Pub Date : 2023-06-01DOI: 10.5114/kitp.2023.129551
Zdenek Sorm, Martin Vobornik, Martin Dergel, Eva Cermakova, Jan Harrer, Jan Gofus
Introduction: The effect of bone wax on sternal infection and intraoperative bleeding in off-pump coronary surgery has not been reported in current literature.
Aim: To prospectively evalute this in a cohort of high risk patients undergoing off-pump coronary artery surgery at our institution. The potential impact on cell saver utilization was also studied.
Material and methods: A prospective randomized study was performed in 58 diabetic patients operated on for two-vessel coronary artery disease by the off-pump technique. They were randomly assigned to the wax or no-wax group.
Results: There was no significant difference in intraoperative blood loss between the wax (550 ml) and no-wax group (750 ml; p = 0.0711). In multivariate analysis the absence (non-use) of bone wax (odds ratio = 3.9 (1.12-13.51), p = 0.027) and preoperative creatinin level (odds ratio = 1.1 (0.99-1.03), p = 0.03) were identified as independent predictors of blood loss ≥ 750 ml. The number of red blood cell units during hospital stay was similar in both groups (p = 0.42). Wound healing complications were not observed in either group.
Conclusions: The use of bone wax does not lead to a higher risk of sternal wound infection. It may reduce the risk of high intraoperative blood loss, thus avoiding the need of a cell saver during off-pump coronary surgery. However, this influence remains questionable.
{"title":"Does bone wax make sense in off-pump coronary surgery? A prospective randomized study.","authors":"Zdenek Sorm, Martin Vobornik, Martin Dergel, Eva Cermakova, Jan Harrer, Jan Gofus","doi":"10.5114/kitp.2023.129551","DOIUrl":"https://doi.org/10.5114/kitp.2023.129551","url":null,"abstract":"<p><strong>Introduction: </strong>The effect of bone wax on sternal infection and intraoperative bleeding in off-pump coronary surgery has not been reported in current literature.</p><p><strong>Aim: </strong>To prospectively evalute this in a cohort of high risk patients undergoing off-pump coronary artery surgery at our institution. The potential impact on cell saver utilization was also studied.</p><p><strong>Material and methods: </strong>A prospective randomized study was performed in 58 diabetic patients operated on for two-vessel coronary artery disease by the off-pump technique. They were randomly assigned to the wax or no-wax group.</p><p><strong>Results: </strong>There was no significant difference in intraoperative blood loss between the wax (550 ml) and no-wax group (750 ml; <i>p</i> = 0.0711). In multivariate analysis the absence (non-use) of bone wax (odds ratio = 3.9 (1.12-13.51), <i>p</i> = 0.027) and preoperative creatinin level (odds ratio = 1.1 (0.99-1.03), <i>p</i> = 0.03) were identified as independent predictors of blood loss ≥ 750 ml. The number of red blood cell units during hospital stay was similar in both groups (<i>p</i> = 0.42). Wound healing complications were not observed in either group.</p><p><strong>Conclusions: </strong>The use of bone wax does not lead to a higher risk of sternal wound infection. It may reduce the risk of high intraoperative blood loss, thus avoiding the need of a cell saver during off-pump coronary surgery. However, this influence remains questionable.</p>","PeriodicalId":49945,"journal":{"name":"Kardiochirurgia I Torakochirurgia Polska","volume":"20 2","pages":"67-71"},"PeriodicalIF":0.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/80/1f/KITP-20-51123.PMC10410631.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10350548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01DOI: 10.5114/kitp.2023.130020
Maria Sabrina Ferrante, Calogera Pisano, Jérôme Van Rothem, Giovanni Ruvolo, Issam Abouliatim
Introduction: Cerebrovascular events after cardiac surgery are among the most serious complications, related to a greater risk of patient mortality. This problem can occur following the formation of gas emboli during open heart surgery.
Aim: To address all the mechanisms that can lead to embolic events after cardiovascular surgery, how to manage them and how to possibly prevent them.
Material and methods: A search of the PubMed database was conducted. We reviewed the clinical literature and examined all aspects to identify the root causes that can lead to the formation of emboli.
Results: Among the studies reviewed, it was found that the main causes include manipulation of the aorta, inadequate deaeration after cardiac surgery, and blood-component contact of extracorporeal circulation. It has been reported that gas emboli can lead to deleterious damage such as damage to the cerebral vascular endothelium, disruption of the blood-brain barrier, complement activation, leukocyte aggregation, increased platelet adhesion, and fibrin deposition in the microvascular system.
Conclusions: Stroke after cardiovascular surgery is one of the most important complications, with a great impact on operative mortality and patient survival. Efforts have been made over time to understand all the pathophysiological mechanisms related to this complication, with the aim of reducing its incidence. One of the goals should be to improve both the surgical technique and the perfusion modality and minimize the formation of air bubbles or to facilitate their elimination during the cardiopulmonary bypass procedure.
{"title":"Cerebrovascular events after cardiovascular surgery: diagnosis, management and prevention strategies.","authors":"Maria Sabrina Ferrante, Calogera Pisano, Jérôme Van Rothem, Giovanni Ruvolo, Issam Abouliatim","doi":"10.5114/kitp.2023.130020","DOIUrl":"https://doi.org/10.5114/kitp.2023.130020","url":null,"abstract":"<p><strong>Introduction: </strong>Cerebrovascular events after cardiac surgery are among the most serious complications, related to a greater risk of patient mortality. This problem can occur following the formation of gas emboli during open heart surgery.</p><p><strong>Aim: </strong>To address all the mechanisms that can lead to embolic events after cardiovascular surgery, how to manage them and how to possibly prevent them.</p><p><strong>Material and methods: </strong>A search of the PubMed database was conducted. We reviewed the clinical literature and examined all aspects to identify the root causes that can lead to the formation of emboli.</p><p><strong>Results: </strong>Among the studies reviewed, it was found that the main causes include manipulation of the aorta, inadequate deaeration after cardiac surgery, and blood-component contact of extracorporeal circulation. It has been reported that gas emboli can lead to deleterious damage such as damage to the cerebral vascular endothelium, disruption of the blood-brain barrier, complement activation, leukocyte aggregation, increased platelet adhesion, and fibrin deposition in the microvascular system.</p><p><strong>Conclusions: </strong>Stroke after cardiovascular surgery is one of the most important complications, with a great impact on operative mortality and patient survival. Efforts have been made over time to understand all the pathophysiological mechanisms related to this complication, with the aim of reducing its incidence. One of the goals should be to improve both the surgical technique and the perfusion modality and minimize the formation of air bubbles or to facilitate their elimination during the cardiopulmonary bypass procedure.</p>","PeriodicalId":49945,"journal":{"name":"Kardiochirurgia I Torakochirurgia Polska","volume":"20 2","pages":"118-122"},"PeriodicalIF":0.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/5a/8f/KITP-20-51137.PMC10410632.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9978698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01DOI: 10.5114/kitp.2023.129538
Fotini Ampatzidou, Odysseas Drosos, Athanasios Madesis, George Drossos
Address for correspondence: Dr. Fotini Ampatzidou, Department of Cardiac Surgery, ICU, General Hospital “G. Papanikolaou”, Exohi, 57010, Thessaloniki, Greece, e-mail: fampatzidou@gmail.com Received: 27.12.2022, accepted: 17.03.2023. Pulmonary artery sarcoma (PAS) is an extremely rare neoplasm arising from mesenchymal cells of the pulmonary artery [1]. PAS was first described in 1923, its incidence is about 0.001% to 0.03% and it is characterized by a very poor prognosis [2]. Early and correct diagnosis is crucial. Unfortunately misdiagnosis is quite common due to overlapping clinical characteristics with pulmonary embolism (PE) or chronic thromboembolic pulmonary hypertension (CTEPH), leading not only to delayed therapeutic management but also to unnecessary (and associated with hemorrhagic risks) thrombolytic and anticoagulation therapy [3]. A 68-year-old woman was referred to our Cardiothoracic Department with a case of chronic pulmonary thromboembolic disease in order to undergo pulmonary endarterectomy. She had a history of dyspnea one year ago with gradual deterioration during the last 3 months. A few days before, she was admitted to the Pneumonology Department suffering from thoracic pain. D-dimer levels were mildly elevated. She underwent a chest computed tomography (CT) scan which revealed an inhomogeneous mass arising into the medial bronchopulmonary segment with irregular borders. Triplex vascular ultrasound was performed twice and was negative for deep venous thrombosis. CT pulmonary angiography was suggestive for pulmonary embolism based on the following signs: filling defects in right main bronchus expanded peripherally to medial and lower lobe. Ventilation/perfusion lung scan showed normal ventilation with complete absence of perfusion of the right lung. Dilated right ventricle and estimated systolic pulmonary artery of 39 mm Hg were the main echocardiographic findings. She underwent an elective cardiothoracic surgical procedure with the use of a cardiopulmonary bypass under deep hypothermia (lowest 19°C). Intraoperatively, material from the right pulmonary artery was obtained and examined in frozen sections (Figure 1). The main finding is a mass protruding in the lumen of the pulmonary artery and filling its branches in a mold-like manner (Figure 2). The frozen sections (Figure 3) demonstrated a malignant neoplasm with sarcomatous features. It consisted of highly pleomorphic cells with evident mitotic activity, in an edematous or slightly myxoid background. The cells were either spindle-shaped with enlarged, elongated nuclei, or round to oval-shaped with vesicular nuclei. There were also scattered multi-nucleated cells with lobular nuclei. Subsequently, a right pneumonectomy was performed. Duration of mechanical ventilation was 20 hours and ICU stay lasted 3 days. The patient was discharged on the 6th postoperative day without complications. She underwent chemotherapy and survived 11 months. Intimal sarcoma of the pulmonary artery
{"title":"Pulmonary artery sarcoma presenting as chronic thromboembolic pulmonary hypertension (CTEPH).","authors":"Fotini Ampatzidou, Odysseas Drosos, Athanasios Madesis, George Drossos","doi":"10.5114/kitp.2023.129538","DOIUrl":"https://doi.org/10.5114/kitp.2023.129538","url":null,"abstract":"Address for correspondence: Dr. Fotini Ampatzidou, Department of Cardiac Surgery, ICU, General Hospital “G. Papanikolaou”, Exohi, 57010, Thessaloniki, Greece, e-mail: fampatzidou@gmail.com Received: 27.12.2022, accepted: 17.03.2023. Pulmonary artery sarcoma (PAS) is an extremely rare neoplasm arising from mesenchymal cells of the pulmonary artery [1]. PAS was first described in 1923, its incidence is about 0.001% to 0.03% and it is characterized by a very poor prognosis [2]. Early and correct diagnosis is crucial. Unfortunately misdiagnosis is quite common due to overlapping clinical characteristics with pulmonary embolism (PE) or chronic thromboembolic pulmonary hypertension (CTEPH), leading not only to delayed therapeutic management but also to unnecessary (and associated with hemorrhagic risks) thrombolytic and anticoagulation therapy [3]. A 68-year-old woman was referred to our Cardiothoracic Department with a case of chronic pulmonary thromboembolic disease in order to undergo pulmonary endarterectomy. She had a history of dyspnea one year ago with gradual deterioration during the last 3 months. A few days before, she was admitted to the Pneumonology Department suffering from thoracic pain. D-dimer levels were mildly elevated. She underwent a chest computed tomography (CT) scan which revealed an inhomogeneous mass arising into the medial bronchopulmonary segment with irregular borders. Triplex vascular ultrasound was performed twice and was negative for deep venous thrombosis. CT pulmonary angiography was suggestive for pulmonary embolism based on the following signs: filling defects in right main bronchus expanded peripherally to medial and lower lobe. Ventilation/perfusion lung scan showed normal ventilation with complete absence of perfusion of the right lung. Dilated right ventricle and estimated systolic pulmonary artery of 39 mm Hg were the main echocardiographic findings. She underwent an elective cardiothoracic surgical procedure with the use of a cardiopulmonary bypass under deep hypothermia (lowest 19°C). Intraoperatively, material from the right pulmonary artery was obtained and examined in frozen sections (Figure 1). The main finding is a mass protruding in the lumen of the pulmonary artery and filling its branches in a mold-like manner (Figure 2). The frozen sections (Figure 3) demonstrated a malignant neoplasm with sarcomatous features. It consisted of highly pleomorphic cells with evident mitotic activity, in an edematous or slightly myxoid background. The cells were either spindle-shaped with enlarged, elongated nuclei, or round to oval-shaped with vesicular nuclei. There were also scattered multi-nucleated cells with lobular nuclei. Subsequently, a right pneumonectomy was performed. Duration of mechanical ventilation was 20 hours and ICU stay lasted 3 days. The patient was discharged on the 6th postoperative day without complications. She underwent chemotherapy and survived 11 months. Intimal sarcoma of the pulmonary artery ","PeriodicalId":49945,"journal":{"name":"Kardiochirurgia I Torakochirurgia Polska","volume":"20 2","pages":"129-131"},"PeriodicalIF":0.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d9/98/KITP-20-51113.PMC10410642.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9970179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01DOI: 10.5114/kitp.2023.129539
Burcu Ancın, Serkan Uysal, Erkan Dikmen, Rıza Doğan
Address for correspondence: Burcu Ancın MD, Department of Thoracic Surgery, Burdur State Hospital, Burdur, Turkey, phone: +90 5357160709, e-mail: ancinburcu@gmail.com Received: 11.01.2023, accepted: 6.03.2023. Pulmonary arteriovenous malformation (PAVM) is an abnormal pulmonary artery to vein connection without a capillary bed [1]. The etiology of pulmonary arteriovenous malformations is not fully known. Although they are generally considered to be congenital, they may rarely arise later due to reasons such as trauma, liver cirrhosis, mitral stenosis, and amyloidosis [2]. Hereditary hemorrhagic telangiectasia (HHT), also known as Rendu-Osler-Weber syndrome, is an autosomal dominant disorder characterized by arteriovenous malformations in the skin, mucous membranes, and visceral organs [3]. Only 80–90% of patients with PAVM have an underlying HHT. On the other hand, PAVM occurs in only 30% of HHT cases [2]. Studies have reported that 13% to 55% of patients with PAVM are asymptomatic. Symptomatic patients exhibit dyspnea, hemoptysis, epistaxis, palpitations, chest pain, and cough. On physical examination, murmurs can be auscultated in the PAVM localization. In addition, clubbing, cyanosis, polycythemia or anemia, and telangiectasias may occur [4]. Contrast-enhanced computed tomography is the gold standard method for diagnosing PAVMs and demonstrating their pre-treatment sizes [5]. There are two treatment methods for PAVMs. These are embolization and surgical (lobectomy, segmentectomy, pneumonectomy, or fistulectomy) resection [6]. In our study, a patient who was operated on for pulmonary arteriovenous malformation in the right middle lobe in our clinic in January 2020 is presented in the light of the literature. The posteroanterior chest radiograph of a 44-year-old female patient, who had been followed up for rheumatoid arthritis in another center for about ten years, showed a homogeneous density increase in the lower zone of the right lung. The patient’s CT angiography showed an appearance of a lobulated aneurysm, measuring 75 × 25 mm, in the medial part of the middle lobe in the right paracardiac region. It was reported that the arterial supply to the aneurysm was from the middle lobe branch of the right pulmonary artery, and the vein was directly draining into the atrium. A few subhilar cystic lymph nodes and a few mediastinal calcified lymph nodes adjacent to the arteriovenous malformation were visualized (Figure 1). The patient was evaluated by the Vascular Interventional Radiology department and was not evaluated to be suitable for embolization. Preoperative examinations were performed. Her physical examination and routine laboratory tests were normal. Her echocardiography revealed no pathological finding. The patient underwent right thoracotomy, and on exploration, a very thin pulsatile mass lesion, 5 × 8 cm in size, was observed in the middle lobe. Enlarged mediastinal lymph nodes, some of which were granulomatous-calcific, were noted. It w
{"title":"Incidental pulmonary arteriovenous malformation.","authors":"Burcu Ancın, Serkan Uysal, Erkan Dikmen, Rıza Doğan","doi":"10.5114/kitp.2023.129539","DOIUrl":"https://doi.org/10.5114/kitp.2023.129539","url":null,"abstract":"Address for correspondence: Burcu Ancın MD, Department of Thoracic Surgery, Burdur State Hospital, Burdur, Turkey, phone: +90 5357160709, e-mail: ancinburcu@gmail.com Received: 11.01.2023, accepted: 6.03.2023. Pulmonary arteriovenous malformation (PAVM) is an abnormal pulmonary artery to vein connection without a capillary bed [1]. The etiology of pulmonary arteriovenous malformations is not fully known. Although they are generally considered to be congenital, they may rarely arise later due to reasons such as trauma, liver cirrhosis, mitral stenosis, and amyloidosis [2]. Hereditary hemorrhagic telangiectasia (HHT), also known as Rendu-Osler-Weber syndrome, is an autosomal dominant disorder characterized by arteriovenous malformations in the skin, mucous membranes, and visceral organs [3]. Only 80–90% of patients with PAVM have an underlying HHT. On the other hand, PAVM occurs in only 30% of HHT cases [2]. Studies have reported that 13% to 55% of patients with PAVM are asymptomatic. Symptomatic patients exhibit dyspnea, hemoptysis, epistaxis, palpitations, chest pain, and cough. On physical examination, murmurs can be auscultated in the PAVM localization. In addition, clubbing, cyanosis, polycythemia or anemia, and telangiectasias may occur [4]. Contrast-enhanced computed tomography is the gold standard method for diagnosing PAVMs and demonstrating their pre-treatment sizes [5]. There are two treatment methods for PAVMs. These are embolization and surgical (lobectomy, segmentectomy, pneumonectomy, or fistulectomy) resection [6]. In our study, a patient who was operated on for pulmonary arteriovenous malformation in the right middle lobe in our clinic in January 2020 is presented in the light of the literature. The posteroanterior chest radiograph of a 44-year-old female patient, who had been followed up for rheumatoid arthritis in another center for about ten years, showed a homogeneous density increase in the lower zone of the right lung. The patient’s CT angiography showed an appearance of a lobulated aneurysm, measuring 75 × 25 mm, in the medial part of the middle lobe in the right paracardiac region. It was reported that the arterial supply to the aneurysm was from the middle lobe branch of the right pulmonary artery, and the vein was directly draining into the atrium. A few subhilar cystic lymph nodes and a few mediastinal calcified lymph nodes adjacent to the arteriovenous malformation were visualized (Figure 1). The patient was evaluated by the Vascular Interventional Radiology department and was not evaluated to be suitable for embolization. Preoperative examinations were performed. Her physical examination and routine laboratory tests were normal. Her echocardiography revealed no pathological finding. The patient underwent right thoracotomy, and on exploration, a very thin pulsatile mass lesion, 5 × 8 cm in size, was observed in the middle lobe. Enlarged mediastinal lymph nodes, some of which were granulomatous-calcific, were noted. It w","PeriodicalId":49945,"journal":{"name":"Kardiochirurgia I Torakochirurgia Polska","volume":"20 2","pages":"132-134"},"PeriodicalIF":0.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/33/a3/KITP-20-51114.PMC10410638.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9970180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01DOI: 10.5114/kitp.2023.129541
Massine El Hammoumi, Saloua Ouraini, Mohammed Bhairis, Hamid Kouatli, Kemini Marius Kamdem, El Hassane Kabiri
Introduction: Mediastinal infection is a persistent and difficult widespread infectious disease caused by secondary complications of adjacent organs. It spreads easily and is often misdiagnosed because of the lack of typical manifestations.
Material and methods: To highlight the clinical features, medical and surgical strategy of descending necrotizing mediastinitis we performed a retrospective study of 25 documented cases during a 10-year period at our hospital, all treated surgically, 10 from the ORL department and 15 from our thoracic surgery department.
Results: Patients were aged from 20 to 84 years, with a median age of 41 years, male predominance (19 men and 6 women), sex ratio of 3.6. A cervicotomy (in 40% of cases) was associated or not with videothoracoscopy (one case) or thoracotomy (in 20% of cases) and wide-spectrum antibiotherapy. In the postoperative period, an irrigation-suction system was used on the drains in 15 patients. In 1 case a rethoracotomy was necessary to remove a residual right pyothorax, and one patient required a tracheostomy. Twenty-two (88%) patients recovered from their mediastinitis. Death of 3 patients by sepsis multiorgan failure occurred. Postoperative follow-up during one year was uneventful without recurrence.
Conclusions: According to our experience, we believe the more aggressive local treatment is, the better are the results.
{"title":"Descending necrotizing mediastinitis: a challenging infection. Selected results of a Moroccan bicentric study.","authors":"Massine El Hammoumi, Saloua Ouraini, Mohammed Bhairis, Hamid Kouatli, Kemini Marius Kamdem, El Hassane Kabiri","doi":"10.5114/kitp.2023.129541","DOIUrl":"https://doi.org/10.5114/kitp.2023.129541","url":null,"abstract":"<p><strong>Introduction: </strong>Mediastinal infection is a persistent and difficult widespread infectious disease caused by secondary complications of adjacent organs. It spreads easily and is often misdiagnosed because of the lack of typical manifestations.</p><p><strong>Material and methods: </strong>To highlight the clinical features, medical and surgical strategy of descending necrotizing mediastinitis we performed a retrospective study of 25 documented cases during a 10-year period at our hospital, all treated surgically, 10 from the ORL department and 15 from our thoracic surgery department.</p><p><strong>Results: </strong>Patients were aged from 20 to 84 years, with a median age of 41 years, male predominance (19 men and 6 women), sex ratio of 3.6. A cervicotomy (in 40% of cases) was associated or not with videothoracoscopy (one case) or thoracotomy (in 20% of cases) and wide-spectrum antibiotherapy. In the postoperative period, an irrigation-suction system was used on the drains in 15 patients. In 1 case a rethoracotomy was necessary to remove a residual right pyothorax, and one patient required a tracheostomy. Twenty-two (88%) patients recovered from their mediastinitis. Death of 3 patients by sepsis multiorgan failure occurred. Postoperative follow-up during one year was uneventful without recurrence.</p><p><strong>Conclusions: </strong>According to our experience, we believe the more aggressive local treatment is, the better are the results.</p>","PeriodicalId":49945,"journal":{"name":"Kardiochirurgia I Torakochirurgia Polska","volume":"20 2","pages":"100-104"},"PeriodicalIF":0.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e8/ba/KITP-20-51116.PMC10410640.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9978692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-01DOI: 10.5114/kitp.2023.129547
Eleonora Latini, Dario Buioni, Paolo Nardi, Calogera Pisano, Cristina Viscogliesi, Federico Agneni, Claudia Altieri, Giovanni Ruvolo
Address for correspondence: Dario Buioni, Cardiac Surgery Division, Tor Vergata University Hospital, Viale Oxford 81, Rome, PC 00133, Italy, e-mail: docyuk@libero.it Received: 14.02.2023, accepted: 5.03.2023. Temporary epicardial pacing wires (TEPWs) have been routinely inserted in all patients undergoing cardiac surgery since the 1960s. The main purposes were, and still are, therapeutic and diagnostic, as they are mainly used to recognize and treat ventricular and/or atrial rhythm disturbances that may be a complication of cardiac interventions and to sustain the possible hemodynamic instability during post-operative intensive care [1]. However, their necessity is often discussed as their use is linked to several but unlikely complications such as cardiac tamponade and hemorrhage at the time of removal [2], or infection, wound dehiscence and migration when retained [3]. The indications for insertion of the TEPWs are several: conduction abnormalities such as AV block, prolonged AV delay, bifascicular block; bradycardia and tachycardia, especially atrial fibrillation, which is common in the period following cardiac surgery; and the need to place both atrial and ventricular wires is often dependent on the patient; furthermore, the pacing system should be checked and reassessed routinely based on the patient’s condition. The removal must be done carefully by gentle and constant traction; if too much traction is needed as they may have been caught in a tight suture, they should be cut as close to the skin as possible due to the risk of tamponade immediately after the removal procedure. For this reason, it is necessary to observe the patient and perform echocardiography a few hours after the removal [1]. Although there is a risk of hemorrhage and cardiac tamponade, to cut the wires flush with the skin is not a procedure free of adverse events such as infection and migration. An 89-year-old woman with severe aortic stenosis and aneurysm of the ascending aorta, with medical history of hypertension, dyslipidemia, obesity and chronic renal failure, underwent aortic valve replacement with a Sorin Mitroflow 21 bioprosthesis and of the ascending aorta with an Intervascular 28 prosthesis, requiring circulatory arrest during the procedure on September 2014. In the immediate post-operative period, due to massive bleeding and hemodynamic instability, it became necessary to conduct a surgical revision of the mediastinum. Two right atrial and two right ventricular epicardial pacing wires were inserted at the moment of the intervention and were not removed during the revision of the mediastinum; on the 6th postoperative day (POD), at the time of removal, only the ones placed on the right ventricle were removed without resistance, while the ones on the right atrium were cut flush with the skin. On the 8th POD, the patient presented strong chest pain, erythema and drainage from the distal third of the sternotomy wound associated with sternal instability; on the 10th
{"title":"Retention of temporary epicardial pacing wires: when migration causes dehiscence of a sternal wound.","authors":"Eleonora Latini, Dario Buioni, Paolo Nardi, Calogera Pisano, Cristina Viscogliesi, Federico Agneni, Claudia Altieri, Giovanni Ruvolo","doi":"10.5114/kitp.2023.129547","DOIUrl":"https://doi.org/10.5114/kitp.2023.129547","url":null,"abstract":"Address for correspondence: Dario Buioni, Cardiac Surgery Division, Tor Vergata University Hospital, Viale Oxford 81, Rome, PC 00133, Italy, e-mail: docyuk@libero.it Received: 14.02.2023, accepted: 5.03.2023. Temporary epicardial pacing wires (TEPWs) have been routinely inserted in all patients undergoing cardiac surgery since the 1960s. The main purposes were, and still are, therapeutic and diagnostic, as they are mainly used to recognize and treat ventricular and/or atrial rhythm disturbances that may be a complication of cardiac interventions and to sustain the possible hemodynamic instability during post-operative intensive care [1]. However, their necessity is often discussed as their use is linked to several but unlikely complications such as cardiac tamponade and hemorrhage at the time of removal [2], or infection, wound dehiscence and migration when retained [3]. The indications for insertion of the TEPWs are several: conduction abnormalities such as AV block, prolonged AV delay, bifascicular block; bradycardia and tachycardia, especially atrial fibrillation, which is common in the period following cardiac surgery; and the need to place both atrial and ventricular wires is often dependent on the patient; furthermore, the pacing system should be checked and reassessed routinely based on the patient’s condition. The removal must be done carefully by gentle and constant traction; if too much traction is needed as they may have been caught in a tight suture, they should be cut as close to the skin as possible due to the risk of tamponade immediately after the removal procedure. For this reason, it is necessary to observe the patient and perform echocardiography a few hours after the removal [1]. Although there is a risk of hemorrhage and cardiac tamponade, to cut the wires flush with the skin is not a procedure free of adverse events such as infection and migration. An 89-year-old woman with severe aortic stenosis and aneurysm of the ascending aorta, with medical history of hypertension, dyslipidemia, obesity and chronic renal failure, underwent aortic valve replacement with a Sorin Mitroflow 21 bioprosthesis and of the ascending aorta with an Intervascular 28 prosthesis, requiring circulatory arrest during the procedure on September 2014. In the immediate post-operative period, due to massive bleeding and hemodynamic instability, it became necessary to conduct a surgical revision of the mediastinum. Two right atrial and two right ventricular epicardial pacing wires were inserted at the moment of the intervention and were not removed during the revision of the mediastinum; on the 6th postoperative day (POD), at the time of removal, only the ones placed on the right ventricle were removed without resistance, while the ones on the right atrium were cut flush with the skin. On the 8th POD, the patient presented strong chest pain, erythema and drainage from the distal third of the sternotomy wound associated with sternal instability; on the 10th ","PeriodicalId":49945,"journal":{"name":"Kardiochirurgia I Torakochirurgia Polska","volume":"20 2","pages":"123-125"},"PeriodicalIF":0.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ae/16/KITP-20-51120.PMC10410639.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9978694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lung cancer is one of the leading causes of cancer-related deaths worldwide. Superior vena cava syndrome (SVCS) is a rare but potentially life-threatening complication of lung cancer, occurring in approximately 5-10% of cases. There are difficulties in the process of surgical treatment of SVC infiltrated by lung tumors but the contribution of technological evolution and innovation is promising. At the same time, the amelioration of survival rates of patients subjected to surgical treatment is equally promising. The reported outcomes of surgical treatment for SVC invasion due to lung tumors vary depending on the extent of the tumor and the patient's overall health status. However, studies clearly suggest that surgical treatment can improve survival and quality of life in selected patients. The literature review showed that the surgical approach to lung cancer invading the SVC constitutes the most indispensable treatment which helps to achieve the long-term survival of patients.
{"title":"Lung cancer invading the superior vena cava - surgical treatment. A short and up-to-date review.","authors":"Eleftherios Nikolaidis, Nikolaos Bolanos, Dimitrios Anagnostopoulos, Vasileios Leivaditis, Konstantinos Grapatsas, Efstratios Koletsis, Athanasios Papatriantafyllou, Ioannis Panagiotopoulos, Francesk Mulita, Nikolaos Baltayiannis, Manfred Dahm, Antonios Chatzimichalis","doi":"10.5114/kitp.2023.129546","DOIUrl":"https://doi.org/10.5114/kitp.2023.129546","url":null,"abstract":"<p><p>Lung cancer is one of the leading causes of cancer-related deaths worldwide. Superior vena cava syndrome (SVCS) is a rare but potentially life-threatening complication of lung cancer, occurring in approximately 5-10% of cases. There are difficulties in the process of surgical treatment of SVC infiltrated by lung tumors but the contribution of technological evolution and innovation is promising. At the same time, the amelioration of survival rates of patients subjected to surgical treatment is equally promising. The reported outcomes of surgical treatment for SVC invasion due to lung tumors vary depending on the extent of the tumor and the patient's overall health status. However, studies clearly suggest that surgical treatment can improve survival and quality of life in selected patients. The literature review showed that the surgical approach to lung cancer invading the SVC constitutes the most indispensable treatment which helps to achieve the long-term survival of patients.</p>","PeriodicalId":49945,"journal":{"name":"Kardiochirurgia I Torakochirurgia Polska","volume":"20 2","pages":"105-110"},"PeriodicalIF":0.7,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/99/46/KITP-20-51119.PMC10410641.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9978696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-01DOI: 10.5114/kitp.2023.126101
Daniele Trombetti, Calogera Pisano, Maria Sabrina Ferrante, Laura Asta, Claudia Altieri, Paolo Nardi, Dario Buioni, Giovanni Ruvolo
Address for correspondence: Daniele Trombetti MD, Department of Cardiac Surgery, University of Tor Vergata, Rome, Italy, e-mail: daniele.trombetti@famigliatrombetti.it Received: 2.10.2022, accepted: 6.02.2023. Primary cardiac angiosarcoma (AS) is a clinically rare (incidence of about 0.017%) and highly invasive cardiac tumor with an unfavorable prognosis. The general prognosis of patients with primary cardiac sarcoma is poor, with median overall survival which ranges from 9 to 27 months in recent case series [1]. Cases of primary cardiac angiosarcoma (PCAS) are extraordinarily rare but represent most cases of malignant cardiac cancer. PCAS originates from vascular endothelial cells or vascular endothelial cells that have differentiated from mesenteric cells. Much of the literature indicates that a majority of PCAS cases occur in the right atrium. Cardiac sarcomas usually present insidious symptoms in young and middle-aged patients. They generally have an unfavorable prognosis with an overall survival of between 6 and 12 months. The treatment of choice for these rare malignancies is a combination of surgical resection and radioand/or chemotherapy [2]. However, in most cases, and in contrast to benign cardiac tumors, surgical resection still represents a palliative strategy for many patients with cardiac sarcomas. Therefore, rapid and accurate diagnosis is necessary and can confer a survival advantage on individual patients [3]. We report our experience with a young patient treated in our unit for an undifferentiated pleomorphic sarcoma who is still alive. As this study was carried out in order to improve the management of primary cardiac angiosarcoma, local approval at the level of the surgical department was obtained prior to data collection and the patient signed the consent form for scientific purposes. In April 2020, a 41-year-old patient was admitted to the Emergency Room of Tor Vergata University for dyspnea associated with chest tightness and vertigo. The echocardiography examination showed a round-shaped hyperechoic formation (6 × 4 cm) occupying all the left atrium until the inflow tract of the left ventricle with a large base of implantation in the anterior portion of the atrial septum (Figures 1 A–C). This mass engaged the mitral valve, resulting in severe steno-insufficiency (transvalvular medium gradient 27 mm Hg). A computed tomography (CT) raised the hypothesis of a PCAS (Figures 2 A–C). After a multidisciplinary clinical discussion, the patient was transferred to our Cardiac Surgery Unit for a cardiac operation. A standard longitudinal sternotomy was performed and the patient underwent cardiopulmonary bypass for exeresis of the mass. At the opening of the left atrium the mass adhered tenaciously to the atrial septum, the left auricle, the free wall of the left atrium and the anterior flap of the mitral valve. Despite the presence of tenacious adhesions of the mass to the atrial structures, it was possible to perform a total mass ex
{"title":"Cardiac angiosarcoma: a formidable challenge.","authors":"Daniele Trombetti, Calogera Pisano, Maria Sabrina Ferrante, Laura Asta, Claudia Altieri, Paolo Nardi, Dario Buioni, Giovanni Ruvolo","doi":"10.5114/kitp.2023.126101","DOIUrl":"https://doi.org/10.5114/kitp.2023.126101","url":null,"abstract":"Address for correspondence: Daniele Trombetti MD, Department of Cardiac Surgery, University of Tor Vergata, Rome, Italy, e-mail: daniele.trombetti@famigliatrombetti.it Received: 2.10.2022, accepted: 6.02.2023. Primary cardiac angiosarcoma (AS) is a clinically rare (incidence of about 0.017%) and highly invasive cardiac tumor with an unfavorable prognosis. The general prognosis of patients with primary cardiac sarcoma is poor, with median overall survival which ranges from 9 to 27 months in recent case series [1]. Cases of primary cardiac angiosarcoma (PCAS) are extraordinarily rare but represent most cases of malignant cardiac cancer. PCAS originates from vascular endothelial cells or vascular endothelial cells that have differentiated from mesenteric cells. Much of the literature indicates that a majority of PCAS cases occur in the right atrium. Cardiac sarcomas usually present insidious symptoms in young and middle-aged patients. They generally have an unfavorable prognosis with an overall survival of between 6 and 12 months. The treatment of choice for these rare malignancies is a combination of surgical resection and radioand/or chemotherapy [2]. However, in most cases, and in contrast to benign cardiac tumors, surgical resection still represents a palliative strategy for many patients with cardiac sarcomas. Therefore, rapid and accurate diagnosis is necessary and can confer a survival advantage on individual patients [3]. We report our experience with a young patient treated in our unit for an undifferentiated pleomorphic sarcoma who is still alive. As this study was carried out in order to improve the management of primary cardiac angiosarcoma, local approval at the level of the surgical department was obtained prior to data collection and the patient signed the consent form for scientific purposes. In April 2020, a 41-year-old patient was admitted to the Emergency Room of Tor Vergata University for dyspnea associated with chest tightness and vertigo. The echocardiography examination showed a round-shaped hyperechoic formation (6 × 4 cm) occupying all the left atrium until the inflow tract of the left ventricle with a large base of implantation in the anterior portion of the atrial septum (Figures 1 A–C). This mass engaged the mitral valve, resulting in severe steno-insufficiency (transvalvular medium gradient 27 mm Hg). A computed tomography (CT) raised the hypothesis of a PCAS (Figures 2 A–C). After a multidisciplinary clinical discussion, the patient was transferred to our Cardiac Surgery Unit for a cardiac operation. A standard longitudinal sternotomy was performed and the patient underwent cardiopulmonary bypass for exeresis of the mass. At the opening of the left atrium the mass adhered tenaciously to the atrial septum, the left auricle, the free wall of the left atrium and the anterior flap of the mitral valve. Despite the presence of tenacious adhesions of the mass to the atrial structures, it was possible to perform a total mass ex","PeriodicalId":49945,"journal":{"name":"Kardiochirurgia I Torakochirurgia Polska","volume":"20 1","pages":"53-56"},"PeriodicalIF":0.7,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b0/6e/KITP-20-50414.PMC10107413.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9377680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-01DOI: 10.5114/kitp.2023.126103
Serkan Burc Deser
{"title":"Hybrid treatment of type 2 right sided aortic arch and Kommerell's diverticulum in an octogenarian.","authors":"Serkan Burc Deser","doi":"10.5114/kitp.2023.126103","DOIUrl":"https://doi.org/10.5114/kitp.2023.126103","url":null,"abstract":"","PeriodicalId":49945,"journal":{"name":"Kardiochirurgia I Torakochirurgia Polska","volume":"20 1","pages":"60-61"},"PeriodicalIF":0.7,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d3/df/KITP-20-50416.PMC10107421.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9377683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号