Journal of Cardiothoracic Surgery最新文献

Objective: To investigate the clinical characteristics and imaging features of patients with spontaneous pneumomediastinum (SPM) and conduct a literature review to provide reference strategies for the diagnosis and treatment of the affected population.

Methods: A retrospective analysis was conducted on patients diagnosed with SPM via chest computed tomography (CT) at our Hospital from January 2022 to December 2023. General information, clinical manifestations, and imaging findings were collected and analyzed. Relevant domestic and international literature was reviewed, and a comparative analysis was performed.

Results: A total of 40 patients were included in this study. Acute retrosternal pain was the most common symptom (45.0%), followed by varying degrees of dyspnea, shortness of breath, and chest tightness (25.0%), persistent coughing (17.5%), and discomfort or pain in the neck and throat (5%). The Macklin effect was observed in 38 patients, characterized by varying degrees of gas accumulation around the mediastinum near the pulmonary hilum. After three days of treatment, the symptoms resolved, and follow-up chest CT scans indicated absorption of mediastinal gas. Patients showed improvement and were discharged.

Conclusion: The clinical manifestations of SPM are complex and diverse, making it prone to clinical misdiagnosis or delayed diagnosis, which may hinder timely treatment. Chest CT is instrumental in the accurate diagnosis of mild mediastinal emphysema. A comprehensive evaluation, incorporating patient complaints and clinical symptoms with chest CT findings, is essential for accurate diagnosis.

Rectus sheath hematoma (RSH) is an uncommon but potentially life-threatening complication of anticoagulant therapy. Bilateral RSH is exceedingly rare. We present a case of a middle aged woman in 40s who presented with acute onset left lower limb swelling with blisters and bluish discoloration due to extensive left lower limb deep vein thrombosis. The patient subsequently underwent emergency fasciotomy followed by above-knee amputation for ischemic limb and started on therapeutic administration of enoxaparin. During the postoperative course, the patient developed a progressive infraumbilical abdominal wall swelling at the site of subcutaneous injections, later confirmed to be bilateral rectus sheath hematomas (RSH). This report highlights the importance of recognizing this rare complication in anticoagulated patients presenting with abdominal wall masses and anaemia.

Background: To study the predictive values of intraoperative hemodynamics and heart rate (HR) variability for the postoperative emergence quality of children undergoing transcatheter closure of ventricular septal defects.

Methods: A total of 110 pediatric patients treated from January 2023 to January 2024 were divided into good and poor emergence groups according to the presence of emergence delirium and/or agitation. Hemodynamic and HR variability parameters were recorded at four time points (T0: start of surgery; T1: 30 min; T2: 60 min; T3: 30 min before end).

Results: The good emergence group showed significantly lower HR from T0 to T3 and higher systolic and diastolic blood pressure from T1 to T3 and T2 to T3 compared with the poor emergence group (P < 0.05). Across T0-T3, total power (TP), high-frequency (HF), and low-frequency (LF) components were significantly higher, whereas the LF/HF ratio was significantly lower in the good emergence group (P < 0.05). At T2, TP was 586.20 ± 130.07 ms² versus 422.16 ± 86.85 ms², HF was 152.36 ± 26.02 ms² versus 93.57 ± 20.49 ms², and the LF/HF ratio was 1.07 ± 0.16 versus 1.35 ± 0.29 in the good and poor groups, respectively. The combined predictive value of intraoperative hemodynamics and HR variability showed an AUC of 0.892 (95% CI: 0.825-0.959), with 93.55% sensitivity and 79.75% specificity.

Conclusions: More stable intraoperative hemodynamics and higher HR variability were associated with better postoperative emergence quality. The combined assessment demonstrated high predictive accuracy, suggesting potential clinical utility.