ASIAN CARDIOVASCULAR & THORACIC ANNALS最新文献

It is desirable to preserve the pulmonary valve annulus as much as possible, but the decision to preserve the annulus should be made by taking into account not only the annulus diameter but also the characteristics of the valve leaflets. Even if the valve annulus diameter is 70% or more of the normal value, in cases where the valve leaflets are poorly mobile or thickened, there is a concern that pulmonary regurgitation will worsen after pulmonary commissurotomy, so it is desirable to reconstruct the right ventricular outflow tract using a valved conduit in order to preserve right ventricular function. The choice of conduit is extremely important. The bovine jugular vein graft, which is associated with a high incidence of complications such as infection, should be avoided as much as possible. The ePTFE valved conduit is useful for preserving right ventricular function, and is recommended as a conduit for right ventricular outflow tract reconstruction. Although ePTFE valved conduits may cause relative stenosis due to weight gain, the possibility of pulmonary regurgitation is low, and the frequency of thrombosis and infection is also low. The conduit exchange free rate for large-diameter ePTFE valved conduits is high, and the need for reintervention is low.

The conventional primary-secondary classification of spontaneous pneumothorax fails to capture the complexity encountered during thoracoscopic surgery, where CT imaging often misses subtle apical scarring, early emphysematous changes, or fibrotic, noncompliant lung tissue. To provide a more operative-relevant clinical framework, we hereby propose the PLEX Classification, based on Pattern of lung abnormality, Location of leak and lung reserve, Extent of disease, and eXpected surgical complexity and surgical outcome. This system categorizes pneumothorax into four different variants: Type I (apical vulnerability pneumothorax), Type II (multibullous pneumothorax), Type III (emphysematous pneumothorax), and Type IV (fibrotic lung pneumothorax). Applied to 710 surgeries, PLEX demonstrated a clear gradient of increasing surgical difficulty and complications from Type I to Type IV. PLEX offers a pragmatic, surgically actionable system for planning, communication, as well as outcome prediction.

Although purulent pericarditis is rare in the modern era, early diagnosis and appropriate therapy with antibiotics and drainage are critical because it remains a rapidly progressive and highly fatal infection. Purulent pericarditis typically occurs as a secondary infection through hematogenous dissemination or contiguous spread from an intrathoracic infection, with most cases occurring in immunocompromised individuals. Herein, we report the case of a 52-year-old male patient with a history of diabetes mellitus who had difficult-to-diagnose chest pain. He was ultimately diagnosed with purulent pericarditis using ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography, then treated via surgical drainage, pericardiectomy, and long-term antibiotic therapy.

Anomalous aortic origin of a coronary artery (AAOCA) represents a rare yet clinically significant congenital anomaly associated with myocardial ischemia and sudden cardiac death, particularly in young individuals. Advances in multimodality imaging have enabled earlier detection and precise anatomical delineation, shifting the paradigm from incidental diagnosis to proactive management. This review synthesizes contemporary understanding of AAOCA pathophysiology, diagnostic strategies, and surgical management. The mechanisms of ischemia-slit-like ostium, intramural course, acute take-off angles, and interarterial compression-underscore the condition's dynamic nature. Diagnostic evaluation integrates anatomical imaging with computed tomography or cardiac magnetic resonance and functional assessment through perfusion testing to identify ischemia. Surgical intervention is indicated for high-risk anatomy or documented perfusion defects. Unroofing and coronary reimplantation remain the mainstays of therapy, while ostioplasty, pulmonary artery translocation, and coronary artery bypass grafting are reserved for anatomically or technically specific scenarios. Successful AAOCA management requires individualized surgical planning grounded in anatomical precision and physiologic understanding. Long-term surveillance with multimodality imaging and stress testing is essential, as residual or delayed complications-such as restenosis, fibrosis, or aortic insufficiency-may occur. With accurate diagnosis, meticulous surgical execution, and disciplined follow-up, most patients achieve excellent outcomes. The era of AAOCA as a mysterious postmortem diagnosis is ending; it is now a surgically correctable entity when addressed proactively and precisely.

We present a case of a 14-year-old boy with a recurrent syncope during exercise, diagnosed with a rare coronary anomaly: an intramural single coronary trunk between the great arteries. The trunk originated from the left sinus of Valsalva with acute angle take-off and ran intramurally. He underwent successful surgical repair using the unroofing technique. Postoperative recovery was uneventful, and he remains symptom-free 3 years after surgery. This report shows a novel application of the unroofing technique for this unique anomaly.

Transcatheter aortic valve implantation (TAVI) has revolutionized the management of aortic stenosis and is now an established alternative to surgical aortic valve replacement (SAVR) for all surgical risk categories. However, the extension of TAVI to younger, low-risk patients has raised important questions regarding the long-term outcomes, valve durability, and lifetime management strategies for these patients. This narrative review summarizes the current evidence from pivotal randomized trials and contemporary registries comparing TAVI and SAVR in young, low-risk patients, integrating the latest 2025 ESC/EACTS guidelines. While short-term outcomes and early recovery favor TAVI, SAVR remains associated with proven durability, lower rates of conduction disturbances, and a potential advantage in long-term outcomes as follow-up data extend beyond five years. Anatomical challenges such as bicuspid valves, coronary access, and patient-prosthesis mismatch further complicate the use of TAVI in this population. A "SAVR-first" lifetime management approach appears to provide greater procedural flexibility and a lower reintervention risk. Ultimately, the choice between TAVI and SAVR in young patients should be individualized through a multidisciplinary Heart Team process, balancing early procedural benefits with long-term durability and reintervention considerations. This review highlights the need for dedicated long-term data and patient-tailored strategies in the evolving management of aortic stenosis in young low-risk individuals.

The introduction of the neonatal arterial switch operation in the 1980s demonstrated that early repair of congenital heart anomalies could be performed with improved patient survival relative to initial palliation and delayed repair in later infancy or beyond. Over the next decade or two, there was a continuing move away from a staged approach at most congenital heart programs. Studies from that era documented that the staged approach increased overall cost and reduced ultimate patient survival. However, over the last decade or two, there has been resurgent popularity of a staged approach, particularly for the management of very small and premature newborns. This paper reviews the factors that have led to increasing enthusiasm for the staged approach to management of congenital heart disease. The danger of using procedural databases like the Society for Thoracic Surgery (STS) and European Association for Cardiothoracic Surgery (EACTS) surgical databases to measure the quality of overall patient management strategy is emphasized. Until diagnosis-based, patient survival databases are used for Quality Assurance, it will not be possible to define whether a tipping point exists, below which very small and complex neonates should be managed with a staged approach. However, current data strongly suggest that neonates of at least average size as well as young infants have improved survival and reduced reintervention as well as markedly reduced time in hospital and overall costs when a strategy of early primary repair is pursued.

BackgroundThe frozen elephant trunk (FET) procedure is developed to treat complex aortic arch diseases. We aimed to share our single centre experience of FET operations over time.MethodsA review of first 100 patients who underwent FET procedures for acute, chronic dissection and thoracic aneurysm from January 2016 to January 2024. The patients were divided into two groups: Group 1 (first 50 cases); Group 2 (subsequent 50 cases) and compared the early and late outcomes.ResultsEarly overall mortality was 9% but reduced with time {12% (6/50) in Group 1 vs. 6% (3/50) in Group 2, p = 0.295} with no deaths among the isolated FET procedures. Morbidity included stroke (4%), spinal cord injury (3%) and temporary renal dialysis (9%). Durations of total operation time, cross clamp, circulatory arrest and cerebral perfusion were shorter in group 2; p < 0.05. Concomitant coronary artery bypass grafting, clamp time >180 min, temperature <20 °C and ventilation >72 h were the significant risk factors for all mortality. The overall 1, 5 and 7-year survival were 93.8, 90.7 and 82.5%, respectively, with freedom from aortic re-intervention reflected at 98.8, 87.8 and 87.8%, accordingly.ConclusionsEarly mortality for FET procedure was significantly reduced to 6% with time and no death among isolated FET. The FET operations became faster with better recovery. Doing more cases, refining surgical techniques and post-operative care are the lessons learned for improvements.

Single Port Video-Assisted Thoracic Surgery (VATS) is now the standard of care for many pulmonary operations. The adoption of Single Port VATS for mediastinal surgery has been considerably slower. Nonetheless, intercostal, subxiphoid, and robot-assisted single-port surgery approaches for mediastinal conditions have been explored in recent years. This narrative review looks at the variety of techniques described and offers an appraisal of the clinical evidence surrounding them.