓解(BR;硬管移植物引导流出移植物)。预防策略一直缺失。面对这个问题,我们决定开窗BR以避免流出性移植物阻塞(OGO)。方法自2010年12月以来,167例患者使用HeartMate II或3植入左心室辅助装置。2018年7月开始采用BR开窗治疗(开窗前108例,开窗后59例)。所有患者均获得随访计算机断层扫描,并由3名独立调查员进行OGO筛查。结果与日志档案病史、超声心动图和临床结果相关。结果组间人口学数据具有可比性,以男性患者为主。BR开窗的患者年龄较大[63(标准差(SD):10.6) vs 58 (SD: 10.7)年],支持时间较短[494 (SD: 383) vs 951 (SD: 875)天]。5例患者观察到OGO,仅在未开窗的患者中发生。重要的是,它发生在术后第412、462、1043、1184和1506天。三名患者仍无症状。另外2例患者因泵血栓形成或持续低流量需要手术翻修。其中1例因右心衰在术后36天死亡。结论:我们的研究结果表明,BR的开窗可能是避免外部OGO的预防策略。OGO发生较晚,提示需谨慎长期随访。
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引用次数: 2
Corrigendum to: Totally endoscopic aortic valve replacement via antero-lateral approach using a standard prosthesis. 更正:使用标准假体经前外侧入路的全内窥镜主动脉瓣置换术。
4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-06-01 DOI: 10.1093/icvts/ivac048
Masayoshi Tokoro, Sadanari Sawaki, Takahiro Ozeki, Mamoru Orii, Akihiko Usui, Toshiaki Ito
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引用次数: 0
Heterotopic lung transplant: a feasible approach to compensate for organ shortages 异位肺移植:一种补偿器官短缺的可行方法
4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-06-01 DOI: 10.1093/icvts/ivac156
Jin Zhao, S. Ye, Feng Liu, Man Huang, Yongshan Xu, Yuan Chen, Jingyu Chen
Abstract Lung transplants are still limited by the shortage of suitable donor lungs, especially during the coronavirus disease 2019 pandemic. A heterotopic lung transplant (HLTx), as a flexible surgical procedure, can maximize the potential of donor lungs in an emergency, but its widespread use is hindered by difficulties in anastomosis and paucity of outcome data. We performed a retrospective review of 4 patients, each of whom received an HLTxs over 1 year, including 1 left-to-right single HLTx, 2 right-to-left single HLTxs and 1 lobar HLTx (right upper lobe-to-left). The median recipient age was 58.5 years (46–68); 3 patients were male. The postoperative hospital stay was 33 days (30–42). One recipient lived for 10 years and died of bronchiolitis obliterans syndrome; the others were alive with no major morbidity at 12 to 31 months after the operation with a 1-year survival of 100%. The follow-up chest images showed that transplanted lungs could be inflated well and adapted morphologically to fill the thoracic cavity in the short and long term. This study demonstrates that an HLTx is a feasible alternative to a conventional lung transplant in emergency cases and could be considered in selected patients at advanced medical centres.
肺移植仍然受到合适供体肺短缺的限制,特别是在2019年冠状病毒病大流行期间。异位肺移植(HLTx)作为一种灵活的外科手术,可以在紧急情况下最大限度地发挥供体肺的潜力,但其广泛应用受到吻合困难和缺乏结果数据的阻碍。我们对4例患者进行了回顾性研究,每例患者均在1年内接受了HLTx,包括1例从左至右的单一HLTx, 2例从右至左的单一HLTx和1例大叶HLTx(右上叶向左)。受者年龄中位数为58.5岁(46-68岁);男性3例。术后住院33天(30 ~ 42天)。一名接受者活了10年,死于闭塞性细支气管炎综合征;其余患者存活,术后12 ~ 31个月无重大发病,1年生存率100%。随访胸部图像显示,移植后的肺能够很好地膨胀,在形态上适应于短期和长期填充胸腔。这项研究表明,在紧急情况下,HLTx是传统肺移植的可行替代方案,可以在高级医疗中心的选定患者中考虑。
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引用次数: 0
Long-term follow-up of thoracoscopic ablation in long-standing persistent atrial fibrillation. 胸腔镜消融治疗长期持续性心房颤动的长期随访。
4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-06-01 DOI: 10.1093/icvts/ivab355
Niels Harlaar, Maurice A Oudeman, Serge A Trines, Gijsbert S de Ruiter, Bart J Mertens, Muchtair Khan, Robert J M Klautz, Katja Zeppenfeld, Andrew Tjon, Jerry Braun, Thomas J van Brakel

Objectives: Catheter ablation of long-standing persistent atrial fibrillation (LSPAF) remains challenging, with suboptimal success rates obtained following multiple procedures. Thoracoscopic ablation has shown effective at creating transmural lesions around the pulmonary veins and box; however, long-term rhythm follow-up data are lacking. This study aims, for the first time, to assess the long-term outcomes of thoracoscopic pulmonary vein and box ablation in LSPAF.

Methods: Rhythm follow-up consisted of continuous rhythm monitoring using implanted loop recorders or 24-h Holter recordings. Rhythm status and touch-up interventions were assessed up to 5 years.

Results: Seventy-seven patients with symptomatic LSPAF underwent thoracoscopic ablation in 2 centres. Freedom from atrial arrhythmias at 5 years was 50% following a single thoracoscopic procedure and 68% allowing endocardial touch-up procedures (performed in 21% of patients). The mean atrial fibrillation burden in patients with continuous monitoring was reduced from 100% preoperatively to 0.1% at the end of the blanking period and 8.0% during the second year. Antiarrhythmic drug use decreased from 49.4% preoperative to 12.1% and 14.3% at 2 and 5 years, respectively (P < 0.001). Continuous rhythm monitoring resulted in higher recurrence detection rates compared to 24-h Holter monitoring at 2-year follow-up (hazard ratio: 6.5, P = 0.003), with comparable recurrence rates at 5-year follow-up.

Conclusions: Thoracoscopic pulmonary vein and box isolation are effective in long-term restoration of sinus rhythm in LSPAF, especially when complemented by endocardial touch-up procedures, as demonstrated by the 68% freedom rate at 5 years. Continuous rhythm monitoring revealed earlier, but not more numerous documentation of recurrences at 5-year follow-up.

目的:导管消融治疗长期持续性心房颤动(LSPAF)仍然具有挑战性,在多次手术后获得了次优成功率。胸腔镜消融对肺静脉和肺盒周围的跨壁病变有效;然而,缺乏长期的心律随访数据。本研究旨在首次评估胸腔镜肺静脉消融和胸腔消融治疗LSPAF的长期疗效。方法:心律随访采用植入循环记录仪或24 h动态心电图连续监测。节律状态和后续干预被评估至5年。结果:77例有症状的LSPAF患者在2个中心接受了胸腔镜消融治疗。单次胸腔镜手术后5年内房性心律失常的发生率为50%,68%允许心内膜补片手术(21%的患者进行了心内膜补片手术)。连续监测患者的平均房颤负担从术前的100%下降到空白期结束时的0.1%,第二年下降到8.0%。抗心律失常药物的使用从术前的49.4%分别下降到2年和5年的12.1%和14.3% (P结论:胸腔镜肺静脉和盒隔离对于LSPAF的窦性心律的长期恢复是有效的,特别是当辅以心内膜补片手术时,5年的自由率为68%。在5年的随访中,持续的心律监测发现复发的时间更早,但没有更多的记录。
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引用次数: 3
Impact of counterclockwise rotation of the right middle lobe following right upper lobectomy. 右上叶切除术后右中叶逆时针旋转的影响。
4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-06-01 DOI: 10.1093/icvts/ivab356
Sachie Koike, Takashi Eguchi, Shunichiro Matsuoka, Tetsu Takeda, Kentaro Miura, Kimihiro Shimizu, Kazutoshi Hamanaka

Objectives: Following right upper lobectomy, the right middle lobe may shift towards the apex and rotate in a counterclockwise direction with respect to the hilum. This study aimed to investigate the incidence and clinical impact of middle lobe rotation in patients undergoing right upper lobectomy.

Methods: From January 2014 to November 2018, 82 patients underwent right upper lobectomy at our institution for lung cancer using a surgical stapler to divide the minor fissure. Postoperative computed tomography scans evaluated the counterclockwise rotation of the middle lobe, in which the staple lines placed on the minor fissure were in contact with the major fissure of the right lower lobe (120° counterclockwise rotation). Clinicoradiological factors were evaluated and compared between patients with and without middle lobe rotation. We also reviewed surgical videos in patients with middle lobe rotation to evaluate the position of the middle lobe at the end of surgery.

Results: Nine patients had a middle lobe rotation (11%), where 1 patient required surgical derotation. Patients with middle lobe rotation were significantly associated with more frequent right middle lobe atelectasis and severe postoperative complications compared with those without rotation. A surgical video review detected potential middle lobe rotation at the end of the surgery.

Conclusions: Middle lobe rotation without torsion following right upper lobectomy is not rare, and it is associated with adverse postoperative courses. Careful positioning of the right middle lobe at the end of surgery is warranted to improve postoperative outcomes.

目的:右上肺叶切除后,右中肺叶可能向顶端移位,并相对于肺门逆时针方向旋转。本研究旨在探讨右上肺叶切除术患者中肺叶旋转的发生率和临床影响。方法:2014年1月至2018年11月,我院82例肺癌患者行右上肺叶切除术,采用吻合器分割小裂。术后计算机断层扫描评估中叶的逆时针旋转,其中放置在小裂缝上的钉线与右下叶的大裂缝接触(逆时针旋转120°)。评估和比较有和没有中肺叶旋转的患者的临床放射学因素。我们还回顾了中肺叶旋转患者的手术视频,以评估手术结束时中肺叶的位置。结果:9例患者中肺叶旋转(11%),其中1例患者需要手术旋转。与没有旋转的患者相比,有中叶旋转的患者更容易出现右侧中叶不张和严重的术后并发症。手术视频检查在手术结束时发现了潜在的中叶旋转。结论:右上肺叶切除术后中肺叶旋转无扭转并不罕见,且与术后不良病程相关。在手术结束时仔细定位右中叶是必要的,以改善术后结果。
{"title":"Impact of counterclockwise rotation of the right middle lobe following right upper lobectomy.","authors":"Sachie Koike,&nbsp;Takashi Eguchi,&nbsp;Shunichiro Matsuoka,&nbsp;Tetsu Takeda,&nbsp;Kentaro Miura,&nbsp;Kimihiro Shimizu,&nbsp;Kazutoshi Hamanaka","doi":"10.1093/icvts/ivab356","DOIUrl":"https://doi.org/10.1093/icvts/ivab356","url":null,"abstract":"<p><strong>Objectives: </strong>Following right upper lobectomy, the right middle lobe may shift towards the apex and rotate in a counterclockwise direction with respect to the hilum. This study aimed to investigate the incidence and clinical impact of middle lobe rotation in patients undergoing right upper lobectomy.</p><p><strong>Methods: </strong>From January 2014 to November 2018, 82 patients underwent right upper lobectomy at our institution for lung cancer using a surgical stapler to divide the minor fissure. Postoperative computed tomography scans evaluated the counterclockwise rotation of the middle lobe, in which the staple lines placed on the minor fissure were in contact with the major fissure of the right lower lobe (120° counterclockwise rotation). Clinicoradiological factors were evaluated and compared between patients with and without middle lobe rotation. We also reviewed surgical videos in patients with middle lobe rotation to evaluate the position of the middle lobe at the end of surgery.</p><p><strong>Results: </strong>Nine patients had a middle lobe rotation (11%), where 1 patient required surgical derotation. Patients with middle lobe rotation were significantly associated with more frequent right middle lobe atelectasis and severe postoperative complications compared with those without rotation. A surgical video review detected potential middle lobe rotation at the end of the surgery.</p><p><strong>Conclusions: </strong>Middle lobe rotation without torsion following right upper lobectomy is not rare, and it is associated with adverse postoperative courses. Careful positioning of the right middle lobe at the end of surgery is warranted to improve postoperative outcomes.</p>","PeriodicalId":13621,"journal":{"name":"Interactive cardiovascular and thoracic surgery","volume":"34 6","pages":"1062-1070"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/87/47/ivab356.PMC9159427.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10244975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Lessons from fatal re-expansion pulmonary oedema: case series. 致命性再扩张性肺水肿的经验教训:病例系列。
4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2022-06-01 DOI: 10.1093/icvts/ivab366
Dambuza Nyamande, Siphosenkosi Mazibuko

The goal of this study was to investigate the extent of the alveolar-capillary membrane porosity in patients with severe re-expansion pulmonary oedema. The biochemistry of airway fluid of two patients who died of re-expansion oedema was compared to their blood biochemistry. The airway fluid was comparable to plasma, while no blood cells were observed across the alveolar-capillary membrane. The membrane was linked to a fishnet that traps cells on one side, while plasma sieved through.

本研究的目的是探讨严重再扩张性肺水肿患者肺泡毛细血管膜孔隙度的程度。对2例再扩张性水肿死亡患者的气道液体生化指标与血液生化指标进行比较。气道液与血浆相似,肺泡毛细血管膜未见血细胞。这种膜被连接到一个渔网上,渔网将细胞困在一边,而等离子体则被筛过。
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引用次数: 2
期刊
Interactive cardiovascular and thoracic surgery
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