Journal of Cardiothoracic Surgery最新文献

Background: Veno-arterial (V-A) extracorporeal membrane oxygenation (ECMO) is commonly used for patients with cardiac arrest, cardiogenic shock, or heart failure and is a life-saving technique. Computed tomography angiography (CTA) examination in patients on ECMO presents certain challenges. Due to the dual circulation characteristics of blood flow in ECMO patients, vascular imaging and interpretation can be difficult and may even present pitfalls.

Case presentation: A 59-year-old male was admitted with a diagnosis of cardiogenic shock due to "sudden onset of chest discomfort for 6 hours and altered mental status for 4 hours". He underwent V-A ECMO treatment twice and had two aortic CTA examinations. The initial CTA mistakenly diagnosed an aortic dissection. Considering the dual circulation blood flow characteristic in ECMO patients, a second CTA was performed. Combined with echocardiography, the patient was accurately diagnosed with left ventricular rupture and underwent left ventricular rupture repair surgery. The patient was successfully weaned off ECMO, transferred out of the ICU, and eventually discharged in good condition.

Conclusion: The unique hemodynamics of V-A ECMO patients necessitate interpreting CTA examinations with an understanding of the dual circulation characteristic to avoid misdiagnosis.

Background: Right ventricular (RV) function assessment by echocardiography can be challenging due to its complex morphology. Also, increasing use of sedation rather than general anesthesia for transfemoral approach transcatheter aortic valve replacement (TAVR) reduces the need for intraoperative transesophageal echocardiography (TEE). Recent clinical studies have demonstrated the importance of 3-dimensional (3D) echocardiography and a longitudinal strain for RV function assessment. In this study, we compared RV function echocardiographic assessment methodologies in TAVR and investigated its clinical utility.

Methods: This was a prospective, observational study of TAVR at a large academic hospital. Inclusion criteria were adult patients undergoing TAVR requiring intraoperative TEE between April 2023 and October 2023. Exclusion criteria include an absolute contraindication to TEE, a pacemaker, or suboptimal intraoperative echocardiography images. The primary goal is to assess the correlation of 3D RV ejection fraction (EF) with RV fraction area change (FAC), and tricuspid annular plane systolic excursion (TAPSE). The secondary goal is to assess the correlation of RV free wall longitudinal strain (FWLS) with any newly diagnosed postoperative ventricular arrhythmia, including complete atrioventricular block (CAVB) and left bundle branch block (LBBB).

Results: Among 33 patients who underwent TAVR, 4 patients were excluded due to poor image quality, and 7 patients were excluded due to existing pacemaker. Thus, data for 22 patients were analyzed in this study. There was a good correlation between 3D RVEF and RV FAC (correlation coefficient 0.789. p = 0.0000482), but poor correlation between 3D RVEF and TAPSE (correlation coefficient 0.182. p = 0.444). Eight patients developed a new left or right BBB and CAVB postoperatively, and 3 patients required permanent pacemaker. Regression analysis of pre and post valve deployment showed RV free wall RVFWLS was each correlated with postoperative new BBB or CAVB (pre valve deployment: hazard ratio 1.272, 95% CI 1.075 to 1.505, p = 0.004981; post valve deployment: hazard ratio 1.134, 95% CI 1.001 to 1.286, p = 0.04846). No mortality was reported during the follow-up period, and no significant tricuspid regurgitation (more than moderate) was reported.

Conclusion: 3D RVEF and RV FAC showed a good correlation. Intraoperative RVFWLS has the potential to predict postoperative new occurrence of BBB or CAVB.

Background: The detection of tumor localization is difficult in robotic surgery because surgeons have no sense of touch and rely on visual information. This study aimed to evaluate the efficacy of preoperative CT-guided dye marking of lung nodules prior to robotic surgery.

Methods: Patients undergoing CT-guided dye marking prior to robotic surgery at our hospital between September 2019 and April 2024 were retrospectively analyzed.

Results: Thirty lung nodules from 29 patients were analyzed. The dye marking procedure was successfully completed. Indigo carmine and indocyanine green were used for 20 and 10 pulmonary nodules, respectively. Slight pneumothorax was the most common complication and occurred in 6 patients (20.7%), none of whom required chest tube placement. Dye marking was visualized in 29/30 (96.7%) nodules and one nodule had poor intraoperative visualization due to severe adhesions. One patient underwent open thoracotomy because of difficulty ventilating one lung. Fourteen patients underwent wide wedge resection and 16 patients underwent segmentectomy for the target nodules. All target nodules were successfully resected with negative margins.

Conclusions: CT-guided dye marking of small pulmonary nodules prior to robotic surgery appears feasible and safe. This procedure can facilitate the performance of robotic sublobar resection.

Background: Chronic empyema after total pneumonectomy is a potentially fatal complication.The aim of the study is to explore the treatment strategy and clinical efficacy of chronic empyema after pneumonectomy.

Methods: A retrospective analysis of 6 patients with chronic empyema after pneumonectomy in our hospital. Utilizing a staged surgical model, the treatment approach involved rib debridement drainage, open-window thoracostomy (OWT), and the application of autologous tissue flaps, including free myocutaneous flap, pedicled muscle flap, and pedicled greater omentum, to effectively eliminate the abscess cavity.

Results: All patients with empyema were successfully treated after surgery, with follow-up durations ranging from 3 to 29 months and an average of (10.50 ± 9.67) months. Re-examination using chest computed tomography (CT) or magnetic resonance imaging (MRI) revealed that the empyema residual cavity had either completely disappeared or had significantly reduced.

Conclusion: The treatment of chronic refractory empyema after total pneumonectomy by rib debridement drainage, OWT and autologous tissue flap transplantation has a high cure rate and satisfactory clinical effect.

Objective: Asthma is a prevalent status attributing to lower respiratory tract chronic inflammation. Azithromycin (AZM) is known to be effective against asthma. Thus, this study delved into the mechanism of AZM repressing airway remodeling (AR) via the SAPK/JNK pathway in asthma.

Methods: Simulated asthmatic AR mouse model was developed by induction with ovalbumin (OVA) and intervened with AZM or dexamethasone (DEX) and anisomycin (JNK activator). Pathological changes in mouse lung tissues and AR were assessed by HE and Masson staining. The numbers of inflammatory cells, macrophages, eosinophils, neutrophils and lymphocytes in bronchoalveolar lavage fluid (BALF) were detected by Diff-Quik staining. Inflammatory factor levels (IL-6, TNF-α, IL-4) in BALF, and Collagen I, Collagen III, SAPK/JNK and p-SAPK/JNK protein levels in lung tissues were measured by ELISA and Western blot.

Results: The OVA-led asthmatic mouse model was successfully established. Relative to the OVA group, AZM and DEX treatment improved pulmonary smooth muscle thickening and bronchial epithelial fibrosis, reduced inflammatory cells, macrophages, eosinophils, neutrophils and lymphocytes in BALF, inhibited inflammatory factor TNF-α, IL-6, and IL-4 levels in BALF, and down-regulated Collagen I, Collagen III, and p-SAPK/JNK protein levels in lung tissues, with no prominent difference between the two regimens. JNK activator partially reversed the protective effect of AZM against OVA-induced asthma in mice.

Conclusion: AZM alleviated airway inflammation by inhibiting the SAPK/JNK pathway, thereby repressing AR in asthmatic mice. This study provided partial theoretical basis for clarifying asthma pathogenesis and new ideas for treating asthma.

Background: The Modified Inflation-Deflation Method (MIDM) is widely used in China in pulmonary segmentectomies. We optimized the procedure, which was named as Blood Flow Blocking Method (BFBM), also known as "No-Waiting Segmentectomy". This method has produced commendable clinical outcomes in segmentectomies. The aim of this research is to confirm whether the intersegmental planes formed by MIDM and BFBM techniques during segmentectomies have high degree of concordance.

Methods: We utilized the Open Sequential Test design in our study. Using both MIDM and BFBM techniques, intersegmental planes were created in the same patient, one after the other. The degree of alignment between the planes formed by the two techniques was assessed by two experienced chief surgeons. Based on the results obtained in each case, a test line was plotted until it intersected the effective or ineffective line.

Results: In every case studied, the intersegmental planes created by the MIDM and BFBM displayed high congruity. The test line crossed the effective line during the 12th case. When comparing the time taken to form the intersegmental plane using either MIDM or BFBM technique, no significant difference was observed. However, the application of the BFBM technique resulted in an average time savings of 13.8 min.

Conclusions: In segmentectomies, the intersegmental planes formed by MIDM and BFBM techniques exhibit high concordance. However, given that BFBM affords a time-saving advantage, we propose that BFBM could potentially replace MIDM in performing lung segmentectomies.

Arterial variations in the upper limb are of significant clinical importance, especially in procedures such as venepunctures, coronary artery bypass grafts, trauma reconstructive surgeries, brachial plexus nerve blocks, and breast reconstructions. This report presents previously undocumented arterial variations in the upper limbs in a 95-year-old female cadaveric donor. We observed bilateral superficial ulnar arteries originating at the cubital fossa, deviating from the previously reported origin at the proximal brachial artery. We found additional variations in the branches of the axillary artery: on the right side, two superior thoracic arteries emerged from the first part of the axillary artery, an accessory branch supplied the subscapular muscle, and the large subscapular artery arising from the third part of the axillary artery gave rise to both the lateral thoracic and posterior circumflex humeral arteries. On the left side, a common trunk was identified, giving rise to the transverse cervical, dorsal scapular, and accessory lateral thoracic and subscapular arteries. Moreover, the acromial artery originated directly from the axillary artery on both sides. This case report discusses the clinical significance of these unique vascular anatomical variants, their prevalence, and potential impact, emphasizing the importance for clinicians to be aware of such variations to enhance surgical planning and patient safety.

Background: Graft versus host disease (GVHD) is an autoimmune disease that affects the oral cavity as well as other parts of the body. Oral GVHD occurs in 45-83% of cases, and chronic GVHD observed in 30-50% of cases usually manifests as an oral presentation.

Case presentation: In this case report, a 13 years-old girl was referred to the periodontics clinic from the pediatric dentistry clinics for proper diagnosis and management of the oral presentations observed after receiving a prosthetic valve replacement 2 years ago. In this study, the xenograft type used was mainly investigated, as similar soft tissue grafts are used in the oral cavity with no GVHD oral manifestations being observed. This brings about an interesting discussion of the use of xenografts in different areas of the human body, but with different presentations.

Conclusions: Thus, future investigations on early diagnostic tools, including saliva or blood examinations, are needed to create preventive methods or create sensitive testing for early diagnosis in such patients.

Objective: To determine the learning curve for double-port video-assisted thoracoscopic (VATS) lung segmentectomy performed by the same surgical team in our center.

Methods: We retrospectively collected clinical data from 193 patients who underwent double-port video-assisted thoracoscopic lung segmentectomy from March 2017 to March 2023. The operative time (OT) was analyzed using the cumulative sum (CUSUM) method, and two stages of the learning curve were obtained. Propensity score matching (PSM) was performed for age, sex, underlying disease, and single-segment resection via radius matching. The OT, estimated amount of intraoperative blood loss, and other complications were analyzed.

Results: We generated a graph of the CUSUM of the OT and found that the learning curve could be differentiated into two stages: the learning stage (1st to 95th surgery) and the proficiency stage (96th to 193rd surgery). Before PSM, there were significant differences in the OT, extent of lymph node station dissection, amount of drainage on the day of surgery, amount of drainage on the first postoperative day, estimated amount of intraoperative blood loss, and length of hospital stay after surgery. There were no significant differences in the average amount of drainage 3 days after surgery, postoperative tube time, or number of intraoperative revolutions. However, after PSM, there were significant differences in the OT, number of lymph node stations removed, amount of drainage on the day of surgery, and amount of drainage on the first postoperative day. There were no significant differences in the estimated amount of intraoperative blood loss, length of hospital stay after surgery, average amount of drainage for 3 days after surgery, postoperative tube time, or number of intraoperative revolutions.

Conclusion: In our center, the learning curve for double-port video-assisted thoracoscopic lung segmentectomy transitions from the learning stage to the proficiency stage when the number of surgical cases reaches 95. There were significant differences in the OT, number of lymph node stations removed, amount of drainage on the day of surgery, and amount of drainage on the first postoperative day.

Objective: The regulatory role of the miR-618/JAK2/STAT3 axis in non-small cell lung cancer cells (NSCLC) was investigated with the objective of identifying a target for the precise treatment of patients with NSCLC.

Methods: Initially, differential gene expression was identified in the GEO database, followed by a comprehensive bioinformatics analysis. The tissue and cell levels of miR-618 were assessed using qRT-PCR, while the protein levels of JAK2 and STAT3 were determined through western blotting analysis. The association between miR-618 and JAK2 was scrutinized through bioinformatics analysis and dual-luciferase experiments. To evaluate cell proliferation, migration, and invasion, MTT, wound-healing, and Transwell assays were employed.

Results: The expression of miR-618 is decreased in NSCLC, and it targets the JAK2/STAT3 pathway to inhibit the proliferation, invasion, and migration of NSCLC.

Conclusion: Our study demonstrates that a novel miR-618/JAK2/STAT3 signaling axis is involved in suppressing malignancy in NSCLC and provides a promising target for NSCLC therapy.