Journal of Cardiothoracic Surgery最新文献

Objectives: Despite the advances in medicine, aortic dissection remains a cardiac surgery emergency with high mortality and morbidity rates. This study examined the effects of the Glue + Felt technique, which uses biological glue and felt to repair the proximal anastomotic site, on the outcomes of patients with acute type A aortic dissection.

Methods: A total of 108 patients who underwent surgery for acute type A aortic dissection at our clinic between 2007 and 2020 were included in the study. The patients were divided into two groups: the "Glue + Felt Technique" and the "Bentall-De Bono" groups, based on the surgical technique used for the aortic root. The effects of these two techniques on the development of intraoperative and postoperative complications and survival rates were statistically analyzed.

Results: The Glue + Felt technique was used for 76 patients, while the Bentall-De Bono technique was used for 32 patients. The Kaplan-Meier analysis revealed significant differences in survival rates between the two groups over the entire follow-up period, both with and without propensity score matching (p < 0.001 and p = 0.02, respectively). However, no significant differences were observed in comparisons beyond the first 30 days of follow-up, either with or without propensity score matching (p = 0.573 and p = 0.561, respectively). The main factors contributing to this difference were the duration of cardiopulmonary bypass and aortic cross-clamp time (p < 0.05). During the average follow-up period of 46.2 ± 31.6 months, no re-intervention was required in patients from the Glue-Felt technique group.

Conclusions: The mortality rate in aortic dissection surgery is higher with more extensive surgical intervention as the duration of cardiopulmonary bypass and aortic cross-clamp time increases. Repairing the lumen and reducing operation time in suitable patients using the Glue-Felt technique for the proximal anastomotic site positively impacts postoperative complications and improves in-hospital and 30-day survival rates, without increasing long-term re-intervention rates.

Background: Gauzoma is a foreign body reactive granuloma which is an extremely rare complication of thoracic surgery. We describe a case of a Gauzoma in which the gauzes were removed by mini-thoracotomy as a less invasive procedure, discovered incidentally after 35 years of follow-up.

Case presentation: A 51-year-old man was referred to our department for hyperhidrosis treatment, and imaging studies and biopsy confirmed the diagnosis of Gauzoma. As the Gauzoma gradually grew for a few years, surgical intervention was judged necessary, and the removal of the gauzes was performed in this case. A two-stage operation in two days was required to complete the surgery. The completion of gauze removal was confirmed in the second surgery using a postoperative computed tomography (CT) scan. The patient is currently doing well 17 months after surgery, and the size of granuloma unchanged.

Conclusion: We performed the removal of the gauzes as the treatment for Gauzoma. Although removing the gauze may have prevented its growth so far, careful follow-up is still needed.

Background: Solid lung lesions are common in clinical practice, and percutaneous thermal ablation has been shown to be an effective treatment for these lesions. While computed tomography (CT)-guided microwave ablation (MWA) therapy is frequently used for adult solid lesions, it is rarely considered for pediatric cases.

Case presentation: A case of an 8-year-old child with adrenal neuroblastoma and a left upper lung mass. The child successfully underwent lung mass ablation and experienced a long-term progression-free period with good recovery and no recurrence.

Conclusions: This case suggests that MWA could be a valuable addition to existing treatment options for solid lesions in children.

Objective: To investigate the therapeutic effect of levosimendan on hemodynamics in patients undergoing major cardiac surgery and presenting with acute postoperative heart failure.

Methods: The subjects of the study were 160 patients with severe cardiac conditions who underwent surgery and had acute heart failure. Eighty cases each were assigned to the research and control groups using a random number table. Document the general patient data for each of the two groups; compare the clinical outcomes of the two groups. The hemodynamic states of the two groups were compared both before and after therapy. 48 h after surgery, echocardiography was performed in both groups to determine cardiac function. 48 h after surgery, N-terminal pro-brain B-type natriuretic peptide (NT-Pro-BNP) levels were compared between the two groups.

Results: The overall effective rate was significantly higher in the research group (92.5%) compared to the control group (76.25%, P < 0.05). Post-treatment, the research group demonstrated a significant reduction in CVP (9.25 ± 2.11 cmH2O vs. 11.36 ± 3.08 cmH2O, P < 0.001), heart rate (100.30 ± 8.69 bpm vs. 105.74 ± 7.69 bpm, P < 0.001), and lactic acid levels (1.68 ± 0.59 mmol/L vs. 2.69 ± 0.55 mmol/L, P < 0.001). The research group also showed improvements in SBP (117.23 ± 8.74 mmHg vs. 113.25 ± 7.55 mmHg, P = 0.002) and urine output (4.21 ± 1.76 mL/kg/h vs. 3.65 ± 1.23 mL/kg/h, P = 0.021). Cardiac function indicators 48 h after surgery indicated a higher LVEF (55.21 ± 8.04% vs. 47.18 ± 6.60%, P < 0.001) and lower LVEDVi and LVESVi in the research group (P < 0.001 for both). NT-Pro-BNP levels were significantly lower in the research group (6010.19 ± 1208.52 pg/mL vs. 9663.21 ± 2391.34 pg/mL, P < 0.001). The incidence of complications was lower in the research group (5% vs. 22.5%, P = 0.001).

Conclusion: Cardiac surgery patients are prone to complications with acute heart failure after surgery. Treatment with levosimendan can significantly improve clinical efficacy and reduce complications. It can also effectively improve patients' cardiac function and promote hemodynamic stability.

Background: The intricate anatomical variations in lung structure often perplex thoracic surgeons, and the accurate identification of these variations is closely associated with favorable surgical outcomes.

Case presentation: A 53-year-old female patient who underwent computed tomography (CT) examination due to chest discomfort, revealing the presence of a partial solid nodule highly suspected of early-stage lung cancer, measuring approximately 2.8 × 2.6 cm in the left lower lobe. Consequently, the patient underwent a single direction thoracoscopic left lower lobectomy and lymph node dissection. Intraoperatively, while attempting to dissect and free the left lower lobe vein from surrounding tissues, technical difficulties were encountered. Upon meticulous review of preoperative CT scans during surgery, an anomalous connection between the lingular vein of the left upper lobe and the left lower lobe vein was identified. Once this anatomical variation was confirmed, surgical intervention proceeded uneventfully without any significant complications.

Conclusion: Precise recognition of pulmonary anatomical structures before and during surgery is paramount in recognizing rare variations such as this one as it aids in preventing potential intraoperative injuries and minimizing postoperative complications.

Introduction: Primary pulmonary meningioma is a rare disease. There have been only a little over 50 cases of primary pulmonary meningioma (PPM) reported in previous literature. The pathogenesis of PPM is still unclear. We report a case of PPM cured by thoracoscopic right middle lobe wedge resection and systematically review previously reported cases in previous literature.

Case report: A 57-year-old male patient was found to have a nodule in the right middle lobe of about 1.8 cm in diameter on a chest-enhanced CT scan performed more than 7 years ago. A re-examination in 2023 found the subpleural nodule in the right middle lobe had grown larger than before. Considering surgical treatment, the patient underwent a thoracoscopic right middle lobe wedge resection after a thorough examination. The final pathological diagnosis was primary pulmonary meningioma. Regular follow-up CT scans showed no recurrence.

Conclusion: Primary pulmonary meningioma is a rare tumor that occurs in sites similar to lung cancer. Most cases are solitary, presenting as ground-glass nodules (GGO), and can occur in multiple lobes, involving the mediastinum and pleura with multiple nodules. Clinical and radiological diagnoses are often challenging, especially distinguishing from primary lung cancer. Surgery remains the optimal choice for the diagnosis and treatment of PPM. Most cases are benign with a good prognosis, and wedge resection is usually the preferred surgical approach. A small proportion of malignant cases may require lobectomy and adjuvant radiotherapy and chemotherapy due to tumor invasiveness.

Background: Hydatid cyst (HC) frequently affects the lungs, making it the second most common site after the liver. This study evaluated the clinical characteristics, surgical procedures, complications, laboratory findings, and factors influencing hospital length of stay (LOS) in patients undergoing surgery for pulmonary hydatid cysts.

Methods: This retrospective observational study included adult patients who underwent surgery for lung HC between 2017 and 2021. Data were collected using a standardized checklist covering demographics, medical history, clinical symptoms, laboratory findings, treatment details, surgical characteristics, and risk factors. The primary outcome was LOS, defined as the duration between surgery and discharge.

Results: A retrospective analysis of 214 patients with pulmonary hydatid cysts revealed a male predominance (59.3%; median age, 36 years). The most common symptom was cough (39.3%), followed by chest pain and dyspnea. Right lower lobe involvement (51.4%) and synchronous liver cysts (13.6%) were frequently observed. Elevated erythrocyte sedimentation rate (ESR), eosinophilia, positive serology, prolonged air leak, and fever were correlated with longer LOS. The dominant surgical procedure was cystotomy with capitonnage (95.8%), performed via thoracotomy.

Conclusions: Most hydatid cysts were located in the right lower lobe, with cough being the most frequent presenting symptom. Thoracotomy and cystotomy with capitonnage were the primary surgical procedures performed. Common postoperative complications included wound infection, empyema, and prolonged air leak. Awareness of factors such as elevated ESR, eosinophilia, positive serology, prolonged air leak, and fever may improve management and reduce hospital LOS.

Introduction: Thymomas and thymic carcinomas are rare anterior mediastinal tumours, accounting for 0.2-1.5% of all cancers. Surgical resection is key to treatment, though invasion of surrounding structures like great vessels can complicate this. This case report details the management of a type B3 thymoma (T4 N0 M0) in a 41-year-old male.

Case report: A 41-year-old male presented with myasthenic symptoms and was diagnosed with a large thymic mass involving the brachiocephalic vein and superior vena cava. After 4 cycles of neoadjuvant chemotherapy, partial resection was performed, followed by radiotherapy. Residual disease led to a second surgery, during which tumour resection and vascular reconstruction using cardiopulmonary bypass were successfully completed. Postoperative recovery was uneventful.

Discussion: Complete resection, including re-resection, when necessary, is crucial for improved outcomes in thymoma patients. Even with great vessel invasion, aggressive surgery, coupled with chemotherapy and vascular reconstruction, can achieve good survival outcomes.

Conclusion: Multimodal management, including chemotherapy, complete resection, and vascular reconstruction, offers the best prognosis for invasive thymomas, even with great vessel involvement.

Background: Diagnosis and prognostic evaluation of acute myocardial infarction (AMI) are crucial for patients.

Objective: The clinical significance of serum miR-199a-5p combined with echocardiography in AMI was investigated to provide some reference for clinical treatment.

Methods: The study subjects were 90 AMI patients and 50 acute chest pain patients (control). All patients were examined by echocardiography and recorded LVEDV, LVESV, and LVEF. RT-qPCR was performed to detect the serum miR-199a-5p level. Pearson analysis was used to analyze the correlation of miR-199a-5p with LVEF and cTnI. The diagnostic value of miR-199a-5p combined with LVEDV, LVESV, and LVEF was assessed by the ROC curve. The occurrence of major adverse cardiovascular events (MACE) was recorded to analyze the prognostic value of miR-199a-5p by the Kaplan-Meier curve and Cox regression.

Results: Serum miR-199a-5p was elevated in AMI, positively correlated with cTnI and negatively correlated with LVEF. The combination of miR-199a-5p with LVEDV, LVESV, and LVEF enhanced the sensitivity and specificity for the diagnosis of AMI. Patients with high miR-199a-5p expression were more likely to develop MACE. The combination of miR-199a-5p with LVEF improved the prediction of MACE.

Conclusions: The combination of miR-199a-5p with echocardiography improved the diagnostic efficiency of AMI and provided prognostic information.