Journal of Cardiothoracic Surgery最新文献

Background: Paragangliomas are rare neuroendocrine tumors predominantly located within the adrenal gland. Extra-adrenal paragangliomas, particularly those in the anterosuperior mediastinum, are exceedingly rare and pose significant diagnostic and therapeutic challenges due to their complex anatomical location.

Case description: A 42-year-old woman was found to have an anterosuperior mediastinal mass during a routine health screening. Enhanced chest computed tomography (CT) revealed an ovoid, low-density mass intricately associated with major vascular structures including the superior vena cava, brachiocephalic trunk, left common carotid artery, aortic arch, right anonymous vein, and right subclavian artery. Despite significant intraoperative blood loss of 2000 ml, the mass was successfully excised with meticulous surgical technique and effective hemostasis. Histopathological examination showed a classic Zellballen pattern with chief cells and sustentacular cells embedded in a vascular-rich stroma. Immunohistochemistry confirmed the tumor's chromaffin nature, with chief cells testing positive for CD56, Synaptophysin, and Chromogranin A, and sustentacular cells positive for S100 protein, consistent with a diagnosis of paraganglioma. The patient's postoperative recovery was uneventful, and she was discharged one week after surgery.

Conclusions: This case highlights the essential role of comprehensive preoperative imaging and the necessity for interdisciplinary surgical expertise in managing complex mediastinal paragangliomas. Advanced surgical techniques and careful intraoperative management are paramount to achieving successful outcomes. Appropriate imaging modalities and auxiliary laboratory tests are crucial for early detection of recurrences in these rare tumors.

Background: Mitochondrial dysfunction may be linked to the development of aortic aneurysm (AA) and aortic dissection (AD). This study aimed to evaluate the potential associations between proteins related to mitochondrial function and the risks of AA/AD using Mendelian randomization (MR).

Methods: Large-scale publicly available genome-wide association studies (GWAS) and FinnGen summary data were utilized for MR analysis. The causal relationship between mitochondrial proteins and AA/AD was assessed using inverse-variance weighted (IVW) as the primary method. Sensitivity analyses were conducted to detect heterogeneity and pleiotropy by Cochran's Q test, MR-Egger test, MR-PRESSO global test, and "leave-one-out" analysis.

Results: There were potential causal relationships between several mitochondrial proteins and AA/AD. Specifically, the iron-sulfur cluster assembly enzyme ISCU (OR = 1.165, 95% CI: 1.051-1.291, P = 0.004) and NFU1 iron-sulfur cluster scaffold homolog (OR = 1.184, 95% CI: 1.056-1.329, P = 0.004) were identified as potential risk factors for AA; whereas the 39 S ribosomal protein L14 (OR = 0.868, 95% CI: 0.764-0.987, P = 0.031) was found to be a protective factor for AA. Furthermore, 39 S ribosomal protein L33 (OR = 1.134, 95% CI: 1.010-1.274, P = 0.033) and cytochrome C oxidase subunit 5B (OR = 1.330, 95% CI: 1.037-1.706, P = 0.025) were associated with increased risks of AD; whereas the 39 S ribosomal protein L52 (OR = 0.736, 95% CI: 0.550-0.984, P = 0.038) and mitochondrial ubiquitin ligase activator of NFKB 1 (OR = 0.806, 95% CI: 0.656-0.989, P = 0.039) were identified as potential protective factors for AD. Sensitivity analysis confirmed the stability of the results.

Conclusions: This study identified potential genetic associations between mitochondrial proteins and AA/AD. Targeting these mitochondrial proteins may help prevent the occurrence of AA/AD.

Cardiac fibromas are rare benign primary tumors of the heart; nearly one-third of affected patients are less than 1 year old, and only 15% of patients develop this disease in adulthood. Here, we report three cases of cardiac fibroma in our hospital. In all the patients, the cardiac mass was diagnosed using cardiac imaging, namely CT and MRI scans. The tumors were surgically resected under cardiopulmonary bypass, and the fibroma was diagnosed by histopathology and microscopy. The cardiac function of the three pediatric patients recovered after the operation, and the patients were discharged successfully.

Background: Postoperative pain control in cardiac surgery is often managed with opioid medications. Insufficient analgesia can result in complications including splinting, pneumonia, and delay of appropriate rehabilitation. Given the risks and adverse effects of opioids including sedation, respiratory depression, delirium, and decreased gastrointestinal motility, hyperalgesia and potential for addiction, strategies for opioid reduction are likely to improve outcomes, therefore multimodal opioid sparing pain regimens are preferred. Recently, there is increased evidence that low dose Ketamine, an N-methyl-D-Aspartate (NMDA) receptor antagonist, is safe and effective for analgesia in postoperative patients and may be appropriate to this setting.

Methods: This is a single center, retrospective, observational, cohort study over a one year period involving postoperative adult cardiac surgery comparing those who received a single dose of postoperative ketamine, 0.3 mg/kg over 30 min, with those who did not receive any ketamine. Other analgesic protocols were similar between groups and did not include additional ketamine. A total of 120 patient charts were reviewed, of which 96 met inclusion criteria, 32 in the ketamine group and 64 in the standard care group. Charts were reviewed for opioid and other pain medication requirements during the postoperative period and on discharge, and for secondary outcomes: hospital length of stay, ICU length of stay, in-hospital and 30-day mortality, 30-day readmission, and rates of delirium, emergence reactions, and need for escalated respiratory support.

Results: The group who received postoperative ketamine required 28.8 morphine milligram equivalents (MME) less postoperative opioid (90.1 mg vs 118.9 mg, p = 0.167), and was prescribed an average of 15.8 MME less on discharge (p < 0.001). Intraoperatively, both groups received 1000 mg acetaminophen, 2 mg intravenous morphine and 100 mcg fentanyl, 26 MME, by protocol. No ketamine was administered intraoperatively or preoperatively. The groups differed in respect to operation type and controlling for this parameter failed to achieve significance in needs during admission (p = 0.215), but remained significant on discharge (p = 0.02). The non-ketamine group received more ketorolac (15.5 vs 10.1, p = 0.06). The ketamine group required less acetaminophen but more gabapentin. There was no difference in hospital or ICU length of stay. There was no delirium or mortality in either group. Respiratory depression occurred in 15 patients who all subsequently received ketamine. No patient developed respiratory depression after ketamine.

Conclusions: Ketamine may be a reasonable choice for postoperative cardiac surgery analgesia and may reduce the need for opioids on discharge, and possibly during admission.

Purpose: To explore the anatomical types and variations of lung segments and subsegment bronchi based on CT 3D reconstruction technology, and to provide anatomical theoretical support for thoracic surgeons in terms of surgical techniques.

Methods: The 3D CT reconstructed images of 541 patients were retrospectively analyzed. We explored the anatomical structure of the bronchi in the middle lobe of the right lung, sorted out the variations, and classified them in detail according to different bronchial types.

Results: In the CT 3D reconstruction of 541 patients, the bronchial anatomical types of the right middle lobe were divided into two types. There were 530 cases (98.0%) of two-branched type and 11 cases (2.0%) of three-branched type, and no four-branched type was found in the data of this paper. In addition, the spatial relationship between B₄ and B₅, and the spatial relationship between subsegmental bronchi B_4a, B_4b, B_5a, and B_5b are analyzed. The most common anatomical type and spatial relationship of the right middle lobe bronchi in the two-branched type were B₄ and B₅ in the external-internal relationship, B_4a and B_4b in the external-internal relationship, and B_5a and B_5b in the upper and lower relationship, and this subtype was 416 cases (76.9%). In addition, 23 cases (3.9%) were found to have a spatial relationship between B₄ and B₅ in the right middle lobe similar to the lingual bronchial subtype in the left upper lobe.

Conclusion: We used a large number of CT 3D reconstructed images to explore the anatomical types and variations of the bronchi in the middle lobe of the right lung. Thoracic surgeons can use our data to guide increasingly delicate lobectomy and segmentectomy.

Background: Anastomotic fistula is a rare but life-threatening complication of esophageal cancer, and its treatment remains challenging.We aimed to evaluate the clinical efficacy of modified cervical drainage in the management of cervical anastomotic fistula in patients after esophageal cancer surgery.

Methods: From June 2017 to December 2021, 25 esophageal cancer patients who developed cervical anastomotic fistula were enrolled in the study. Among them, 14 patients were treated with modified cervical drainage, which served as the observation group, while the remaining 11 patients underwent open incision and drainage, which served as the control group. The treatment outcomes of the two groups were compared and analyzed.

Results: The observation group had a significantly shorter healing time, fewer dressing changes, shorter hospital stay, and lower hospitalization costs compared to the control group (P < 0.05). The incidence of complications in the neck was not significantly different between the two groups (P > 0.05). All patients resumed a normal diet without experiencing fever, coughing or other discomfort, and were discharged after a smooth recovery.

Conclusions: Modified neck drainage, as a treatment method for cervical anastomotic leakage in esophageal cancer patients, has preliminarily demonstrated potential in promoting patient recovery. However, its efficacy still requires further validation and confirmation through studies with larger sample sizes.

Background: As one of the tumors with the highest fatality rates in the world, LUAD has a high risk of concealment, recurrence, and metastasis, which has turned into a significant issue in the medical community. To find possible treatment targets for LUAD, the study investigated the relationship between FAM66C and the prognosis of LUAD as well as the mechanism by which it interacts with miR-339-3p.

Methods: Tissue samples and clinicopathological data were collected from 117 LUAD patients. Polymerase chain reaction assay was used to find FAM66C and miR-339-3p expression in LUAD tissues. Utilizing CCK-8, Transwell, and flow cytometry, the relationship between LUAD cell proliferation, migration, apoptosis, and FAM66C expression was assessed. The dual luciferase reporter gene assay was utilized to investigate the interaction between miR-339-3p and FAM66C. The prognostic potential and connection of FAM66C with clinicopathology were evaluated using the Chi-square test, Kaplan-Meier, and multivariate Cox regression analysis.

Results: FAM66C expression was drastically reduced and miR-339-3p expression was upregulated in LUAD cells and tissues. There was a negative correlation between FAM66C and miR-339-3p. FAM66C inhibits the expression of miR-339-3p, and miR-339-3p can reverse the inhibitory impact of FAM66C on LUAD cells. FAM66c expression was substantially associated with clinical TNM stage and lymph node metastases When FAM66C expression is low, the prognosis of LUAD patients is bad.

Conclusions: In conclusion, lower FAM66C expression can be utilized to predict the poor prognosis of LUAD, and FAM66C is negatively linked with miR-339-3p, which can influence cancer cell development by modulating miR-339-3p expression.

Background: Percutaneous vertebroplasty is commonly used to treats vertebral fractures, tumors, and osteolytic vertebral metastases. However, cement leakage during the procedure can lead to severe complications, including cardiac perforation. This report presents a case of right atrial perforation and pulmonary embolism caused by cement leakage, emphasizing the clinical significance of these events and discussing the treatment strategy.

Case presentation: A 57-year-old female was admitted to the hospital with a slipped lumbar vertebra and back pain, for which she underwent percutaneous vertebroplasty. On the 10th postoperative day, the patient suddenly developed chest tightness and shortness of breath, accompanied by a gradual decline in hemoglobin levels. After several imaging studies, a diagnosis of right atrial perforation caused by bone cement was confirmed. The patient subsequently underwent open cardiac foreign body removal and made a full recovery, with no residual cardiac dysfunction.

Conclusion: This case highlights the rare but serious complication of right atrial perforation caused by bone cement leakage during percutaneous vertebroplasty. The report emphasizes the importance of early identification of bone cement-related complications. While conservative management may suffice for pulmonary embolism, urgent surgical treatment is required for cardiac cement embolism to prevent further complications.