Journal of Cardiothoracic Surgery最新文献

Background: Surgical treatment is crucial in managing bronchiectasis. Segmentectomy, although a complex procedure, has become more feasible with advancements in thin-slice CT and three-dimensional imaging. These technologies enhance preoperative anatomical understanding and surgical planning. This study aims to demonstrate the viability of using three-dimensional imaging assistance for treating localized bronchiectasis through segmentectomy.

Methods: From 2021 to 2023, a total of 34 patients with bronchiectasis underwent segmentectomy. We collected and then analyzed potential factors including general conditions, preoperative clinical symptoms, surgical procedures, length of postoperative hospital stay, incidence of postoperative complications and postoperative follow-ups.

Results: Of the 34 surgical patients, 8 were men and 26 were women, resulting in a total of 34 operations. The average surgical time for segmentectomy was 157.7 ± 63.4 min. The average intraoperative blood loss was 115.9 ± 107.4 ml. Postoperative tube placement lasted an average of 6.5 ± 2.4 days, with an average drainage volume of 724.7 ± 500.9 ml. The average hospital stay was 8.2 ± 3.4 days. Among these patients, 2 developed pneumothorax and 2 experienced air leaks. Additionally, 4 patients developed pneumonia postoperatively. Over an average follow-up period of 14.3 months, most patients showed symptom improvement, with only two cases of recurrence.

Conclusions: Segmentectomy has acceptable postoperative morbidity, mortality, and outcomes. Therefore, segmentectomy is a viable option for the treatment of localized bronchiectasis.

Purpose: Our study aims to evaluate the outcomes of children with congenital lung malformation (CLM) who have undergone surgical resection.

Methods: A retrospective analysis was conducted among children under 18 who were diagnosed with CLM and underwent surgery at Srinagarind Hospital, Khon Kaen University between January 2007 and December 2023. We collected data on surgical outcomes, including operative time, postoperative complications, and mortality rate.

Results: During our study period, a total of 38 children with CLM were undergone surgery. The median time for diagnosis was 9 months (IQR 1-33 months). Congenital pulmonary airway malformation was the most common diagnosis, affecting 26 children (68.4%). Of these, 25 children were operated on when they presented with symptoms, while 13 children were operated on even though they were asymptomatic. The median age at surgery was 12 months (IQR 3-32 months) for symptomatic children and 6 months (IQR 3-12 months) for asymptomatic children (P = 0.201). After the surgery, symptomatic children had a higher rate of postoperative complications than asymptomatic children, with 52% and 15.4%, respectively (P = 0.028). The median length of stay for symptomatic children was 17 days, compared to 11 days for asymptomatic children (P = 0.280).

Conclusions: Early surgery of CLM in asymptomatic children was associated with a lower rate of postoperative complications. Further studies are needed to investigate long-term complications.

Background: Studies show conflicting results regarding the impact of the COVID-19 pandemic on the treatment of patients with coronary artery disease requiring cardiac surgery and data from Germany are lacking. In this study, two patient cohorts who underwent coronary artery bypass graft surgery before and after the start of the COVID-19 pandemic were compared.

Methods: Patients who presented for coronary artery bypass graft surgery before (01.05.18-30.04.19; group "B") or during the COVID-19 pandemic (01.05.20-30.04.21; group "P") at the University Hospital Münster in Germany were retrospectively identified and compared regarding demographics, preoperative status, surgical data, and postoperative outcome.

Results: 513 (group "B") and 501 patients (group "P") were included, demographics were comparable. In group "P", preoperative myocardial infarction and emergency indications were more frequent, heart-lung machine and aortic clamping times were longer. Postoperative ICU-days and inpatient stay did not differ. Postoperative need of an extracorporeal life support system and intrahospital mortality tended to be higher in group "P", without reaching statistical significance.

Conclusion: The COVID-19 pandemic had a significant impact on cardiac surgical care with the prioritization of emergency procedures. Patients treated during the pandemic were in a more critical preoperative condition, duration of surgery was longer, but post-operative mortality was comparable.

Background: This study aimed to investigate the effects of general intravenous anesthesia and combined inhalation anesthesia on regional saturation of oxygen (rSO₂) and cerebral hemodynamics during carotid endarterectomy (CEA). Optimizing intraoperative brain protection strategies has become a key focus in CEA research.

Methods: Fifty-four patients (43 males, 11 females, aged 44-80) undergoing unilateral CEA were randomly assigned to Group IVA (intravenous anesthesia) or Group CIA (combined inhalation anesthesia), with 27 patients each. Group IVA was maintained with propofol and remifentanil, while Group CIA used sevoflurane, propofol, and remifentanil, with sevoflurane stopped after carotid exposure. Hemodynamics were controlled at various stages: ±10% before clamping, + 20% during clamping (metaraminol), and 0 to -10% after exposure. HR, MAP, and rSO₂ were recorded at T0 (pre-induction), T1 (pre-clamping), T2 (post-clamping), T3 (5 min post-clamping), T4 (10 min post-clamping), T5 (15 min post-clamping), and T6 (15 min post-reperfusion). Blood samples were taken at T1, T6, and T7 (24 h post-surgery) for blood gas and S100-β analysis.

Results: No significant differences in rSO₂ were observed at T0 and T6 (P > 0.05). However, Group CIA had significantly higher rScO₂ at T1, T2, T3, T4, and T5 (P < 0.05). From T2 to T5, rSO₂ increased in both groups (P < 0.05). MAP and HR showed no significant differences (P > 0.05). ΔrSO₂ increased more in Group CIA (P < 0.05). At T6, S100-β protein was higher in Group IVA (P = 0.016), and pH differed significantly at T1 (P = 0.009). No other significant differences were observed.

Conclusion: Both intravenous and combined inhalation anesthesia may reduce rSO₂ decline during temporary clamping in CEA. Combined inhalation anesthesia showed a trend toward higher rSO₂ levels, potentially leading to better outcomes, but further studies are needed to confirm these findings.

Retrospectively registered clinical trial number: ISRCTN17014575; Registration Date: 2024/6/10.

Introduction: Congenital pericardial agenesis is a rare congenital anomaly resulting from the incomplete development of the pleuropericardial membranes during embryogenesis, leading to the partial or complete absence of the pericardial sac. Although this condition usually remains asymptomatic, it can present with various misleading symptoms such as chest pain (add some other, maybe 2, more prevalent presenting symptoms), making diagnosis challenging. Advanced imaging techniques are crucial for accurate diagnosis and management, especially when usual diagnostic modalities do not achieve a definite diagnosis.

Case presentation: The history and diagnostic process of a 16-year-old female who presented with isolated, non-exertional chest pain are detailed. A comprehensive diagnostic work-up was initiated, including chest X-ray (CXR), transthoracic echocardiogram (TTE), CT angiography (CTA), and cardiac magnetic resonance imaging (CMRI). These advanced imaging modalities unveiled the rare and elusive diagnosis of left-sided pericardial agenesis, decisively ruling out other potential causes and shedding light on an extraordinary case that challenges conventional diagnostic pathways.

Conclusion: Unilateral pericardial agenesis, though typically benign and often shrouded in clinical obscurity, can manifest with enigmatic symptoms such as isolated chest pain, necessitating a meticulous and comprehensive diagnostic approach. Multimodal imaging is essential for accurate diagnosis and for ruling out complications such as cardiac herniation or coronary artery compression. Considering the absence of significant complications, conservative management was chosen in this case, with the patient being discharged with instructions to monitor for any warning signs.

Clinical key message: Clinicians should consider congenital pericardial agenesis as one of the potential causes of unexplained chest pain, particularly when the initial investigations are inconclusive. Advanced imaging techniques (such as CXR and MRI) are vital for confirming the diagnosis and subsequently appropriate and timely management and preventing potential complications.

Objective: Unnecessary blood preparation by surgeons adversely affects blood bank stocks and the healthcare system in many ways. In this study, it is aimed to evaluate the patient blood management strategy in patients in whom we performed lobectomy and pneumonectomy with thoracotomy.

Methods: A total of 87 patients have been included in this study. Patient specific data, such as demographic information, laboratory information, preoperative blood ordering, and blood transfusion information have been recorded.

Results: All patients were cross-matched, but only 32 (36.7%) of the patients received blood transfusions. Although a total of 264 units of blood had been reserved, the amount of blood used for transfusion was 68 (25.7%) units. The cross-match / transfusion rate was 3.88, the transfusion index was 0.78, and the transfusion probability was 36.7%. There is a positive and statistically significant correlation between the amount of blood allocated (r = 0.591, p = 0.00) and the duration of intensive care and hospital stay (r = 0.266, p = 0.013). There was also a positive and statistically significant correlation between the amount of blood used and the duration of intensive care and hospital stay (r = 0.422, p = 0.00) (r = 0.474, p = 0.00).

Conclusion: In elective lung resection performed by thoracotomy, the amount of blood wasted during the patient's blood preparation process is high. During the patient blood preparation process, institution-controlled programs should be implemented instead of subjective evaluation at the discretion of the surgeon Planning a patient-specific blood preparation process to alleviate the burden on the healthcare system may prove to be more efficient.

Background: Chest trauma may precipitate a spectrum of injuries, among which tracheal laceration represents an uncommon but critical sequela. The occurrence of tracheal laceration could significantly impair respiratory and cardiovascular homeostasis, thereby posing a life-threatening risk to the patient. Expeditious surgical intervention is paramount for therapeutic management, and in certain instances, the administration of venovenous extracorporeal membrane oxygenation (VV ECMO) may be necessitated to support the patient's respiratory function.

Case presentation: This case report discusses the surgical management of a delayed partial bronchial rupture following thoracic trauma, supported by VV ECMO. The patient, who sustained multiple rib fractures, hemopneumothorax, and scapular fractures due to a motor vehicle accident, developed progressive dyspnea one month post-trauma. Imaging revealed right lung atelectasis and pleural effusion, necessitating emergency surgery. VV ECMO was used to stabilize oxygenation, allowing for successful right main bronchus resection and anastomosis. Intraoperative bronchoscopy played a crucial role in identifying the rupture site and ensuring effective anastomosis. The patient recovered well, with no significant complications at follow-up.

Conclusions: This case highlights the importance of timely surgical intervention in bronchial rupture, the utility of VV ECMO for respiratory support, and the role of bronchoscopy in managing airway injuries. It underscores that delayed bronchial rupture, though rare, requires prompt recognition and treatment to prevent life-threatening complications.

Objective: Percutaneous coronary intervention (PCI) can effectively restore myocardial perfusion in patients with ST-segment elevation myocardial infarction (STEMI). Nevertheless, STEMI patients may still experience a "no-reflow" phenomenon after PCI. Accordingly, this study focused on the clinical value of low-dose dobutamine stress myocardial contrast echocardiography (MCE) for evaluating myocardial microcirculation perfusion and long-term prognosis in STEMI patients after PCI.

Methods: This study included 70 STEMI patients receiving PCI. Low-dose dobutamine stress MCE was performed to detect viable myocardium at 72 h after PCI and quantitatively analyze myocardial microcirculation perfusion at 72 h and 6 months after PCI. Patients were categorized into dobutamine stress echocardiography (DSE)-positive and DSE-negative groups, followed by comparisons of LVEF. The 3-year survival of STEMI patients after PCI was analyzed.

Results: No adverse reactions occurred during low-dose dobutamine stress MCE. Low-dose dobutamine stress MCE effectively detected viable myocardium at 72 h after PCI (AUC: of 0.849). Under the basal or stress state, A, β, and A × β values of viable myocardium at 6 months after PCI were prominently higher than values at 72 h after PCI. A and A × β values of viable myocardium at 6 months after PCI were considerably higher in the stress state than in the basal state. LVEF and long-term survival rates after PCI were markedly higher in the DSE-positive group than in the DSE-negative group.

Conclusion: Low-dose dobutamine stress MCE is an effective evaluation method for myocardial perfusion, left ventricular function recovery, and poor long-term prognosis in STEMI patients after PCI.

Background: Right middle lobe (RML) torsion is the most common form of lobar torsion. It usually happens after right upper lobe (RUL) lobectomy, especially when pneumopexy is not performed. Although various surgical techniques have been introduced to prevent RML torsion, the efficacy of these techniques is not yet fully understood. We herein report a case of RML torsion that happened after RUL lobectomy despite pneumopexy together with a literature review.

Case presentation: A 62-year-old female patient underwent RUL lobectomy due to adenocarcinoma of the lung. Prophylactic pneumopexy with a single stitch was performed to fix RML to the right lower lobe. RML was well inflated and did not rotate before wound closure was performed. However, the patient complained of foreign body sensation inside her chest on postoperative day 5, and a chest X-ray revealed atelectasis of RML. Bronchoscopy showed a collapsed middle lobe bronchus. Exploratory thoracotomy showed congested RML with a twisting bronchovascular pedicle, and therefore, RML lobectomy was performed.

Conclusions: RML torsion is a rare but potentially fatal condition requiring high clinical alertness. Through our literature review and the presented case, we demonstrate that RML torsion may occur despite pneumopexy. A combination of surgical methods, such as the use of continuous sutures or fibrin glue, may be more effective in preventing torsion.

Background: Hereditary multiple osteochondromas (HMO) are benign neoplasms that predominantly affect the bones around the knee joint, proximal humerus, wrist, pelvis, and to a lesser extent, the rib. Although rib-origin osteochondromas are uncommon and often asymptomatic, they can lead to pleural, pericardial, and diaphragmatic injuries secondary to tumour related pressure. We are presenting a unique case of a vascular-related giant osteochondroma rib that is hereditary, originating from the right second, third, and fourth ribs causing compression symptoms in a young child. The child underwent wide local excision and reconstruction using polypropylene mesh that was managed successfully with no recurrence.

Case presentation: A 9-year-old male experiencing fullness and pain in the right chest for two months with a parallel medical history of swellings in first- and second-generation relatives that is hereditary in origin underwent contrast-enhanced computed tomography revealing a sessile rib osteochondroma arising from the anterior aspects of the right second to fourth ribs with an associated large cartilaginous cap. The bony growth measured 4.5 × 2.5 cm indenting the right upper lobe while, its cartilaginous cap measured 2.5 × 4.8 cm posterior-superiorly seen encasing the axillary artery and 3D volumetric reconstructive image revealed the proximity of the axillary and subclavian artery with the lesion. A biopsy was inconclusive with no malignant cells, so he underwent wide local excision of the tumour and reconstruction with polypropylene mesh. Follow-ups at one, three, six, and nine months were uneventful with normal thoracic curvature and no sign of recurrence.

Conclusion: This case illustrates the surgical challenges addressed and the successful outcome of a paediatric chest wall reconstruction in a growing child, utilizing advanced imaging techniques, to underscore the importance of an individualized, innovative approach in managing rare skeletal anomalies.