ASIAN CARDIOVASCULAR & THORACIC ANNALS最新文献

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.

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.

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.

We describe a rare case of left pulmonary artery (LPA) originating from a closed left patent ductus arteriosus (PDA). A neonate underwent left PDA reopening and stenting. Reperfusion injury was minimized while allowing time for interval growth of the distal LPA. At four months of age, surgical reconstruction was performed to reconnect the LPA to the main pulmonary artery (MPA) with an anterior MPA flap augmented with pericardial patch. Autograft reconstruction is preferred to accommodate patients' growth. Postoperative angiogram showed confluent flow into LPA and distal pulmonary branches. Patient was discharged without complications and was well after 1 year.

BackgroundSurgical repair of complete atrioventricular septal defect (CAVSD) has evolved substantially, with early mortality markedly reduced over the past decades. However, achieving durable left atrioventricular valve (LAVV) competence and preserving left ventricular outflow tract (LVOT) geometry remain critical determinants of long-term success.MethodsThis review summarizes the anatomical principles, operative details, and clinical outcomes of the Nunn-modified single-patch ("Australian") technique for CAVSD repair.ResultsThe Australian technique-characterized by direct approximation of bridging leaflets to the septal crest without a ventricular patch-demonstrates superior preservation of LVOT architecture and promotes symmetrical LAVV coaptation. Contemporary series report >90% freedom from LAVV reoperation and >97% freedom from LVOT obstruction at 10-15 years, outperforming traditional repairs in multiple institutional and multicenter cohorts. These advantages are consistent across a wide spectrum of ventricular septal defect sizes and patient ages, provided anatomical prerequisites are met.ConclusionsBy minimizing prosthetic material and restoring native leaflet geometry, the Australian Repair achieves excellent long-term valve competence and reoperation-free survival. It should be considered a first-line option in appropriately selected CAVSD patients, particularly where durable LAVV function and LVOT integrity are paramount.

BackgroundRobotic-assisted mitral valve surgery (RAMVS) has emerged as an alternative to conventional minimally invasive mitral valve surgery (MIMVS). However, previous studies have been limited by small sample sizes, heterogeneous techniques and reliance on unmatched or indirectly compared cohorts, resulting in inconclusive evidence. This meta-analysis focuses exclusively on propensity-matched studies to provide a more robust comparison of RAMVS and MIMVS.MethodsA comprehensive literature search was performed to identify propensity-matched studies comparing RAMVS and MIMVS. Pooled odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using RevMan 8.13.0. Subgroup analyses, including mitral valve repair only, non-isolated mitral valve surgery and MIMVS via right minithoracotomy, were conducted to explore heterogeneity.ResultsEight studies comprising 3352 patients were included, with 1578 (47.1%) undergoing RAMVS. The RAMVS was associated with a shorter hospital stay (MD -1.8 days; 95% CI -3.0 to -0.5; p = 0.006) but significantly longer cardiopulmonary bypass time (MD 21.8 min; 95% CI 0.8-42.9; p = 0.04), and higher odds of conversion to sternotomy (OR 2.9; 95% CI 1.6-5.4; p = 0.0007) and re-exploration for bleeding (OR 1.86; 95% CI 1.1-3.2; p = 0.02). Intensive care unit stay, operative time and postoperative complications were comparable. All subgroup analyses consistently showed higher conversion rates with RAMVS.ConclusionThe RAMVS offers potential recovery benefits but at the cost of greater intraoperative complexity. Careful patient selection and technical expertise are essential to maximise outcomes.