Thoracic and Cardiovascular Surgeon Reports最新文献

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.

Mechanical cardiopulmonary resuscitation (CPR) devices like Lund University Cardiopulmonary Assist System (LUCAS) cause more skeletal and visceral injuries than standard CPR. A 62-year-old woman with ST-elevation myocardial infarction was resuscitated with LUCAS and Impella CP for refractory cardiogenic shock during percutaneous coronary intervention. She suffered delayed ascending aortic rupture necessitating supracommissural ascending aortic replacement plus triple bypass grafting. Prolonged mechanical CPR with concomitant Impella may lead to aortic rupture. The combined use of LUCAS and Impella may have disastrous consequences.

Cardiac resynchronization therapy device with defibrillator (CRT-D) implantation is indicated for patients with a history of malignant ventricular arrhythmias, symptomatic heart failure, wide QRS, or high-degree atrioventricular block. A 67-year-old patient with dilated cardiomyopathy received a CRT-D with the conventional method but 1 month later skin necrosis was diagnosed above the device. The complete system was extracted from the patient and we utilized negative pressure wound therapy for the treatment of the remaining tissue. We decided to perform surgical reimplantation of the device using minithoracotomy: right atrial and right ventricular leads were introduced through the right atrial appendage and the left ventricular lead was inserted transapically. The device was implanted under the less scabby abdominal skin. We successfully applied the combination of transatrial and transapical lead placement, which has not been reported in the literature yet. It serves as an alternative method if the standard approach is not feasible.

Background  Ectopic deciduosis is a benign presence of endometrial tissue outside of the uterus during pregnancy that rarely presents with pleuropulmonary manifestations and recurrent pneumothorax. Case Description  We report a 35-year-old woman at 15 weeks' gestation with a history of recurrent intrapartum right pneumothorax found to have pleural, pulmonary, and diaphragmatic lesions and a middle lobe air leak. Wedge resection of the middle lobe and mechanical pleurodesis was performed. Histopathological analysis was progesterone receptor and PAX8 positive consistent with ectopic deciduosis. Conclusion  Ectopic deciduosis is a rare cause of recurrent pneumothorax in pregnancy and should be considered when evaluating these patients.

Background  Lung cancer screening programs have increased the detection of early-stage lung cancer. High-resolution computed tomography can detect small, low-density pulmonary nodules, or ground-glass opacities. Obtaining a tissue diagnosis can be challenging, often necessitating surgical diagnosis. Preoperative localization and intraoperative fluoroscopy are valuable tools to guide resections for small pulmonary nodules. Case Description  We present three cases using intraoperative fluoroscopy and Faxitron Bioptics that enhanced our certainty of resection of nonpalpable nodules. Conclusion  We support the use of intraoperative fluoroscopy with the unique addition of Faxitron BioVision as safe and reliable methods to enhance the certainty of resection.

Background  Myxomas are the most common primary cardiac tumor in adults and are most commonly found within the left atrium. These are usually asymptomatic, detected incidentally, or present gradually with symptoms typical of heart failure. Case Description  This case report is a description of a case of syncope caused by a large left atrial myxoma. Conclusion  Atrial myxomas may present with transient loss of consciousness, especially when they prolapse through the atrioventricular valves or when embolization occurs. Non-invasive diagnostic tools (e.g., echocardiogram, cardiac computed tomography) should be considered to thoroughly evaluate cardiogenic causes of syncope.

Background  Quadricuspid aortic valve is rare and occasionally associated with aortic regurgitation and ascending aortic dilatation. Recent studies suggest an association of aortic regurgitation with ascending aortic medial degeneration. Case Description  Histologic evaluation of ascending aortic tissue of two individuals with regurgitant quadricuspid aortic valve, one dilated, one non-dilated, yielded comparable degeneration in the Media. Conclusion  Regurgitation of quadricuspid aortic valve may lead to the degeneration of Tunica media of the ascending aorta.