Thoracic and Cardiovascular Surgeon Reports最新文献

Surgery for Bentall's endocarditis poses challenges because the infection spreads to the aortic valve annulus, leading to an annular abscess that necessitates reconstruction. We present a straightforward miniskirt Bentall procedure using an annular pericardial patch to treat Bentall's endocarditis with an annular abscess. After removing the former composite graft and debriding the aortic root and annulus, we created a miniskirt-composite graft using a mechanical or bioprosthetic valve, a straight or Valsalva graft, and an annular bovine pericardial patch with a valve prosthetic sizer. The miniskirt-composite graft, along with the underlying annular pericardial patch, was implanted using a double-layered suture technique.

Symptoms of papillary fibroelastomas are often related to thromboembolic events but are rarely caused by a mechanical impairment of blood supply by the tumor itself. We describe a case of a papillary fibroelastoma in a 91-year-old female patient leading to a cardiac arrest through intermittent occlusion of the left coronary artery.

We report two cases of rare invasive tumors presenting with transvenous and intracardiac extensions. In one instance, an unusual invasive thymoma type A penetrated into the heart chamber; the other case was an extension of a myxoma into the right atrium that was associated with superior vena cava syndrome. Our interest was stimulated by the rarity of these clinicopathological observations and the unusual clinical features of diagnostic and therapeutic methods presented by these cases.

A 71-year-old man with dilated cardiomyopathy without clinical complaints revealed a suspicious finding in checkup. After a multimodality cardiac imaging, the suspicion of a malignant primary cardiac tumor in the left ventricle was substantiated and the patient underwent minimally-invasive cardiac surgery for tumor resection. Postoperative chemotherapy with multiple cycles of liposomal doxorubicin was established and supported by proton beam radiotherapy. Two-year follow-up revealed no disease recurrence.

We present the case of a minimally invasive surgical correction for failed percutaneous atrial septal defect (ASD) closure in a 57-year-old female patient with residual ASD, tricuspid regurgitation, atrial fibrillation, and embolization of one of two occluders to the superior mesenteric artery. Our surgical approach consisted of anterolateral minithoracotomy, aortic and femoral vein cannulation, cryoablation, cardiac device removal, closure of ASD with autologous pericardium, and tricuspid repair. The procedure was uneventful and patient was discharged home on postoperative day 4.

Background  No consensus exists regarding surgical intervention for rheumatoid nodule-related pneumothorax. Clinical policy decisions rely on individual clinicians' experience and are usually intractable. Case Description  A 50-year-old man with a difficult-to-treat rheumatoid arthritis-related pneumothorax was successfully treated with pedicle omentoplasty without recurrence at approximately 2 years posttreatment. To the best of our knowledge, this is the first report of a patient where pneumothorax did not recur due to firm adhesions despite fluctuating postoperative rheumatoid nodules, as captured by regular computed tomography imaging follow-ups. Conclusion  Pedicled omentoplasty is effective for rheumatoid nodule-related pneumothorax as it reduces pneumothorax recurrence.

Background  Patients with primary cardiac tumors may present with symptoms based on the size and location of the tumor. Symptoms may include congestive heart failure secondary to intracardiac obstruction, systemic embolization, arrhythmias, and constitutional symptoms. Case Description  A patient presented with new onset atrial fibrillation and heart failure. Workup including open surgery revealed a primary cardiac lymphoma. Conclusion  Cardiac tumors present with a variety of symptoms and are best evaluated by echocardiogram, computed tomography angiography, and magnetic resonance imaging. Tissue diagnosis is necessary. Although primary cardiac lymphoma is rare, long-term survival after chemotherapy and rituximab is superior to other cardiac malignancies.

Background  There are many known complications that occur after surgical revascularization for patients with significant left main coronary artery disease. Case Description  This case report highlights the preoperative workup, surgical approach, and postoperative management of a patient who presents with an aortic pseudoaneurysm and dissection 2 years after the index CABG. Conclusion  The development of an aortic pseudoaneurysm in combination with an ascending aortic dissection after prior coronary artery bypass grafting (CABG) is a rare compilation of complications that has scarcely been reported in the literature.

Background  Airway management in case of acute tracheal injury is a challenging situation where the use of Extracorporeal Membrane Oxygenation (ECMO) has recently gained more importance. Case Description  We report the case of a 60-year old women with aspiration of a large blister pack tablet causing acute tracheal obstruction with asphyxia as well as tracheal perforation with tension pneumothorax. As bronchoscopy failed to retrieve the blister pack, emergency tracheal reconstruction with Extracorporeal Membrane Oxygenation (ECMO) support was carried out. Conclusion  The application of ECMO instantly alleviated the acute situation and provided excellent conditions for technically demanding emergency tracheal repair.

Background  The so-called nonintubated or awake video-assisted thoracoscopic surgery (NIVATS) is performed on spontaneously breathing patients, which was shown to reduce postoperative complications and shorten hospital stay. Case Description  Awake uniportal VATS was indicated for the evacuation of an extensive, superinfected hemothorax with symptomatic mediastinal shift in a patient with advanced mediastinal SMARCA4-deficient tumor and declined condition, who did not allow a general anesthetic procedure and was not a candidate for extensive surgery. Conclusion  This short microinvasive intervention was a prerequisite to stabilize the threat to the patient's life and thus potentially enable any further tumor-specific therapy.