Thoracic and Cardiovascular Surgeon Reports最新文献

Background: Redo aortic interventions after failed transcatheter aortic valve replacement (TAVR) are challenging, particularly with low coronary heights and dense frame ingrowth.

Case description: An 83-year-old woman with prior TAVR developed severe prosthetic stenosis. Surgical Resection of Prosthetic Valve Leaflets Under Direct Vision (SURPLUS) with implantation of a balloon-expandable aortic valve and intraoperative low-dose indocyanine green (ICG) near-infrared (NIR) angiography was performed. Real-time NIR imaging confirmed symmetric coronary opacification. The valve was well seated with improved ejection fraction (60-65%), and recovery was uneventful.

Conclusion: SURPLUS with ICG-NIR angiography ensured coronary patency and safe hemodynamic restoration.

This case report describes a 23-year-old male with a history of bicuspid aortic valve endocarditis managed with an emergency Ross procedure in 2020, whereby a xenograft pulmonary conduit prosthesis was implanted in the pulmonary position, followed by pulmonary conduit stenosis treated initially with high-pressure balloon dilatation 3 years later. The consequent diagnosis of iatrogenic aortopulmonary (AP) window, combined with severe recurrent pulmonary conduit stenosis, necessitated reoperation with right ventricle-to-pulmonary artery homograft replacement and repair of the AP shunt.

Background: Parachute mitral valve (PMV) is a rare congenital anomaly where all chordae tendineae insert into a single papillary muscle, causing stenosis or regurgitation. Adult presentations are uncommon and often underdiagnosed.

Case description: A 35-year-old male presented with exertional dyspnea. Echocardiography demonstrated severe mitral stenosis, reduced ejection fraction, a bicuspid aortic valve, and pulmonary hypertension. Intraoperative findings confirmed true PMV. Due to anatomical complexity, a 27-mm mechanical prosthesis replacement was performed successfully, with rapid postoperative recovery.

Conclusion: Adult PMV requires high clinical suspicion and often surgical confirmation. Valve replacement is effective in complex cases, emphasizing the importance of early diagnosis and intervention.

Gastrointestinal bleeding (GIB) is the most common and potentially life-threatening bleeding complication in pediatric patients on left ventricular assist devices (LVAD), particularly under anticoagulation. We report a 13-year-old female with dilated cardiomyopathy on HeartMate 3 support who developed acute GIB after participating in a "Hot Chip Challenge," consuming excessive spicy chips. The bleeding required blood transfusion and intensive management. This case highlights the potential impact of lifestyle factors, especially dietary choices, on GIB risk in pediatric LVAD patients.

Background: Nutcracker syndrome is a rare condition caused by compression of the left renal vein, often underdiagnosed in adolescents.

Case description: We report a 16-year-old male with painful left testicular swelling and grade 3 varicocele. Imaging confirmed anterior nutcracker syndrome. He underwent successful left renal vein transposition with complete symptom resolution and normal imaging at 24 months.

Conclusion: Nutcracker syndrome should be considered in young patients with varicocele and testicular pain. Renal vein transposition is a safe and effective treatment when conservative approaches fail, with long-term clinical and radiological benefits.

Background: Ectopia cordis (EC) is an exceptionally rare congenital anomaly with a poor prognosis, particularly in resource-limited settings.

Case description: We present a newborn with complete thoracic EC who underwent surgical correction on day 5 of life. Although cardiac repositioning and soft tissue coverage were achieved, the infant died 72 hours postoperatively from septic shock, reflecting the significant challenges faced in such contexts.

Conclusion: This case underscores the urgent need for improved antenatal care and technical resources to enhance outcomes for complex congenital anomalies in sub-Saharan Africa.

Background: In patients on direct oral anticoagulants (DOAC), emergency surgery is characterized by the occurrence of a massively increased tendency to bleed. Currently, there is no approved antidote for postoperative patients, making specific therapy challenging in these situations.

Case description: Emergency surgery was required for a 72-year-old male patient who was in cardiogenic shock due to severe aortic regurgitation resulting from acute prosthetic valve endocarditis. Due to atrial fibrillation, the patient was on apixaban, a factor Xa (FXa) inhibitor anticoagulant, until surgery. We used the ADVanced Organ Support (ADVOS) albumin hemodialysis system postoperatively to treat persisting shock with multi-organ failure, acidosis, and DOAC removal. Serial drug-level measurements revealed strongly accelerated apixaban clearance. In line with this, we observed only moderate drainage losses.

Conclusion: ADVOS accelerates the removal of apixaban and is a promising therapy for preventing bleeding complications in patients receiving DOAC therapy after emergency surgery.

Background: Cardiomyopathy is the leading indication for transplantation in children. Mechanical cardiac support systems play a significant role in treating severe pediatric heart failure for cardiomyoptahy or myocarditis either for recovery or as bridge to transplant. In most cases of chronic heart failure extending over the acute inflammatory phase transplantation is necessary. Organ shortage results in a necessity for further treatment options in terminal heart failure. A new and controversially discussed approach to treat failing (left) ventricles includes pulmonary banding; In some observational studies pulmonary artery banding was performed in patients with severe (left) heart failure and adequate function of the right ventricle. The effect is postulated by improving the contra-lateral (left) ventricular function with intraventricular cross-talk and subsequent myocardial changes. Whereas selected patients may however benefit from PA banding with subsequent training of the left ventricle, nevertheless this strategy is controversially discussed.

Case description: A 3-year-old girl with inflammatory myocarditis required left ventricular assist device (LVAD, Berlin Heart)) support. After repetitive weaning failure, pulmonary artery (PA) banding was performed during LVAD support that resulted in an improvement of the left ventricular function and finally LVAD explantation.

Conclusion: Selected patients may benefit from PA banding with subsequent training of the left ventricle even in the setting of LVAD.This case here is the first reported case where PA banding was successful in the weaning process of a child on mechanical circulatory support (MCS). This principle of pulmonary banding to improve left ventricular function in severe heart failure can apparently also be applied to patients on left ventricular assist devices (LVAD).

Cardiogenic shock in the setting of a ruptured papillary muscle can be extremely challenging to manage. We report two cases of successful and safe hemodynamic optimization with a modern axial-flow temporary left ventricular assist device, the Impella 5.5, prior to mitral valve replacement for this indication.

Background: Abdominal aortic aneurysms frequently coincide with popliteal artery aneurysms. The association with multiple peripheral aneurysms, sometimes called polyaneurysmal disease, is less frequent.

Case description: An 82-year-old male was diagnosed with polyaneurysmal disease. He was treated by femoral, popliteal, and profundal interposition grafts as well as fenestrated endovascular repair (FEVAR) using an Anaconda (Terumo Aortic, Inchinnan, Scotland) endoprosthesis combined with BeGraft peripheral and BeFlared (BF) bridging stent grafts (Bentley InnoMed, Hechingen, Germany).

Conclusion: Polyaneurysmal disease in an aged patient can be treated successfully by thorough case planning, staging of procedures, and combining different vascular surgical techniques. It demonstrates the smooth implantation of the BeFlared in an Anaconda FEVAR.