Kardiochirurgia I Torakochirurgia Polska最新文献

Lung parenchymal injuries frequently result from thoracic trauma and can lead to significant morbidity and mortality. The lung's unique biomechanical properties - including its architecture, histology, extracellular matrix (ECM), and respiratory physiology - play a critical role in determining how it responds to mechanical forces during trauma. Based on the mechanism of injury, lung trauma is typically categorized into three primary types: blunt, penetrating, and blast injuries. Each mechanism leads to distinct parenchymal injuries, including contusions, lacerations, herniation, and vascular injuries, which present with unique clinical features and management requirements. A comprehensive understanding of the biomechanics and tissue response to these injuries is essential for optimizing therapeutic strategies and improving patient outcomes in both the acute and long-term phases of lung trauma management. This review aims to provide a detailed exploration of lung parenchymal trauma, focusing on injury mechanisms, classifications, and the importance of accurate diagnosis and treatment.

Introduction: Newborns with critical aortic valve stenosis (AVS) constitute a challenging group of patients, requiring urgent treatment, which in most centers is currently transcatheter balloon aortic valvuloplasty (BAV).

Aim: Assessment the immediate and long-term outcome of BAV in newborns including preterm infants with critical AVS.

Material and methods: We analyzed retrospectively 28 neonates (including 7 preterm infants) with critical AVS treated with the BAV procedure at mean age of 12.1 days. The mean follow-up period was 6.4 years. Patients were divided into 2 groups depending on the left ventricle ejection fraction (LVEF) ≤ 40% - group I (n = 12 patients, including 5 preterm infants) and > 40% - group II (n = 16 patients, including 2 prematures).

Results: In both groups, the peak transvalvular pressure gradient across the aortic valve (TAPG) decreased significantly after BAV, whereas the mean LVEF increased significantly only in group I newborns. Various adverse events occurred in 6 (21.4%) newborns. A total of 12 (42.8%) children required re-intervention, including 1 child who underwent 3 procedures. They occurred slightly more often in children born prematurely (57.1%) compared to children born at term (38%). During follow-up, 6 patients died, 5 patients in group I and 1 in group II, including 3 of 7 preterm infants (all in group I). The Kaplan-Meier survival curve showed significantly higher mortality in group I patients (p = 0.03).

Conclusions: BAV as the initial treatment for newborns with critical AVS gives satisfactory results, but further follow-up shows a frequent need for re-intervention. Significant LV systolic dysfunction and prematurity are risk factors for higher mortality in these patients.

Introduction: Thoracic ultrasound (US) is a practical tool in radiology that has been commonly used for decades. Its daily clinic use in thoracic surgery is rising, and scientific evidence is needed to support its use.

Aim: We aimed to determine the diagnostic value of handheld, portable thoracic ultrasound scanning (HH-US) in patients referred to the thoracic surgery outpatient clinic with suspected pleural effusion and compare the diagnostic role with chest X-rays (CXR) or computed tomography (CT).

Material and methods: We analyzed the patients between 2020 and 2023 who were referred to our outpatient clinic with various symptoms and having differential diagnosis of pleural effusion. In total, 91 patients fulfilled the inclusion criteria. Ultrasonographic (US) scans were performed by thoracic surgeons who were educated and certified in ultrasonography training. All patients underwent US first and then were referred for chest X-ray or computed tomography. All the results were compared focusing on the efficacy of US initially. If the amount of the effusion required drainage, thoracentesis was carried out with US support. The indications, methods, time, and related complications, with demographic data of the patients were recorded and analyzed.

Results: There were 57 (62.6%) male and 34 female (37.4%) patients. Only diagnostic thoracentesis was performed in 16 patients, catheter thoracostomy was performed in 47 patients, minimal effusion not requiring pleural intervention was observed in 6 patients (2 patients were trauma patients who applied to the emergency department), minimal effusion was detected in 14 patients, and no intervention was performed. No complications were observed. The sensitivity of US in detecting fluid effusion compared to CXR was 83.3%, while its sensitivity compared to thorax computed tomography (CT) was 88.5%.

Conclusions: Proficient thoracic surgeons can effectively employ ultrasound devices for diagnosing and managing pleural effusions. This would be helpful for decision making and treatment.

Introduction: Extracorporeal membrane oxygenation (ECMO) is a rescue method in the treatment of severe cardiac or respiratory failure in patients with various etiological factors contributing to this failure and of different ages. The question of ECMO support for patients has recently arisen more frequently, due to the expansion of indications for this method and an increase in the number of patients with severe cardiac or respiratory failures.

Aim: To present a single center's 10-year experience with ECMO support, outcomes and mortality.

Material and methods: A retrospective single-center study was conducted on patients with VA-ECMO for cardiac and/or respiratory indications. In this retrospective study, the treatment outcomes of patients undergoing VA-ECMO over a 10-year period within one ECMO center were analyzed, focusing on hospitalization mortality (mid-term outcomes). Additionally, the structure of treated patients was analyzed secondarily according to age, gender, and length of hospitalization.

Results: Out of 114 patients treated with VA-ECMO, 34.2% survived for 30 days, 28.1% survived for 90 days, and 26.3% survived for 12 months. The median age of the patients was 58 years. The median duration of cardiopulmonary support was 2.6 days and duration of hospitalization after support explantation was 2.5 days. There was no significant difference between men and women in terms of age, length of hospitalization, hospitalization mortality, and survival at 30 days, 90 days, and 12 months.

Conclusions: The use of VA-ECMO support in patients with severe to critical cardiopulmonary failure is a commonly employed method in many centers. Data analysis reveals high hospitalization mortality. No predictive factors for short-term and medium-term survival were identified among patient age, gender, duration of support, and length of hospitalization after VA-ECMO support explantation.