Journal of Cardiothoracic Surgery最新文献

Background: Congenital bronchial displacement with concomitant vascular anomalies complicates anatomical segmentectomy. We report a thoracoscopic combined S1 + 2 and S6 segmentectomy for early lung cancer in a patient with displaced left B1 + 2 and persistent left superior vena cava (PLSVC).

Case: A 75-year-old man underwent chest computed tomography (CT) as part of a routine health examination, which revealed a 2.5-cm nodule in the left upper lobe. Computed tomography and bronchoscopy revealed a three‑branch carinal variation with left B¹⁺² arising dorsally from the left main bronchus; A¹⁺²and V¹⁺²coursed abnormally. The left lung was fissureless and PLSVC was present. After pulmonary rehabilitation his FEV1 improved from 1.20 L to 1.64 L. Given limited reserve, video‑assisted thoracoscopic combined segmentectomy (S¹⁺²+S⁶) was performed using a dorsal‑first hilar approach. Indocyanine green (ICG) fluorescence delineated the intersegmental planes, facilitating precise stapled transection. Final pathology revealed moderately to poorly differentiated squamous cell carcinoma, no visceral pleural invasion, intravascular tumor emboli, and spread through air spaces (STAS), with no perineural invasion and station 12 node 0/1. The postoperative course was uneventful without air leak; the patient was discharged on postoperative day 5. At 18‑month follow‑up, quality of life was good with no dyspnea or cough.

Conclusion: In rare left B¹⁺² displacement associated with vascular variants and PLSVC, 3D planning plus ICG mapping enables safe combined segmentectomy for pT1bN0M0 IA2 squamous cell carcinoma, balancing oncologic clearance with parenchymal preservation. The presence of STAS and vascular invasion underscores the need for generous margins and multidisciplinary surveillance.

Objectives: Vascular rings are rare anomalies of congenital cardiovascular. This study aimed to assess the outcome of surgical repair of congenital vascular rings in children.

Methods: This retrospective study reviewed data from 237 patients with congenital vascular rings who underwent surgical division from January 2008 to October 2022.

Results: The mean age of patients was 12 months (Interquartile range, IQR, 6, 32 months) and their mean weight was 9.5 kg (IQR, 8, 14 kg). The data revealed that 153 patients (65%) were boys. The complete vascular rings consisted of a Double aortic arch (DAA, 33%), Right aortic arch (RAA) with left ligamentum arteriosum (LLA, 39%), and circumflex aorta (0.8%). The incomplete vascular rings consisted of a pulmonary artery sling (PAS, 26%), innominate artery compression syndrome (0.4%), and Left aortic arch (LAA) with Aberrant right subclavian artery (ARSCA, 0.8%). There were 3 hospital deaths (1.3%) and only one late death during the study. The overall mortality was 1.7% (4 patients). Eighteen patients underwent reintervention for complications. The overall survival rates at 1, 5, and 10 years were 98.3%, 98.3%, and 98.3%, respectively. The rate of freedom from residual symptoms at 1, 5, and 10 years was 97%, 91.3%, and 86.2%, respectively.

Conclusion: The results show that surgical repair of congenital vascular rings in pediatric patients yields excellent outcomes: most patients' symptoms improved and only a small proportion required reintervention. Although the pulmonary artery sling forms an incomplete vascular ring, it is associated with a higher incidence of tracheal stenosis and an increased risk of persistent postoperative respiratory symptoms. These observations suggest that more proactive intraoperative management of tracheal stenosis should be considered during the primary operation.