Operative Techniques in Thoracic and Cardiovascular Surgery最新文献

Direct true lumen cannulation through aortic incision for cardiopulmonary bypass during surgery for acute Stanford type A aortic dissection was reported by Jacob, followed by Conzelmann who used a Mersilene tourniquet to snag the ascending aorta. Since 2013, Samurai cannulation, a modified version of the direct true lumen cannulation, has been used in surgery for acute type A aortic dissection at Kitasato University Hospital. Here, this surgical technique is described.

The concept of a short esophagus defined as less than 2.5 cm of intra-abdominal esophageal is still a highly debated topic among benign UGI surgeons. Giant hiatal hernias and peptic strictures are a few conditions associated with lack of intra-abdominal esophageal length. All paraesophageal hernia operations necessitate adequate mediastinal esophageal mobilization until the inferior pulmonary vein. However, if despite this maneuver, a short esophagus is encountered, then a lengthening procedure is recommended to reduce the risk of a slipped wrap and hernia recurrence. Several options for esophageal lengthening are available including a left transthoracic, or a right transthoracic Collis stapled approach, modified collis gastroplasty and wedge gastroplasty.

Transapical ventriculotomy is an important technique in the surgical management of hypertrophic cardiomyopathy (HCM). It is our preferred method for addressing complex long-segment subaortic obstruction and isolated midventricular HCM, as it provides better exposure of the midcavity than alternate methods such as the transaortic or transmitral approach. The procedure can also be used to improve symptoms of diastolic heart failure caused by reduced left ventricular end-diastolic volume as may occur in patients with apical HCM. In this article, we describe our surgical method for transapical myectomy to relieve midventricular obstruction or enlarge the left ventricular cavity to improve diastolic dysfunction in cases of extensive apical hypertrophy.

The Ross procedure is superior as a valve substitute in children and early adulthood because of its clear survival benefits. The free standing-root implantation is associated with failure of the autograft and inclusion techniques that support externally the autograft warrants its longevity. The current technique consists in the implantation of the autograft within the native aortic root thereby both supporting the autograft and avoiding any coronary distortion.

Autograft stabilization has proven beneficial in adults but the same technique could not always be adopted in growing children undergoing the Ross procedure. The major concern regarding the longevity of autograft after the Ross operation in a growing child is the lack of means to stabilize the aortic root. Herein we described a modified root inclusion technique that achieves aortic root stabilization using autologous tissue.

Though their etiology and pathology are distinct, the treatment of symptomatic diaphragm eventration and paralysis is the same – diaphragm plication. Though there is little data to objectively compare plication techniques, all offer significant improvement in symptoms, pulmonary function, and respiratory quality-of-life scores. Nonetheless, potential advantages of a robot assisted laparoscopic approach to plication include lower morbidity than thoracotomy and laparotomy techniques; avoidance of single lung ventilation, less intercostal nerve pain, and greater working domain compared with thoracotomy and thoracoscopic approaches; and enhanced dexterity as compared with standard laparoscopic instrumentation.

Aberrant subclavian arteries are a result of unusual involution of the branchial arches resulting in persistent arteries that can cause tracheal or esophageal compression. Many are incidental findings but may be associated with dysphagia (dysphagia lusus naturae, Latin for “jest of nature”), a long history of asthma treatment for wheezing, or more uncommonly, aneurysms or aortic dissection. There are 5 basic approaches for repair discussed herein, determined by which subclavian artery is involved and where the aortic arch and descending thoracic aorta lie, as well as the size of the latter, classified as Groups A to E, in order of frequency. These include: A: Aberrant RSCA and left arch; B: Aberrant LSCA and right arch; C: Aberrant RSCA, no significant Kommerell's and descending aneurysm; D: Aberrant LSCA and right-sided arch but compression from a vascular ring; and E: Aberrant RSCA and extensive arch and descending aneurysm.

Postinfarction ventricular septal rupture, or postinfarction ventricular septal defect is rare but lethal if not repaired, and various repair techniques have been tried over many years. However, there still remain problems of high mortality rates and shunt recurrence, particularly in the acute phase and posterior defects. The extended sandwich patch repair via the right ventriculotomy was developed to overcome those problems. The 3 key features are, first, access and eventual closure through the low-pressure right ventricle; second, using the septal defect for a portal to reach into the left ventricle; and third, “sandwiching” the defect between 2 patches, both large enough to be anchored by transmural sutures through relatively stable myocardium. Detailed technical steps are presented here.