Journal of Cardiothoracic Surgery最新文献

Background: The current study was performed aimed at investigating the impact of bicuspid aortic valve (BAV) with a giant aneurysm of the ascending aorta (AAo) on hemodynamics within the aorta using Computational fluid dynamics (CFD), with an attempt to gain insights into the clinical management strategies based on hemodynamic considerations.

Methods: One numerical model of the AAo with BAV (specifically, a left/right cusp fusion type) and a giant aneurysm was constructed using MRI medical images. The aneurysm had a diameter of 10.5 cm. Subsequently, hemodynamics in this model were simulated numerically, and flow patterns and loading distributions were investigated. To understand these characteristics, we applied the CFD method to simulate the hemodynamics and estimate the risk associated with the fully dilated aorta.

Results: The presence of a giant aneurysm significantly influenced and altered hemodynamics within the AAo in this BAV patient case. In our model of a 10.5 cm aneurysm, the BAV-induced eccentric jet impinged on the aortic wall, generating complex, recirculating flow patterns and elevated turbulent kinetic energy within the aneurysmal sac. Hemodynamic parameters were asymmetrically distributed at the aneurysm, and the wall shear stress (WSS) in this aneurysm was pathologically low. These conditions suggest the risk of asymmetric dilation and aortic dissection, and thereafter, the risk of aneurysm rupture was further heightened, especially when the aneurysm reached 10.5 cm in size.

Conclusion: The CFD-based analysis method helped elucidate the biomechanical mechanisms that a BAV may contribute to the development of a giant aneurysm in the AAo, offering valuable insights for treatment strategies in patients with giant aneurysms.

Background: In this study, it was aimed to evaluate the diagnostic value of myosin binding protein C (cMyBP-C) as a new cardiac injury marker in demonstrating myocardial injury in Coronary Artery Bypass Surgery patients.

Methods: Prospectively collected data from 60 coronary artery bypass surgery patients were evaluated and the results were compared. The study included 60 patients who applied to the Cardiovascular Surgery Clinic between March 2024 and September 2024 and who were going to undergo coronary bypass surgery. The patients' high-sensitivity cardiac troponin T (hs-cTnT) and Cardiac myosin binding protein C (cMyBP-C) levels, clinical and descriptive information were analyzed before the bypass procedure, after the cross clamp and at the sixth hour post-operation.

Results: Area under curve (AUC) for cMyBP-C for Length of ICU stay was 0.673, whereas AUC mean for hs-cTnT was 0.590. For cMyBP-C preop cut off level at 4836.50, sensitivity was 66.7% and specificity was 22.2%. Preoperative cMyBP C was significantly correlated with HT(r=-0,299; p < 0.05), DM (r=-0.350; p < 0.01), cardiopulmonary bypass time (CPB) time (r=-0.339; p < 0.01), and preop lactate (0.349; p < 0.01). Postoperative cMyBP-C level was significantly correlated with HT(r=-0.320; p < 0.05), DM (r=-0.462; p < 0.01), Perioperative lactate (r = 0.277; p < 0.05) and lactate at 6th hour (r = 0.280; p < 0.05). DM (B = 2602.92; p < 0.01), Length of hospital stay (B = 254.83; p < 0.05) and ascending aorta with (B = 249.50; p < 0.05) positively association with perioperative cMyBP-C levels.

Conclusion: The cMyBP-C biomarker may be an alternative biomarker for myocardial injury in cases where high hs-cTnT levels are insufficient to indicate myocardial injury. DM should be considered as an important and determining variable in myocardial injury, including hs-cTnT.

Objective: To investigate the prognostic factors of bronchial artery embolization (BAE) for hemoptysis. Please verify if the provided city are correct and amend if necessary." Resolved="yes"--> METHODS: Initially, we collected information on 179 patients who underwent BAE for hemoptysis in the Department of Interventional Vascular Medicine of Jiangxi Provincial Chest Hospital and the Department of Respiratory and Critical Care Medicine of the First People's Hospital of Jingdezhen from March 2023 to August 2023. Further, the correlation between different influencing factors and the clinical success rate of the procedure was assessed. The most relevant prognostic factors were selected using the univariate analysis and LASSO, performing the logistic regression modeling for the final selected predictors.

Results: Among the selected subjects (n = 160), the technical and clinical success rates of BAE were 99% (159/160) and 86.25% (138/160), respectively. The predictive factors associated with the reduced clinical success were hemoptysis due to lung tumors, severe hemoptysis, recent anticoagulant/antiplatelet drugs, the presence of pulmonary artery pseudoaneurysm, and elevated blood sedimentation values. The developed model from these five predictors showed excellent ability with a well-calibrated area under the curve (AUC) of 0.864.

Conclusion: In summary, the developed model could feasibly predict the clinical success of BAE for hemoptysis, which could promptly support clinicians in making decisions on treatment options.

Background: Patients with parastomal recurrence have poor prognosis and pose a great challenge to the surgeons. Surgical resection is the only curable choice. Treating this patient group with a patent tracheostoma and a stable airway is the main objective.  CASE PRESENTATION: We present an extremely rare case of a parastomal relapse after laryngectomy and radiochemotherapy for laryngeal carcinoma. Partial resection of the manubrium, medial part of the right clavicle, medial parts of the 1st and 2nd ribs, proximal part of the trachea below the cervical tracheostomy and subtotal thyroidectomy were performed. For reconstruction around the mediastinal tracheostomy Conley-Sisson right thoracoacromial myocutaneous pectoral "nipple" flap was carried out. The patient complicated with skin dehiscence and necrosis and spontaneous pharyngo-esophageal fistula. A retrosternal omentoplasty of the fistula and a feeding gastrostomy were successfully executed, followed by closure of the skin defect at the base of the neck above omentoplasty by means of a free split thickness skin graft from the left anterior thigh region and degastrostomy.

Conclusions: Surgical treatment of laryngeal carcinoma recurrence in the region of tracheostomy is a feasible and promising way for prolonging patients' life. This extremely rare case presents an evidence of the primary sole of surgery in the treatment of laryngeal carcinoma parastomal relapse.

Background: Percutaneous coronary intervention of calcified coronary lesions is fraught with short-term and long-term risks. Judicious use of adjunct intracoronary imaging and lesion modification techniques minimizes adverse outcomes. We present an exceedingly rare case of stent loss, stent-in-stent entrapment, and eventual surgical revascularization after failed percutaneous coronary intervention.

Case presentation: A 59-year-old man with a history of obstructive coronary artery disease and prior percutaneous coronary intervention presented with accelerating angina and exertional dyspnea. Elective angiography revealed a heavily calcified right coronary artery with significant stenoses. He underwent elective percutaneous coronary intervention without lesion interrogation or preparation, complicated by distal stent under-expansion and balloon entrapment within the proximal stent. He was subsequently transferred to a tertiary referral center to undergo heart-team approach for salvage and eventual revascularization. Surgical foreign body removal and on-pump coronary artery bypass grafting were successful under trans-esophageal echocardiographic guidance. Remnants of the original stent were left in place to prevent collateral flow and mitigate the risk of graft failure. The patient was symptom-free with preserved left ventricular ejection fraction one year after surgery.

Conclusions: Current guidelines recommend thorough interrogation of calcified lesions (intracoronary imaging, functional testing), and, if indicated, adequate lesion preparation (lithotripsy, atherectomy, cutting/scoring balloon) prior to percutaneous coronary intervention. This case highlights the technical reasons for this complication, discussion on various percutaneous retrieval techniques, and the critical importance of a multidisciplinary heart-team approach in preventing complications, but also in salvaging them after failed percutaneous coronary intervention.

Background: Giant coronary aneurysms are rarely described in current literature, with an incidence of only 0.02%. Treatment strategies vary and there is no definitive recommendation; however, surgical treatment should be considered to prevent future complications.

Case presentation: We report the case of a 58-year-old patient with a history of hypertension, diabetes, and obesity who presented with non-ST-segment elevation myocardial infarction (NSTEMI), ischemic cardiomyopathy with reduced ejection fraction, coronary artery disease, and a giant right coronary artery (RCA) aneurysm with compressive effects and secondary hemodynamic repercussions, requiring surgical management.

Conclusion: This case describes an acute myocardial infarction associated with a giant compressive RCA aneurysm initially mistaken for a mediastinal mass. It highlights its challenge as a differential diagnosis and the importance of early surgical intervention and literature production on this rare entity.