ASIAN CARDIOVASCULAR & THORACIC ANNALS最新文献

Aortic valve patient-prosthesis mismatch is associated with unfavorable outcomes. There are several techniques to mitigate this. Occasionally, root replacement may be required in the context of small aortic annuli or hypoplastic left ventricular outflow tract (LVOT). For children or young adults, the Ross operation (± Konno aortoventriculoplasty) may constitute a satisfactory solution. However, most adults, particularly those older than 50 years, may not be considered candidates for the Ross operation, particularly if associated annular enlargement is needed. In clinical practice, a subgroup of patients requiring root replacement present with the need for simultaneous LVOT/annular enlargement who can benefit from an aortoventriculoplasty (Bentall-Konno). Through this modified Konno procedure, a larger prosthesis can be implanted. This option is of interest when an anterior root enlargement is prioritized, as in cases of hypoplasia of the LVOT. The technique could be especially useful in patients presenting with a normal functioning mitral prosthesis, when seeking a durable mechanical prosthetic substitute, and in patients with debilitated anterior aortic annuli (endocarditis with anterior invasion or anterior annular defects consequence of or multiple prior interventions). The use of two unified patches anchored with interrupted stitches simplifies the operation, provides a platform for root conduit anchorage, and allows appropriate right ventricular outflow tract reconstruction. We provide a detailed description of the technique, present two videos from different patients, and supplement this material with a wet lab model to facilitate safe adoption of this approach.

IntroductionThromboelastography (TEG), which indicates hemostatic ability, is useful for monitoring coagulation during extracorporeal circulation (ECC). However, the extent to which TEG levels are independently affected by ECC exposure remains unclear. To determine the effects of TEG levels in blood exposed to a membrane oxygenator, we performed in vitro experiments using whole human blood with ECC circuits including a membrane oxygenator.MethodsBlood provided by healthy volunteers was heparinized and circulated in three types of experimental circuits: polymer-coating, heparin-coating (HC), or non-coating (NC) membrane oxygenators (five of each type). Thromboelastography tests using a global hemostasis assay were performed at 3, 6, 12, and 24 h of circulation in each experiment. During TEG, the sampled blood was reversed with 0.05 mg of protamine. One-way analysis of variance (ANOVA) and two-way repeated measures ANOVA were performed to evaluate trends in circulation duration and coating types, respectively.ResultsCitrated kaolin with heparinase reaction times (CKHR) were significantly shortened at 6 and 12 h but prolonged at 24 h. The maximum amplitude for citrated kaolin with heparinase (CKHMA) was magnified from 6 to 12 h. Regarding the coating type, a significant difference was observed between HC and NC in CKHR at 6 h, but significance was not noted in other comparisons of coating types in CKHR and CKHMA.ConclusionsThromboelastography data indicated that the hemostatic capability of blood exposed to membrane surfaces was maintained after 12 h of circulation. The effects on TEG data in terms of coating type remain to be determined.

IntroductionTuberculosis (TB) is a rare cause of chylopericardium. Optimal management remains unclear.Methods/ResultsA 30-year-old Filipino male presented with recurrent massive pericardial effusions, with pericardiostomy revealing chylopericardium. Microbiologic TB studies were negative, and other etiologies were excluded. Pericardial fluid adenosine deaminase was elevated; anti-TB regimen was initiated, leading to resolution.DiscussionThere is no consensus about the optimal management of TB chylopericardium. Adenosine deaminase represents a useful test to diagnose TB in inflammatory, lymphocyte-predominant effusions, especially when other tests are negative. Failed conservative management merits more invasive approaches.ConclusionWhile data remain lacking, this case suggests that TB chylopericardium responds to anti-TB therapy.

BackgroundBenign broncho-esophageal fistula (BEF) is a rare condition that often results from infections, trauma, or prior surgical interventions. This study evaluates the outcomes of surgical management of BEF, emphasizing the role of video-assisted thoracoscopic surgery.MethodsA retrospective analysis of 19 patients who underwent surgical management for benign BEF was conducted. Patient demographics, fistula characteristics, surgical approach, perioperative outcomes, and complications were assessed.ResultsThe cohort comprised 14 males (73.7%) and 5 females (26.3%) with a median age of 34 years (range: 19-63 years). The left main bronchus was the most common fistula location (n = 10, 52.6%) followed by right lower lobe (n = 6, 31.6%), left lower lobe (n = 2, 10.5%), and right bronchus intermedius (n = 1, 5.3%). A prior history of antitubercular treatment was noted in 15 patients (79%). Video-assisted thoracic surgery was successfully performed in 17 patients (89.5%), while 2 (10.5%) required conversion to thoracotomy due to dense adhesions. During surgery, division of fistula alone was performed in 14 patients (73.7%). The distal lung destruction necessitated lobectomy in 3 patients (15.78%) and wedge resection in 2 patients (10.52%). The mean operative time was 120 min, with a median hospital stay of 5.5 days. Two patients (10.5%) experienced complications, including a minimal esophageal leak managed with a stent and a case of postoperative pneumonia which resolved with conservative measures. No recurrences were observed during a median follow-up of 48 months.ConclusionsVideo-assisted thoracic surgery is a safe and effective approach for managing benign BEF, offering excellent long-term outcomes with minimal morbidity. Conversion to thoracotomy is required in select cases with dense adhesions.

BackgroundDirect oral anticoagulants (DOACs) have been linked to better renal outcomes than warfarin in non-valvular atrial fibrillation (NVAF). We aimed to compare the renal function outcomes in Asian NVAF patients treated with warfarin and DOAC.MethodsThis multicentre retrospective study analysed NVAF patients newly initiated on oral anticoagulant (OAC) from 2013 to 2022 across seven tertiary hospitals. Using propensity-score matching, warfarin and DOAC recipients were matched by incorporating 22 variables potentially affecting renal outcomes. Primary endpoints include clinically significant (≥30%) estimated glomerular filtration rate (eGFR) decline and worsened chronic kidney disease (CKD) stage.ResultsA total of 766 subjects (383 warfarin; 383 DOAC; mean age 70.7 ± 9.6 years) were analysed. Baseline eGFR was 75.0 (59.0-89.0) for warfarin and 76.0 (59.0-88.0) ml/min/1.73 m² for DOAC groups. Following median OAC treatment of 2.8 ± 1.6 years, 14.5% experienced clinically significant eGFR decline and 31.9% had worsened CKD stage. DOAC was associated with a lower risk of clinically significant eGFR decline (OR 0.529, 95% CI 0.343-0.817, p = 0.004) and worsened CKD stage (OR 0.713, 95% CI 0.521-0.975, p = 0.034). In subgroup analysis, rivaroxaban (OR 0.337, 95% CI 0.157-0.724, p = 0.005) and dabigatran (OR 0.516, 95% CI 0.285-0.934, p = 0.029), but not apixaban (OR 0.759, 95% CI 0.432-1.333, p = 0.338), were associated with a lower risk of clinically significant eGFR decline.ConclusionsSignificant renal function decline is common during follow-up of Asian NVAF patients on OAC. Among the DOACs, rivaroxaban and dabigatran, but not apixaban, were associated with a lower risk of renal function decline than warfarin. These findings warrant confirmation in prospective randomised studies.

We present the case of a 61-year-old male who was admitted with superior vena cava syndrome. Patient's medical history includes a coronary artery bypass surgery 5 years ago. Echocardiography and computed tomography angiography showed a giant right coronary artery aneurysm compressing the superior vena cava. Due to hemodynamic deterioration, emergent cardiac surgery was performed to alleviate the compression, and veno-arterial extracorporal membrane oxygenation (VA ECMO) was necessary during intensive care unit. Hemodynamic improvement over 6 days allowed for successful ECMO weaning and eventually patient's discharge.

The DeVega annuloplasty procedure involves a double-running suture line along the circumference of the tricuspid annulus, encircling the anterior and posterior leaflets. A rare mechanical complication of this technique is the detachment of the suturing from the annulus, which can be referred to as the "bowstring sign" or "guitar string sign."

Cardiac tumors, whether primary (mostly benign) or secondary (metastatic), are extremely rare, and very few cases of retiniform hemangioendothelioma have been documented since its initial diagnosis in 1994. We present a 67-year-old male who presented with pericarditis, recurrent pericardial and pleural effusions. On computed axial tomography, an oval lesion located on the superior aspect of the left pulmonary pericardial recess within the transverse sinus, adjacent to the trunk of the pulmonary artery. In the operating room, after dissection and resection of the mass, the histopathological diagnosis of retiniform hemangioendothelioma was confirmed.

IntroductionCoronary artery bypass graft (CABG) surgery is performed globally around 400,000 times annually. Despite its benefits, CABG can lead to complications, including chylothorax, a rare condition where chyle accumulates in the pleural cavity due to thoracic duct trauma. Currently, there are no international guidelines for traumatic chylothorax management post-CABG. This is the first systematic review to provide a comprehensive overview of the current state of management for chylothorax post-CABG.MethodsThis systematic review was conducted by searching EMBASE, Cochrane, Ovid and PubMed databases on 16 June 2024. The inclusion criteria focused on studies addressing post-CABG chylothorax management and reporting clinical outcomes. Data was extracted from 11 studies focusing on graft type, complications and management strategies.ResultsThis review included 11 case report studies with 14 cases of post-CABG chylothorax. Conservative management was attempted in all cases, with varying components such as total parenteral nutrition, nil by mouth, octreotide and low-fat diets. High-output chylothorax (>1000 mL/day) often necessitated surgical intervention after an average of 12.5 days of conservative management. Surgical approaches included thoracic duct ligation, embolisation and pleurodesis. Surgical ligation was effective in three cases, while thoracic duct embolisation was successful in one case.ConclusionsChylothorax post-CABG is managed initially with conservative strategies, but high-output cases often necessitate surgical intervention. This review highlights the need for standardised guidelines, regarding the timing of surgical escalation and the use of octreotide and somatostatin. Further research should focus on higher-powered studies to validate these findings and establish clinical guidelines for managing chylothorax post-CABG.