Pub Date : 2023-06-01DOI: 10.5114/kitp.2023.130019
Dariusz Zieliński, Wojciech Dyk, Krzysztof Wróbel, Andrzej Biederman
Acute pulmonary embolism is a significant cause of morbidity and mortality. Patients in life-threatening conditions require timely and effective interventions to improve pulmonary perfusion. The indications for surgical embolectomy in the thrombolysis era have been limited. This article discusses surgical techniques and outlines the position of surgical embolectomy concerning other treatment modalities.
{"title":"Surgical pulmonary embolectomy: state of the art.","authors":"Dariusz Zieliński, Wojciech Dyk, Krzysztof Wróbel, Andrzej Biederman","doi":"10.5114/kitp.2023.130019","DOIUrl":"https://doi.org/10.5114/kitp.2023.130019","url":null,"abstract":"<p><p>Acute pulmonary embolism is a significant cause of morbidity and mortality. Patients in life-threatening conditions require timely and effective interventions to improve pulmonary perfusion. The indications for surgical embolectomy in the thrombolysis era have been limited. This article discusses surgical techniques and outlines the position of surgical embolectomy concerning other treatment modalities.</p>","PeriodicalId":49945,"journal":{"name":"Kardiochirurgia I Torakochirurgia Polska","volume":null,"pages":null},"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/1e/c7/KITP-20-51136.PMC10410633.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9970181","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.2023.129553
Bartosz Kubisa, Anna Lesińska, Krzysztof Safranow, Jarosław Pieróg, Janusz Wójcik, Małgorzata Edyta Wojtyś, Tomasz Grodzki, Kajetan Kiełbowski
Introduction: Near-infrared spectroscopy (NIRS) is a non-invasive method of regional tissue oxygenation measurement. Intraoperative use of NIRS to monitor brain oxygenation (BO) during surgery might be beneficial to identify cerebral desaturations.
Aim: To compare peripheral blood saturation (SpO2) with BO measurements and evaluate the utility of BO in thoracic surgery.
Material and methods: We took BO and SpO2 measurements in a group of 100 patients undergoing standard thoracic surgery. Measurements were made every 15 minutes. The Mann-Whitney U test was used to compare study groups. Spearman's rank correlation coefficient was used to determine correlation between studied parameters.
Results: We found a negative correlation between patients' age and BO at the beginning of surgery. Operations lasted between 30 and 200 minutes. We found a positive correlation between BO and SpO2 between 15 and 90 minutes of surgery. Subsequently, BO remained at a low level while SpO2 returned to baseline values. Higher minimum SpO2 values were noted in patients undergoing left-sided procedures.
Conclusions: Cerebral oxygenation does not return to baseline values until the end of the surgery as opposed to the SpO2. Furthermore, both SpO2 and BO correlate negatively with the overall duration of thoracic surgery. In addition, after 90 minutes of surgery, SpO2 stopped reflecting brain oxygenation.
{"title":"Comparison of peripheral blood saturation with brain oxygenation in patients undergoing thoracic surgery.","authors":"Bartosz Kubisa, Anna Lesińska, Krzysztof Safranow, Jarosław Pieróg, Janusz Wójcik, Małgorzata Edyta Wojtyś, Tomasz Grodzki, Kajetan Kiełbowski","doi":"10.5114/kitp.2023.129553","DOIUrl":"https://doi.org/10.5114/kitp.2023.129553","url":null,"abstract":"<p><strong>Introduction: </strong>Near-infrared spectroscopy (NIRS) is a non-invasive method of regional tissue oxygenation measurement. Intraoperative use of NIRS to monitor brain oxygenation (BO) during surgery might be beneficial to identify cerebral desaturations.</p><p><strong>Aim: </strong>To compare peripheral blood saturation (SpO<sub>2</sub>) with BO measurements and evaluate the utility of BO in thoracic surgery.</p><p><strong>Material and methods: </strong>We took BO and SpO<sub>2</sub> measurements in a group of 100 patients undergoing standard thoracic surgery. Measurements were made every 15 minutes. The Mann-Whitney U test was used to compare study groups. Spearman's rank correlation coefficient was used to determine correlation between studied parameters.</p><p><strong>Results: </strong>We found a negative correlation between patients' age and BO at the beginning of surgery. Operations lasted between 30 and 200 minutes. We found a positive correlation between BO and SpO<sub>2</sub> between 15 and 90 minutes of surgery. Subsequently, BO remained at a low level while SpO<sub>2</sub> returned to baseline values. Higher minimum SpO<sub>2</sub> values were noted in patients undergoing left-sided procedures.</p><p><strong>Conclusions: </strong>Cerebral oxygenation does not return to baseline values until the end of the surgery as opposed to the SpO<sub>2</sub>. Furthermore, both SpO<sub>2</sub> and BO correlate negatively with the overall duration of thoracic surgery. In addition, after 90 minutes of surgery, SpO<sub>2</sub> stopped reflecting brain oxygenation.</p>","PeriodicalId":49945,"journal":{"name":"Kardiochirurgia I Torakochirurgia Polska","volume":null,"pages":null},"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/35/d6/KITP-20-51124.PMC10410636.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9970182","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.2023.129549
Dominika Katarzyńska, Anna Olasińska-Wiśniewska, Marcin Misterski, Marek Grygier, Mateusz Puślecki, Sebastian Stefaniak, Tomasz Urbanowicz, Bartłomiej Perek, Marek Jemielity
Address for correspondence: Dominika Katarzyńska MD, University Clinical Hospital, Poznan, Poland, e-mail: dominika.katarzynska@gmail.com Received: 12.05.2023, accepted: 25.06.2023. A 77-year-old male patient presented with heart failure symptoms (NYHA class III), which developed after probable infective endocarditis (IE) a few months earlier. Physical examination revealed new heart murmur and peripheral oedema. His other medical history includes hypertension, laryngeal tumor, and spine surgery. Nine years prior to this presentation, he was qualified for surgical aortic valve replacement (SAVR) due to a symptomatic severe aortic stenosis with mild aortic regurgitation. After sternotomy, he was deferred from prosthesis implantation as the porcelain aorta was revealed. Subsequently, he underwent successful transcatheter aortic valve implantation (TAVI) with Medtronic CoreValve 29 mm (Medtronic, Minneapolis, MN, USA) bioprosthesis. Postprocedural transthoracic echocardiography (TTE) showed proper bioprosthesis function with maximal transaortic gradient of 25 mm Hg without a paravalvular leak (PVL). The postoperative course was uneventful and on the 7th day he was discharged home. Three weeks after the procedure, the patient developed recurrent syncope, dizziness and chest pain. Electrocardiogram showed severe bradycardia with periodic third-degree atrioventricular block. A dual chamber pacemaker (BiotronicEcuro DR, Biotronik, Berlin, Germany) was implanted. During next 9 years the patient remained in a good clinical condition, though he underwent successful treatment of laryngeal tumor. The repeated echocardiographic examination confirmed proper bioprosthesis function. Six months before current hospitalization he presented with infection which was interpreted as pneumonia and treated successfully with antibiotics. Nevertheless, thereafter symptoms of heart failure occurred and gradually exacerbated. During the hospitalization due to heart failure worsening, TTE revealed hemodynamically severe intraprosthetic aortic regurgitation which had not been observed before (confirmed in transesophageal echocardiography (TEE) (Figure 1)) with transaortic maximal and mean gradients of 21 and 10 mm Hg, respectively, preserved left ventricular ejection fraction, and increased pulmonary artery systolic pressure. Laboratory tests did not present significant deviations in inflammatory markers and blood cultures were negative. After careful assessment by the heart team the patient was qualified for valve-in-valve TAVI (ViV-TAVI) due to a high perioperative risk and porcelain aorta. After careful assessment of computed tomography, he underwent successful uncomplicated implantation of Edwards Sapien (Edwards Lifesciences Corp., Irvine, CA, USA) prosthesis, which was chosen based on its optimal profile not limiting access to the coronary ostia. During follow-up he remains asymptomatic with good prosthesis function on control echocardiography. IE post-TAVI is not a commo
{"title":"Late consequences of masked bioprosthetic valve endocarditis: diagnostic and treatment options.","authors":"Dominika Katarzyńska, Anna Olasińska-Wiśniewska, Marcin Misterski, Marek Grygier, Mateusz Puślecki, Sebastian Stefaniak, Tomasz Urbanowicz, Bartłomiej Perek, Marek Jemielity","doi":"10.5114/kitp.2023.129549","DOIUrl":"https://doi.org/10.5114/kitp.2023.129549","url":null,"abstract":"Address for correspondence: Dominika Katarzyńska MD, University Clinical Hospital, Poznan, Poland, e-mail: dominika.katarzynska@gmail.com Received: 12.05.2023, accepted: 25.06.2023. A 77-year-old male patient presented with heart failure symptoms (NYHA class III), which developed after probable infective endocarditis (IE) a few months earlier. Physical examination revealed new heart murmur and peripheral oedema. His other medical history includes hypertension, laryngeal tumor, and spine surgery. Nine years prior to this presentation, he was qualified for surgical aortic valve replacement (SAVR) due to a symptomatic severe aortic stenosis with mild aortic regurgitation. After sternotomy, he was deferred from prosthesis implantation as the porcelain aorta was revealed. Subsequently, he underwent successful transcatheter aortic valve implantation (TAVI) with Medtronic CoreValve 29 mm (Medtronic, Minneapolis, MN, USA) bioprosthesis. Postprocedural transthoracic echocardiography (TTE) showed proper bioprosthesis function with maximal transaortic gradient of 25 mm Hg without a paravalvular leak (PVL). The postoperative course was uneventful and on the 7th day he was discharged home. Three weeks after the procedure, the patient developed recurrent syncope, dizziness and chest pain. Electrocardiogram showed severe bradycardia with periodic third-degree atrioventricular block. A dual chamber pacemaker (BiotronicEcuro DR, Biotronik, Berlin, Germany) was implanted. During next 9 years the patient remained in a good clinical condition, though he underwent successful treatment of laryngeal tumor. The repeated echocardiographic examination confirmed proper bioprosthesis function. Six months before current hospitalization he presented with infection which was interpreted as pneumonia and treated successfully with antibiotics. Nevertheless, thereafter symptoms of heart failure occurred and gradually exacerbated. During the hospitalization due to heart failure worsening, TTE revealed hemodynamically severe intraprosthetic aortic regurgitation which had not been observed before (confirmed in transesophageal echocardiography (TEE) (Figure 1)) with transaortic maximal and mean gradients of 21 and 10 mm Hg, respectively, preserved left ventricular ejection fraction, and increased pulmonary artery systolic pressure. Laboratory tests did not present significant deviations in inflammatory markers and blood cultures were negative. After careful assessment by the heart team the patient was qualified for valve-in-valve TAVI (ViV-TAVI) due to a high perioperative risk and porcelain aorta. After careful assessment of computed tomography, he underwent successful uncomplicated implantation of Edwards Sapien (Edwards Lifesciences Corp., Irvine, CA, USA) prosthesis, which was chosen based on its optimal profile not limiting access to the coronary ostia. During follow-up he remains asymptomatic with good prosthesis function on control echocardiography. IE post-TAVI is not a commo","PeriodicalId":49945,"journal":{"name":"Kardiochirurgia I Torakochirurgia Polska","volume":null,"pages":null},"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/56/25/KITP-20-51121.PMC10410635.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9970175","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.2023.129550
Adem Gencer, Gürhan Öz, Ersin Gunay, Ahmet Dumanlı
Introduction: Video-assisted thoracoscopic surgery (VATS) is a common surgical procedure.
Aim: To find out how educating patients using multimedia affects their pain and anxiety before and after VATS surgery.
Material and methods: The study included 50 patients who underwent VATS between December 2017 and December 2018. The subjects were divided into two groups: the multimedia information group (MIG) and the control group (n = 25). The subjects underwent STAI-T testing, preoperative and postoperative STAI-S testing, and pulmonary function tests (PFT) before surgery and after surgery.
Results: The patients in the MIG had higher baseline anxiety levels than those in the control groups. There were no significant differences between the two groups in terms of demographic information, surgical characteristics, or vital signs. There was a statistically significant difference in the preoperative (p = 0.001) and the postoperative (p = 0.0001) pain scores between MIG and control groups. The postoperative STAI-S scores of MIG increased, but this increase was not significant. In both groups, there was no significant difference in the changes in systolic blood pressure (p = 0.656) or respiratory rate (p = 0.05). There was no difference between post-training and pre- and post-operative pain scores in both groups.
Conclusions: Providing multimedia information before surgery has some effect on pain. However, providing multimedia information does not reduce postoperative anxiety.
{"title":"Effects of education on pain and anxiety before and after video-assisted thoracoscopic surgery.","authors":"Adem Gencer, Gürhan Öz, Ersin Gunay, Ahmet Dumanlı","doi":"10.5114/kitp.2023.129550","DOIUrl":"https://doi.org/10.5114/kitp.2023.129550","url":null,"abstract":"<p><strong>Introduction: </strong>Video-assisted thoracoscopic surgery (VATS) is a common surgical procedure.</p><p><strong>Aim: </strong>To find out how educating patients using multimedia affects their pain and anxiety before and after VATS surgery.</p><p><strong>Material and methods: </strong>The study included 50 patients who underwent VATS between December 2017 and December 2018. The subjects were divided into two groups: the multimedia information group (MIG) and the control group (<i>n</i> = 25). The subjects underwent STAI-T testing, preoperative and postoperative STAI-S testing, and pulmonary function tests (PFT) before surgery and after surgery.</p><p><strong>Results: </strong>The patients in the MIG had higher baseline anxiety levels than those in the control groups. There were no significant differences between the two groups in terms of demographic information, surgical characteristics, or vital signs. There was a statistically significant difference in the preoperative (<i>p</i> = 0.001) and the postoperative (<i>p</i> = 0.0001) pain scores between MIG and control groups. The postoperative STAI-S scores of MIG increased, but this increase was not significant. In both groups, there was no significant difference in the changes in systolic blood pressure (<i>p</i> = 0.656) or respiratory rate (<i>p</i> = 0.05). There was no difference between post-training and pre- and post-operative pain scores in both groups.</p><p><strong>Conclusions: </strong>Providing multimedia information before surgery has some effect on pain. However, providing multimedia information does not reduce postoperative anxiety.</p>","PeriodicalId":49945,"journal":{"name":"Kardiochirurgia I Torakochirurgia Polska","volume":null,"pages":null},"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/69/04/KITP-20-51122.PMC10410629.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9970177","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.2023.129537
Anshuman Darbari, Devender Singh, Shubham S Rawat, Ajay Kumar
). Conventional coro - nary angiography confirmed these findings. Imaging results with the ongoing ischemic symptoms confirmed the diag - nosis of right-sided CCF in this patient. After being stabi - lized, she was taken up for surgical repair of CCF. Intraop - erative examination revealed that the RA and right atrial appendage were hugely dilated. The RCA followed a tortu - ous path over the right atrioventricular groove and opened into the RA. Standard surgical steps included aorto-bicaval cannulation, antegrade cardioplegia
{"title":"Management of right coronary-cameral fistula in a young woman presenting with ischemic symptoms.","authors":"Anshuman Darbari, Devender Singh, Shubham S Rawat, Ajay Kumar","doi":"10.5114/kitp.2023.129537","DOIUrl":"https://doi.org/10.5114/kitp.2023.129537","url":null,"abstract":"). Conventional coro - nary angiography confirmed these findings. Imaging results with the ongoing ischemic symptoms confirmed the diag - nosis of right-sided CCF in this patient. After being stabi - lized, she was taken up for surgical repair of CCF. Intraop - erative examination revealed that the RA and right atrial appendage were hugely dilated. The RCA followed a tortu - ous path over the right atrioventricular groove and opened into the RA. Standard surgical steps included aorto-bicaval cannulation, antegrade cardioplegia","PeriodicalId":49945,"journal":{"name":"Kardiochirurgia I Torakochirurgia Polska","volume":null,"pages":null},"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/f5/d1/KITP-20-51112.PMC10410637.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9970178","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.2023.129551
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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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":null,"pages":null},"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}