Turk Gogus Kalp Damar Cerrahisi Dergisi-Turkish Journal of Thoracic and Cardiovascular Surgery最新文献

Lymphatic complications are associated with increased morbidity and mortality in single-ventricle patients. T2-weighted magnetic resonance lymphangiography is an imaging modality of increasing importance both to identify the risk status before Fontan palliation and to reveal lymphatic complications that may occur in the postoperative period. In this article, we present the management of a pediatric case who was followed and treated for prolonged chylothorax after Fontan palliation and discuss the use of magnetic resonance lymphangiography in this process.

Background: This study aims to evaluate the clinical characteristics, interventions performed, and follow-up outcomes of patients undergoing bronchoscopy or surgical intervention for tracheobronchial diseases.

Methods: A total of 47 patients (28 males, 19 females; mean age: 49±19 years; range, 4 to 78 years) who underwent bronchoscopy or surgical interventions for tracheobronchial diseases between 2018 and 2023 were included in the retrospective study. Patients who underwent stent placement, tracheal resection, or bronchoscopic interventions due to tracheobronchial disease were included in the study.

Results: The most common presenting symptom was dyspnea, with 76.6%. The most frequent lesion location was the trachea (74.5%). Malignant etiologies were found in 29.8% of the patients, while benign causes were observed in 70.2%. Stent placement was performed in 57.4% of patients. The mean follow-up period was 13.51±1.65 months, and five (10.6%) patients died during follow-up. A significant correlation was found between stent placement and longer survival (p<0.05). The survival time was positively correlated with the diagnosis, need for stent placement, and control bronchoscopy.

Conclusion: Bronchoscopy and surgical interventions for tracheobronchial diseases are effective and safe treatment options. Stent placement, particularly in malignant or severe benign airway obstructions, significantly improves survival. Regular follow-up and early intervention are crucial for improving patient prognosis.

Background: This study aims to identify clinical and pathological factors associated with spread through air spaces (STAS) positivity in patients with non-small cell lung cancer.

Methods: Between September 2001 and November 2024, a total of 380 patients (279 males, 101 females; mean age: 61.6±10.1 years; range, 20 to 87 years) who were diagnosed with primary lung cancer and underwent surgical resection were retrospectively analyzed. Demographic, clinical, and pathological data of the patients were collected and their association with STAS positivity was evaluated.

Results: A higher preoperative monocyte count was significantly associated with STAS positivity (0.73±0.63 vs. 0.58±0.22; p=0.003; odds ratio=5.57; 95% confidence interval: 1.76-17.6). Pathological N1 and N2 stages, along with increased maximum standardized uptake value (SUV_max) in the lymph nodes, were related to STAS positivity. In the multivariate analysis, only adenocarcinoma histology and elevated monocyte count were found to be independently associated with STAS positivity.

Conclusion: Adenocarcinoma histology and increased preoperative monocyte levels are independent predictors of STAS in patients with non-small cell lung cancer. Elevated SUV_max values in the lymph nodes may indicate a potential association with STAS positivity. These findings may be a guide for preoperative risk stratification and individualized treatment planning in clinical practice.

Background: This study aims to investigate the effects of Panax ginseng (P. ginseng) on intimal hyperplasia following intimal injury induced in the abdominal aortas of rats.

Methods: Twenty-four Wistar Albino rats were divided into four equal groups. Group A was designated as the control group and underwent laparotomy alone. In Group B, following laparotomy, the abdominal aorta was partially transected, and intimal injury was induced proximally using a 2F Fogarty catheter. Groups C and D received 20 mg/kg and 40 mg/kg of P. ginseng, respectively, and both groups underwent the same procedure as Group B. Two samples were collected from all rats with aortic injury: one from the primarily repaired aortic segment and another from the aortic segment with intimal injury caused by a Fogarty catheter. One sample was collected from the control group. The intima and media thicknesses of the collected aortic samples were histopathologically evaluated.

Results: No significant intimal hyperplasia was observed in the primarily repaired aortic segments, and P. ginseng did not have significant effect in these segments (p=0.394 and p=0.580, p=0.180, p>0.05). However, significant intimal hyperplasia developed in the aortic segments with injury induced by the Fogarty catheter (p=0.012, p<0.05). High-dose P. ginseng (40 mg/kg) significantly reduced intimal hyperplasia in these segments (p=0.036, p<0.05), while the low dose (20 mg/kg) did not show statistically significant effect (p=1.000, p>0.05).

Conclusion: Our study results showed that P. ginseng reduced intimal hyperplasia in a dose-dependent manner in rat abdominal aortas.

Background: This study aims to evaluate the long-term outcomes of patients undergoing right ventricle-to-pulmonary artery reconstruction with valved homografts.

Methods: A total of 106 patients (49 males, 57 females; median age: 5 years; range, 2 to 49 years) who underwent right ventricle-to-pulmonary artery reconstruction between January 2002 and January 2024 were retrospectively analyzed. The study utilized cryopreserved homografts and surgical procedures were conducted under moderate hypothermic conditions using cardiopulmonary bypass. Homograft failure was defined as the need for reintervention or replacement. The primary outcome measures were overall survival, freedom from conduit replacement rate, and freedom from any required reinterventions rate.

Results: The median follow-up was 7 years. The overall survival rate was 92.5%, with early mortality primarily due to low cardiac output. Freedom from reintervention rates were 90.8%, 84.8%, and 76.3% at three, five, and 10 years, respectively. Thirteen patients required conduit replacement, with pulmonary homografts showing improved durability. Risk factors for homograft failure included pulmonary valve regurgitation treatment, lower patient weight, younger age, and female sex.

Conclusion: This study highlights the excellent survival and durability of valved homografts in cardiac reconstruction, with implications for patient management and surgical decision-making in complex congenital heart disease procedures.

Retroperitoneal paragangliomas are neuroendocrine tumors originating from chromaffin cells in the sympathetic nerves. These tumors are commonly located around the abdominal aorta and inferior vena cava and can cause significant bleeding during surgery due to their hypervascular nature. In such cases, preoperative selective embolization can facilitate tumor resection and reduce both morbidity and mortality. This case report presented a 38-year-old male patient with a retroperitoneal paraganglioma who underwent surgery following preoperative embolization due to tumor hypervascularity.

Endovascular treatment methods are often preferred in suitable patients with complicated acute type B aortic dissection due to the high mortality and morbidity associated with the open surgical procedure. Retrograde aortic dissection is a rare complication of endovascular procedures. Herein, we reported surgical treatment of a retrograde aortic dissection that developed after thoracic endovascular aortic repair in a 53-year-old male patient with a history of liver transplantation two years ago and taking immunosuppressive medication.

Background: The aim of this study is to identify risk factors for recurrence of hemoptysis after bronchial artery embolization and to evaluate patient feedbacks on this intervention.

Methods: Between August 2013 and October 2022, a total of 122 patients (83 males, 39 females; mean age: 59.7±17.3 years; range, 13 to 91 years) who underwent bronchial artery embolization were retrospectively analyzed. The endpoint event was hemoptysis recurrence or death. Baseline data of the patients, technical and clinical success rates, complications, postoperative recovery time in hospital and patient satisfaction and re-acceptance rates were evaluated via a questionnaire.

Results: During follow-up, 24 patients died. A total of 50 patients experienced recurrence, and the overall recurrence rate was 40.98%. Patients with embolization of single culprit artery had a higher recurrence-free survival rate (p=0.049). Of 97 respondents, 81 were satisfied with the result of the procedure and 84 gave consent for re-intervention, if necessary.

Conclusion: Bronchial artery embolization is a safe and effective method of hemoptysis suppression, particularly for those with embolization of single culprit artery. Better suppression of hemoptysis and strengthening communication with patients in the perioperative period can improve the patient satisfaction.

Background: In this review, we discuss the risk factors of intraabdominal hypertension developing after cardiac surgery.

Methods: We used records from electronic databases (PubMed, Scopus, Web of Science and Ovid) between 1980 and 2025. All studies in which possible pre- and intraoperative risk factors (age, sex, hypertension, diabetes mellitus, lung disease, coronary artery bypass grafting, body mass index and, cardiopulmonary bypass duration) were recorded were included in the analysis. The results of the studies were evaluated with a random or fixed effect model depending on the presence of heterogeneity (I² >25%).

Results: A total of 4,286 articles were found from the database search. After analyzing the abstract and full texts, six articles which met the inclusion criteria and covered 696 patients were included in the analysis. The overall rate of intraabdominal hypertension was 44.68%. Age (standardized mean difference [SMD]: 0.303, 95% confidence interval [CI]: 0.123-0.484, p<0.001), hypertension (odds ratio [OR]=0.524, 95% CI: 0.087-0.960, p=0.019), body mass index (SMD: 0.532, 95% CI: 0.004-1.061, p=0.048), and cardiopulmonary bypass duration (SMD: 0.545, 95% CI: 0.184-0.907, p=0.003) were preoperative risk factors.

Conclusion: The patient's age, hypertension, body mass index, and duration of cardiopulmonary bypass are the risk factors for the development of intraabdominal hypertension after cardiac surgery. However, larger studies are needed to avoid heterogeneity of results.