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Surgical pulmonary embolectomy: state of the art. 外科肺栓塞切除术:最先进的技术。
IF 0.7 Q3 Medicine Pub Date : 2023-06-01 DOI: 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.

急性肺栓塞是发病率和死亡率的重要原因。危及生命的患者需要及时有效的干预措施来改善肺灌注。在溶栓时代,手术栓塞切除的适应症是有限的。本文讨论了手术技术,并概述了手术栓塞术与其他治疗方式的关系。
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引用次数: 0
Comparison of peripheral blood saturation with brain oxygenation in patients undergoing thoracic surgery. 胸外科手术患者外周血饱和度与脑氧合的比较。
IF 0.7 Q3 Medicine Pub Date : 2023-06-01 DOI: 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.

简介:近红外光谱(NIRS)是一种非侵入性的区域组织氧合测量方法。术中使用近红外光谱监测术中脑氧合(BO)可能有助于识别脑去饱和。目的:比较外周血饱和度(SpO2)与BO测量值,评价BO在胸外科手术中的应用价值。材料和方法:我们对100例接受标准胸外科手术的患者进行了BO和SpO2测量。每15分钟测量一次。曼-惠特尼U测试用于比较研究小组。采用Spearman等级相关系数来确定研究参数之间的相关性。结果:我们发现患者的年龄与手术开始时的BO呈负相关。手术持续了30到200分钟。我们发现BO和SpO2在手术15到90分钟之间呈正相关。随后,BO保持在较低水平,而SpO2恢复到基线值。接受左侧手术的患者最低SpO2值较高。结论:与SpO2相反,脑氧合直到手术结束才恢复到基线值。此外,SpO2和BO与胸外科手术总时间呈负相关。此外,手术90分钟后,SpO2停止反映脑氧合。
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引用次数: 0
Late consequences of masked bioprosthetic valve endocarditis: diagnostic and treatment options. 隐蔽性生物瓣膜心内膜炎的晚期后果:诊断和治疗选择。
IF 0.7 Q3 Medicine Pub Date : 2023-06-01 DOI: 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
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引用次数: 0
Effects of education on pain and anxiety before and after video-assisted thoracoscopic surgery. 教育对胸腔镜手术前后疼痛和焦虑的影响。
IF 0.7 Q3 Medicine Pub Date : 2023-06-01 DOI: 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.

视频辅助胸腔镜手术(VATS)是一种常见的外科手术。目的:探讨多媒体教育对VATS手术前后患者疼痛和焦虑的影响。材料和方法:该研究包括50名在2017年12月至2018年12月期间接受VATS治疗的患者。将受试者分为两组:多媒体信息组(MIG)和对照组(n = 25)。患者术前、术后均行STAI-T检测、STAI-S检测、肺功能检测(PFT)。结果:MIG组患者的基线焦虑水平高于对照组。两组在人口学信息、手术特征或生命体征方面无显著差异。MIG组与对照组术前(p = 0.001)和术后(p = 0.0001)疼痛评分比较,差异均有统计学意义。术后MIG的STAI-S评分升高,但升高不显著。两组患者收缩压变化(p = 0.656)、呼吸频率变化(p = 0.05)差异无统计学意义。两组的训练后和术前、术后疼痛评分均无差异。结论:术前提供多媒体信息对缓解疼痛有一定作用。然而,提供多媒体信息并不能减少术后焦虑。
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引用次数: 0
Management of right coronary-cameral fistula in a young woman presenting with ischemic symptoms. 一例以缺血性症状为表现的年轻女性右冠状动脉-照相机瘘管的治疗。
IF 0.7 Q3 Medicine Pub Date : 2023-06-01 DOI: 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
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引用次数: 0
Does bone wax make sense in off-pump coronary surgery? A prospective randomized study. 骨蜡在非体外循环冠状动脉手术中有意义吗?一项前瞻性随机研究。
IF 0.7 Q3 Medicine Pub Date : 2023-06-01 DOI: 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.

前言:目前文献尚未报道骨蜡对非体外循环冠状动脉手术中胸骨感染和术中出血的影响。目的:对我院接受非体外循环冠状动脉手术的高危患者进行前瞻性评价。还研究了对细胞保存器利用的潜在影响。材料与方法:对58例采用非泵手术治疗双支冠状动脉病变的糖尿病患者进行前瞻性随机研究。他们被随机分配到蜡组和不蜡组。结果:有蜡组(550 ml)术中出血量与无蜡组(750 ml)术中出血量差异无统计学意义;P = 0.0711)。在多因素分析中,骨蜡的缺失(未使用)(优势比= 3.9 (1.12-13.51),p = 0.027)和术前创造素水平(优势比= 1.1 (0.99-1.03),p = 0.03)被确定为失血量≥750 ml的独立预测因素。两组住院期间红细胞单位数相似(p = 0.42)。两组均未见创面愈合并发症。结论:使用骨蜡不会增加胸骨伤口感染的风险。它可以减少术中大量失血的风险,从而避免在非体外循环冠状动脉手术中需要细胞保存器。然而,这种影响仍然值得怀疑。
{"title":"Does bone wax make sense in off-pump coronary surgery? A prospective randomized study.","authors":"Zdenek Sorm,&nbsp;Martin Vobornik,&nbsp;Martin Dergel,&nbsp;Eva Cermakova,&nbsp;Jan Harrer,&nbsp;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}
引用次数: 0
Cerebrovascular events after cardiovascular surgery: diagnosis, management and prevention strategies. 心血管手术后脑血管事件:诊断、处理和预防策略。
IF 0.7 Q3 Medicine Pub Date : 2023-06-01 DOI: 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.

心脏手术后脑血管事件是最严重的并发症之一,与患者死亡风险增加有关。这个问题可能发生在心脏直视手术中形成气体栓塞之后。目的:探讨可能导致心血管手术后栓塞事件的所有机制,如何处理它们以及如何可能地预防它们。材料和方法:检索PubMed数据库。我们回顾了临床文献,并检查了各个方面,以确定可能导致栓塞形成的根本原因。结果:在回顾的研究中,发现主动脉操作、心脏手术后脱氧不充分、体外循环血液成分接触是导致主动脉脱氧的主要原因。据报道,气体栓塞可导致有害的损害,如对脑血管内皮的损害、血脑屏障的破坏、补体活化、白细胞聚集、血小板粘附增加和微血管系统的纤维蛋白沉积。结论:卒中是心血管手术后最重要的并发症之一,严重影响手术死亡率和患者生存。随着时间的推移,人们努力了解与该并发症相关的所有病理生理机制,以减少其发生率。其中一个目标应该是改进手术技术和灌注方式,尽量减少气泡的形成或促进体外循环过程中气泡的消除。
{"title":"Cerebrovascular events after cardiovascular surgery: diagnosis, management and prevention strategies.","authors":"Maria Sabrina Ferrante,&nbsp;Calogera Pisano,&nbsp;Jérôme Van Rothem,&nbsp;Giovanni Ruvolo,&nbsp;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}
引用次数: 0
Pulmonary artery sarcoma presenting as chronic thromboembolic pulmonary hypertension (CTEPH). 肺动脉肉瘤表现为慢性血栓栓塞性肺动脉高压(CTEPH)。
IF 0.7 Q3 Medicine Pub Date : 2023-06-01 DOI: 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,&nbsp;Odysseas Drosos,&nbsp;Athanasios Madesis,&nbsp;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}
引用次数: 0
Incidental pulmonary arteriovenous malformation. 偶发性肺动静脉畸形。
IF 0.7 Q3 Medicine Pub Date : 2023-06-01 DOI: 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,&nbsp;Serkan Uysal,&nbsp;Erkan Dikmen,&nbsp;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}
引用次数: 0
Descending necrotizing mediastinitis: a challenging infection. Selected results of a Moroccan bicentric study. 下行坏死性纵隔炎:一种具有挑战性的感染。摩洛哥双中心研究的选定结果。
IF 0.7 Q3 Medicine Pub Date : 2023-06-01 DOI: 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.

摘要纵隔感染是一种由邻近脏器继发性并发症引起的持续性、难治的广泛性传染病。它很容易传播,由于缺乏典型的表现,经常被误诊。材料和方法:为了突出下行坏死性纵隔炎的临床特点、内科和外科治疗策略,我们对我院10年间25例有记录的病例进行了回顾性研究,所有病例均采用手术治疗,其中10例来自ORL科,15例来自胸外科。结果:患者年龄20 ~ 84岁,中位年龄41岁,男性为主(男性19例,女性6例),性别比3.6。宫颈切开术(40%的病例)与胸腔镜(1例)或开胸术(20%的病例)和广谱抗生素治疗相关或不相关。术后15例患者在引流管上采用灌吸系统。1例需要开胸切除残留的右脓胸,1例需要气管切开术。22例(88%)患者从纵隔炎中恢复。脓毒症并发多器官功能衰竭死亡3例。术后随访1年,无复发。结论:根据我们的经验,我们认为局部治疗越积极,效果越好。
{"title":"Descending necrotizing mediastinitis: a challenging infection. Selected results of a Moroccan bicentric study.","authors":"Massine El Hammoumi,&nbsp;Saloua Ouraini,&nbsp;Mohammed Bhairis,&nbsp;Hamid Kouatli,&nbsp;Kemini Marius Kamdem,&nbsp;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}
引用次数: 0
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Kardiochirurgia I Torakochirurgia Polska
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