Background: The coronary sinus type of atrial septal defect is rare. Standard treatment typically involves intracardiac repair using conventional sternotomy or thoracotomy incisions; however, robotic technology can offer a feasible alternative due to its ability to provide a high-quality surgical view of this anomaly.
Case presentation: A 72-year-old man presented with asymptomatic atrial septal defect. Echocardiography revealed a direct communication between the left atrium and CS with left-to-right shunt flow and a Qp/Qs ratio of 2.1:1. The coronary sinus type of atrial septal defect was indicated for the totally endoscopic robotic repair considering few comorbidities. We present a successful robotic repair of coronary sinus atrial septal defect with concomitant tricuspid annuloplasty via the right atrium, properly identifying the boundary between the mitral annulus and coronary sinus through a high-quality surgical view.
Conclusion: Robotic repair can serve as a viable and therapeutically effective alternative for cases of coronary sinus atrial septal defect with concomitant tricuspid annuloplasty.
{"title":"Totally endoscopic robotic repair of coronary sinus atrial septal defect with concomitant tricuspid annuloplasty.","authors":"Kazuki Noda, Yosuke Takahashi, Akimasa Morisaki, Yoshito Sakon, Kenta Nishiya, Goki Inno, Yukihiro Nishimoto, Munehide Nagao, Toshihiko Shibata","doi":"10.1186/s44215-024-00167-1","DOIUrl":"10.1186/s44215-024-00167-1","url":null,"abstract":"<p><strong>Background: </strong>The coronary sinus type of atrial septal defect is rare. Standard treatment typically involves intracardiac repair using conventional sternotomy or thoracotomy incisions; however, robotic technology can offer a feasible alternative due to its ability to provide a high-quality surgical view of this anomaly.</p><p><strong>Case presentation: </strong>A 72-year-old man presented with asymptomatic atrial septal defect. Echocardiography revealed a direct communication between the left atrium and CS with left-to-right shunt flow and a Qp/Qs ratio of 2.1:1. The coronary sinus type of atrial septal defect was indicated for the totally endoscopic robotic repair considering few comorbidities. We present a successful robotic repair of coronary sinus atrial septal defect with concomitant tricuspid annuloplasty via the right atrium, properly identifying the boundary between the mitral annulus and coronary sinus through a high-quality surgical view.</p><p><strong>Conclusion: </strong>Robotic repair can serve as a viable and therapeutically effective alternative for cases of coronary sinus atrial septal defect with concomitant tricuspid annuloplasty.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"3 1","pages":"42"},"PeriodicalIF":0.0,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11533694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635283","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}
Background: Horner's syndrome is a rare complication of cardiovascular surgery. A bone fragment and hematoma due to rib fracture after cardiac surgery may cause injury to the brachial nerve plexus and sympathetic nerve trunk, leading to neurologic disorders and Horner's syndrome. However, few reports have revealed the etiology of Horner's syndrome after cardiovascular surgery based on imaging. Herein we present a case in which a plain CT scan confirmed the etiology of Horner's syndrome after coronary artery bypass grafting (CABG), reviewing 139 CABG cases retrospectively in our hospital and 6 case reports of Horner's syndrome associated with cardiovascular surgery.
Case presentation: A 69-year-old woman with a history of percutaneous coronary intervention and total abdominal hysterectomy with bilateral salpingo-oophorectomy had chest pain on exertion. Coronary angiography showed severe triple vessel disease. She underwent off-pump coronary artery bypass grafting (CABG). A median sternotomy was performed, and the split sternums were widened using a sternal retractor. The bilateral internal thoracic arteries were harvested. A triple CABG was performed. She had left shoulder pain after surgery. She complained of anhidrosis involving the left face and hyperhidrosis involving the right face from postoperative day (POD) 6. Left ptosis and blurry vision appeared after discharge from the hospital, for which she saw a neurologist in our hospital on POD 48. Miosis could not be clearly confirmed. She was diagnosed with Horner's syndrome. A plain CT scan revealed displaced fractures of the bilateral first ribs and left second rib. The bone fragment of the left first rib head was displaced 3 mm anteriorly compared to the left first rib head before surgery, which suggested that the fragment affected the stellate ganglion in the sympathetic trunk. The patient had regular follow-up evaluations. The anhidrosis persisted, but the ptosis improved, and the miosis was not confirmed at the 6-month follow-up evaluation.
Conclusions: We should recognize that Horner's syndrome is one of the complications of cardiovascular surgery, especially CABG. Fracture of the first rib head with a displaced bone fracture was shown to be a contributor to ipsilateral Horner's syndrome. When symptoms of Horner's syndrome and other neurologic symptoms are noted after open heart surgery, a plain CT examination should be obtained.
{"title":"Horner's syndrome caused by the first rib fracture sustained during coronary artery bypass grafting: a case report and literature review.","authors":"Hiroto Yasumura, Koji Tao, Ryo Imada, Yushi Yamashita, Naoki Tateishi, Tamahiro Kinjo","doi":"10.1186/s44215-024-00166-2","DOIUrl":"10.1186/s44215-024-00166-2","url":null,"abstract":"<p><strong>Background: </strong>Horner's syndrome is a rare complication of cardiovascular surgery. A bone fragment and hematoma due to rib fracture after cardiac surgery may cause injury to the brachial nerve plexus and sympathetic nerve trunk, leading to neurologic disorders and Horner's syndrome. However, few reports have revealed the etiology of Horner's syndrome after cardiovascular surgery based on imaging. Herein we present a case in which a plain CT scan confirmed the etiology of Horner's syndrome after coronary artery bypass grafting (CABG), reviewing 139 CABG cases retrospectively in our hospital and 6 case reports of Horner's syndrome associated with cardiovascular surgery.</p><p><strong>Case presentation: </strong>A 69-year-old woman with a history of percutaneous coronary intervention and total abdominal hysterectomy with bilateral salpingo-oophorectomy had chest pain on exertion. Coronary angiography showed severe triple vessel disease. She underwent off-pump coronary artery bypass grafting (CABG). A median sternotomy was performed, and the split sternums were widened using a sternal retractor. The bilateral internal thoracic arteries were harvested. A triple CABG was performed. She had left shoulder pain after surgery. She complained of anhidrosis involving the left face and hyperhidrosis involving the right face from postoperative day (POD) 6. Left ptosis and blurry vision appeared after discharge from the hospital, for which she saw a neurologist in our hospital on POD 48. Miosis could not be clearly confirmed. She was diagnosed with Horner's syndrome. A plain CT scan revealed displaced fractures of the bilateral first ribs and left second rib. The bone fragment of the left first rib head was displaced 3 mm anteriorly compared to the left first rib head before surgery, which suggested that the fragment affected the stellate ganglion in the sympathetic trunk. The patient had regular follow-up evaluations. The anhidrosis persisted, but the ptosis improved, and the miosis was not confirmed at the 6-month follow-up evaluation.</p><p><strong>Conclusions: </strong>We should recognize that Horner's syndrome is one of the complications of cardiovascular surgery, especially CABG. Fracture of the first rib head with a displaced bone fracture was shown to be a contributor to ipsilateral Horner's syndrome. When symptoms of Horner's syndrome and other neurologic symptoms are noted after open heart surgery, a plain CT examination should be obtained.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"3 1","pages":"41"},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11533436/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635631","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}
A 50-year-old woman with systemic lupus erythematosus and a history of aortic arch replacement surgery for Stanford type A aortic dissection experienced a reoccurrence of an ascending aortic aneurysm and coronary artery occlusion. Computed tomography revealed that the aneurysm was compressing the superior vena cava and right atrium. The patient underwent urgent surgery to repair the aneurysm. This case highlights that aortic aneurysms can reoccur even after total arch replacement in systemic lupus erythematosus patients.
{"title":"Ascending aortic aneurysm after acute aortic dissection in a case with systemic lupus erythematosus.","authors":"Hanae Sasaki, Ryosuke Kowatari, Yuki Imamura, Shintaro Goto, Akira Kurose, Masahito Minakawa","doi":"10.1186/s44215-024-00165-3","DOIUrl":"10.1186/s44215-024-00165-3","url":null,"abstract":"<p><p>A 50-year-old woman with systemic lupus erythematosus and a history of aortic arch replacement surgery for Stanford type A aortic dissection experienced a reoccurrence of an ascending aortic aneurysm and coronary artery occlusion. Computed tomography revealed that the aneurysm was compressing the superior vena cava and right atrium. The patient underwent urgent surgery to repair the aneurysm. This case highlights that aortic aneurysms can reoccur even after total arch replacement in systemic lupus erythematosus patients.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"3 1","pages":"40"},"PeriodicalIF":0.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11533674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635606","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}
Background: Calcified amorphous tumor (CAT) of the heart is a rare, non-neoplastic cardiac mass with mitral valves and annuli being the most common sites. The presence of mitral annular calcification (MAC) is associated with an increased risk of stroke or other systemic embolisms. Here, we report a case of CAT showing rapid growth with MAC and investigate the link between the two.
Case presentation: A 71-year-old man presented at our hospital with dyspnea and had been undergoing hemodialysis for 26 years for chronic glomerulonephritis. Transthoracic echocardiography (TTE) revealed moderate mitral stenosis with bulky MAC. Two months later, the patient developed progressive dyspnea, and follow-up TTE revealed a highly mobile mass (8 × 5 mm) attached to the left ventricular (LV) side of the posterior MAC. He underwent surgery because of congestive heart failure and a high risk of embolization. Surgical inspection revealed that the tumor was attached beneath the P3 segment of the mitral valve on the LV side and was removed. When removing the MAC, toothpaste-like contents drained from the encapsulated mass inside the MAC at the P3 segment, where the tumor was located. After reconstructing the posterior mitral annulus defect with a bovine pericardial patch, mitral valve replacement with a mechanical prosthesis, a maze procedure, and left appendage closure were performed. Histopathological examination revealed that the excised tumor contained fibrin and calcium deposits. The mass was diagnosed as a CAT.
Conclusions: CAT may be one of the causes of stroke induced by MAC. Routine follow-up echocardiography should be recommended for patients with MAC, especially those undergoing hemodialysis.
背景:心脏钙化无定形瘤(CAT)是一种罕见的非肿瘤性心脏肿块,最常见的部位是二尖瓣和二尖瓣环。二尖瓣瓣环钙化(MAC)的出现与中风或其他全身性栓塞的风险增加有关。在此,我们报告了一例伴有二尖瓣瓣环钙化(MAC)的二尖瓣瓣环钙化(CAT)病例,该病例显示二尖瓣瓣环钙化(MAC)快速生长,我们将研究两者之间的联系:一名 71 岁的男性因呼吸困难来我院就诊,他因慢性肾小球肾炎接受血液透析治疗已有 26 年。经胸超声心动图(TTE)显示二尖瓣中度狭窄,澳门巴黎人娱乐官网膨出。两个月后,患者出现进行性呼吸困难,随访 TTE 发现左心室(LV)侧后方澳门巴黎人娱乐官网附着一个高度移动的肿块(8 × 5 毫米)。由于充血性心力衰竭和栓塞的高风险,他接受了手术。手术检查发现,肿瘤附着在左心室侧二尖瓣 P3 节段下方,于是将其切除。切除澳门巴黎人娱乐官网时,牙膏样内容物从肿瘤所在的P3段澳门巴黎人娱乐官网内包裹的肿块中流出。用牛心包补片重建二尖瓣环后缺损后,进行了二尖瓣机械假体置换术、迷宫术和左阑尾闭合术。组织病理学检查显示,切除的肿瘤含有纤维蛋白和钙沉积物。该肿块被诊断为CAT:结论:CAT 可能是 MAC 诱发中风的原因之一。结论:CAT 可能是 MAC 诱发中风的原因之一,建议对 MAC 患者,尤其是接受血液透析的患者进行常规超声心动图随访。
{"title":"Rapid growth of calcified amorphous tumor with mitral annulus calcification: a case report.","authors":"Satoki Ozoe, Yutaka Koyama, Masahiro Inagaki, Shinji Tomita","doi":"10.1186/s44215-024-00164-4","DOIUrl":"10.1186/s44215-024-00164-4","url":null,"abstract":"<p><strong>Background: </strong>Calcified amorphous tumor (CAT) of the heart is a rare, non-neoplastic cardiac mass with mitral valves and annuli being the most common sites. The presence of mitral annular calcification (MAC) is associated with an increased risk of stroke or other systemic embolisms. Here, we report a case of CAT showing rapid growth with MAC and investigate the link between the two.</p><p><strong>Case presentation: </strong>A 71-year-old man presented at our hospital with dyspnea and had been undergoing hemodialysis for 26 years for chronic glomerulonephritis. Transthoracic echocardiography (TTE) revealed moderate mitral stenosis with bulky MAC. Two months later, the patient developed progressive dyspnea, and follow-up TTE revealed a highly mobile mass (8 × 5 mm) attached to the left ventricular (LV) side of the posterior MAC. He underwent surgery because of congestive heart failure and a high risk of embolization. Surgical inspection revealed that the tumor was attached beneath the P3 segment of the mitral valve on the LV side and was removed. When removing the MAC, toothpaste-like contents drained from the encapsulated mass inside the MAC at the P3 segment, where the tumor was located. After reconstructing the posterior mitral annulus defect with a bovine pericardial patch, mitral valve replacement with a mechanical prosthesis, a maze procedure, and left appendage closure were performed. Histopathological examination revealed that the excised tumor contained fibrin and calcium deposits. The mass was diagnosed as a CAT.</p><p><strong>Conclusions: </strong>CAT may be one of the causes of stroke induced by MAC. Routine follow-up echocardiography should be recommended for patients with MAC, especially those undergoing hemodialysis.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"3 1","pages":"39"},"PeriodicalIF":0.0,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11533609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633014","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}
Background: The occurrence of aorto-right atrial fistula in a patient with Stanford type A aortic dissection is exceedingly rare, and the treatment has not been established.
Case presentation: A 60-year-old male presented to the emergency department with acute lumbar pain and, based on contrast-enhanced computed tomography, was diagnosed with Stanford type A aortic dissection. Emergency surgery was performed. Transesophageal echocardiography during the surgery did not reveal an aorto-right atrial fistula. After establishing cardiopulmonary bypass, circulatory arrest was induced, and the primary entry in the proximal ascending aorta for the aortic dissection was identified. The aorta was dissected between the right brachiocephalic artery and the left common carotid artery, and an artificial conduit was anastomosed. After re-establishing circulation, venous blood flow from the dissected area at the base of the aortic root was observed, indicating communication between the aorta and the right atrium. Circulatory arrest was induced again, and the ruptured outer aortic adventitia was repaired by continuous suturing using 5-0 prolene. The atrial fistula was repaired from within the right atrium using 5-0 prolene with felt reinforcement. Thus, successful closure was achieved. Proximal anastomosis and right brachiocephalic artery reconstruction were subsequently performed. Postoperative transesophageal echocardiography revealed no shunt flow and no bleeding from the aortic root. The patient recovered smoothly and was discharged without significant complications.
Conclusions: Aorto-right atrial fistula associated with Stanford type A aortic dissection is rare, and in this case, the shunt blood flow was low, making preoperative diagnosis difficult. However, after intraoperative diagnosis, direct suture was used to complete the treatment, which was a simple and effective method.
{"title":"Surgical management of aorto-right atrial fistula induced by Stanford type A aortic dissection: a case report.","authors":"Takahito Yokoyama, Yasutoshi Tsuda, Katsuyuki Shigehara, Ryo Niside, Daiki Sato, Masato Nakajima","doi":"10.1186/s44215-024-00163-5","DOIUrl":"10.1186/s44215-024-00163-5","url":null,"abstract":"<p><strong>Background: </strong>The occurrence of aorto-right atrial fistula in a patient with Stanford type A aortic dissection is exceedingly rare, and the treatment has not been established.</p><p><strong>Case presentation: </strong>A 60-year-old male presented to the emergency department with acute lumbar pain and, based on contrast-enhanced computed tomography, was diagnosed with Stanford type A aortic dissection. Emergency surgery was performed. Transesophageal echocardiography during the surgery did not reveal an aorto-right atrial fistula. After establishing cardiopulmonary bypass, circulatory arrest was induced, and the primary entry in the proximal ascending aorta for the aortic dissection was identified. The aorta was dissected between the right brachiocephalic artery and the left common carotid artery, and an artificial conduit was anastomosed. After re-establishing circulation, venous blood flow from the dissected area at the base of the aortic root was observed, indicating communication between the aorta and the right atrium. Circulatory arrest was induced again, and the ruptured outer aortic adventitia was repaired by continuous suturing using 5-0 prolene. The atrial fistula was repaired from within the right atrium using 5-0 prolene with felt reinforcement. Thus, successful closure was achieved. Proximal anastomosis and right brachiocephalic artery reconstruction were subsequently performed. Postoperative transesophageal echocardiography revealed no shunt flow and no bleeding from the aortic root. The patient recovered smoothly and was discharged without significant complications.</p><p><strong>Conclusions: </strong>Aorto-right atrial fistula associated with Stanford type A aortic dissection is rare, and in this case, the shunt blood flow was low, making preoperative diagnosis difficult. However, after intraoperative diagnosis, direct suture was used to complete the treatment, which was a simple and effective method.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"3 1","pages":"38"},"PeriodicalIF":0.0,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11533569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142634977","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}
Background: Cholesterol granuloma (CG) is a benign entity characterized by the presence of cholesterol crystals and foreign body giant cells. This condition can be attributed to cholesterol crystals that are deposited in the tissues and react with foreign body giant cells, resulting in granuloma formation. Lesions commonly develop in the otolaryngeal region, such as the middle ear. However, crystals rarely form in the thymus, accounting for 1% of all mediastinal tumors. Herein, we present five cases of mediastinal CG.
Case presentation: The patients were aged 49-61 (mean, 55.4) years. Among them, three were men and two women. One patient had fever, and four patients were asymptomatic. The patients' lesions were detected during follow-up of other diseases or medical examinations showing the presence of abnormal chest shadows. The patients did not have a history of trauma or surgery. All lesions were located within the thymus gland. Three patients presented with multifocal lesions and two with a single lesion. Four patients had contrast effect on computed tomography scan. Four patients had abnormal fluorodeoxyglucose accumulation (mean maximum standardized uptake value, 4.67) on positron emission tomography-computed tomography. Four patients underwent complete surgical resection. The size of the resected lesions ranged from 1.8 to 5.1 (mean, 3.24) cm. Histologically, all patients presented with small nodules with cholesterol clefts and foreign body giant cells and histiocyte infiltration within the thymic tissue. The postoperative course was excellent. None of the patients who underwent complete resection presented with recurrence. Moreover, the patient who underwent partial resection did not have lesion enlargement.
Conclusions: CG in the thymus is clinically challenging to differentiate from malignant lesions, and histologic diagnosis via surgical resection is required.
{"title":"A report on five cases of cholesterol granulomas in the thymus.","authors":"Ryosuke Matsuda, Naoko Ose, Hideki Nagata, Eiichi Morii, Yasushi Shintani","doi":"10.1186/s44215-024-00159-1","DOIUrl":"10.1186/s44215-024-00159-1","url":null,"abstract":"<p><strong>Background: </strong>Cholesterol granuloma (CG) is a benign entity characterized by the presence of cholesterol crystals and foreign body giant cells. This condition can be attributed to cholesterol crystals that are deposited in the tissues and react with foreign body giant cells, resulting in granuloma formation. Lesions commonly develop in the otolaryngeal region, such as the middle ear. However, crystals rarely form in the thymus, accounting for 1% of all mediastinal tumors. Herein, we present five cases of mediastinal CG.</p><p><strong>Case presentation: </strong>The patients were aged 49-61 (mean, 55.4) years. Among them, three were men and two women. One patient had fever, and four patients were asymptomatic. The patients' lesions were detected during follow-up of other diseases or medical examinations showing the presence of abnormal chest shadows. The patients did not have a history of trauma or surgery. All lesions were located within the thymus gland. Three patients presented with multifocal lesions and two with a single lesion. Four patients had contrast effect on computed tomography scan. Four patients had abnormal fluorodeoxyglucose accumulation (mean maximum standardized uptake value, 4.67) on positron emission tomography-computed tomography. Four patients underwent complete surgical resection. The size of the resected lesions ranged from 1.8 to 5.1 (mean, 3.24) cm. Histologically, all patients presented with small nodules with cholesterol clefts and foreign body giant cells and histiocyte infiltration within the thymic tissue. The postoperative course was excellent. None of the patients who underwent complete resection presented with recurrence. Moreover, the patient who underwent partial resection did not have lesion enlargement.</p><p><strong>Conclusions: </strong>CG in the thymus is clinically challenging to differentiate from malignant lesions, and histologic diagnosis via surgical resection is required.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"3 1","pages":"36"},"PeriodicalIF":0.0,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11533621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635555","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}
Background: Redo isolated tricuspid valve surgery has high in-hospital mortality and morbidity and is a challenging procedure. We report a successful case of redo isolated tricuspid valve replacement for structural valve deterioration of a bioprosthesis in a patient with isolated persistent left superior vena cava (PLSVC).
Case presentation: An 81-year-old man with a history of tricuspid valve replacement using a porcine bioprosthetic valve 9 years previously presented with dyspnea on exertion. Right heart failure due to worsening transvalvular leakage in the bioprosthetic tricuspid valve was considered to be the cause of his symptoms, and the decision was made to replace the tricuspid valve. An isolated PLSVC is considered to be an obstacle in right-sided heart valve surgery. The PLSVC was located deep to the left of the pulmonary artery and, after some effort, was cannulated by obtaining an excellent surgical view using retraction sutures on the left side of the pericardium. Cardiopulmonary bypass was initiated after cannulation of the ascending aorta, PLSVC, and femoral vein. After cross-clamping of the ascending aorta, cold blood cardioplegic arrest was induced under moderate hypothermia, and the PLSVC and inferior vena cava were snared. The right atrium was opened and the prosthetic tricuspid valve was examined. One of the leaflets was shortened, which appeared to cause the transvalvular leak. The prosthetic valve was explanted, the annulus was trimmed, and a new bioprosthetic valve was implanted. The postoperative course was uneventful.
Conclusions: It is important to treat structural valve deterioration of a prosthetic tricuspid valve in a timely manner. We hope that our intervention timing and surgical strategy can help surgeons to consider early intervention in similar cases, even if there are surgical obstacles such as isolated PLSVC.
{"title":"Redo isolated tricuspid valve replacement in a patient with isolated persistent left superior vena cava: a case report.","authors":"Ryotaro Yamada, Homare Okamura, Rie Iwasaki, Atsushi Yamaguchi","doi":"10.1186/s44215-024-00160-8","DOIUrl":"10.1186/s44215-024-00160-8","url":null,"abstract":"<p><strong>Background: </strong>Redo isolated tricuspid valve surgery has high in-hospital mortality and morbidity and is a challenging procedure. We report a successful case of redo isolated tricuspid valve replacement for structural valve deterioration of a bioprosthesis in a patient with isolated persistent left superior vena cava (PLSVC).</p><p><strong>Case presentation: </strong>An 81-year-old man with a history of tricuspid valve replacement using a porcine bioprosthetic valve 9 years previously presented with dyspnea on exertion. Right heart failure due to worsening transvalvular leakage in the bioprosthetic tricuspid valve was considered to be the cause of his symptoms, and the decision was made to replace the tricuspid valve. An isolated PLSVC is considered to be an obstacle in right-sided heart valve surgery. The PLSVC was located deep to the left of the pulmonary artery and, after some effort, was cannulated by obtaining an excellent surgical view using retraction sutures on the left side of the pericardium. Cardiopulmonary bypass was initiated after cannulation of the ascending aorta, PLSVC, and femoral vein. After cross-clamping of the ascending aorta, cold blood cardioplegic arrest was induced under moderate hypothermia, and the PLSVC and inferior vena cava were snared. The right atrium was opened and the prosthetic tricuspid valve was examined. One of the leaflets was shortened, which appeared to cause the transvalvular leak. The prosthetic valve was explanted, the annulus was trimmed, and a new bioprosthetic valve was implanted. The postoperative course was uneventful.</p><p><strong>Conclusions: </strong>It is important to treat structural valve deterioration of a prosthetic tricuspid valve in a timely manner. We hope that our intervention timing and surgical strategy can help surgeons to consider early intervention in similar cases, even if there are surgical obstacles such as isolated PLSVC.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"3 1","pages":"37"},"PeriodicalIF":0.0,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11533688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633015","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}
Background: Calcified amorphous tumor of the heart is a rare non-neoplastic cardiac mass composed of calcified nodules over amorphous fibrous tissue with degeneration and some chronic inflammation. Calcified amorphous tumor is often associated with mitral annular calcification in patients with end-stage renal disease on dialysis. However, the exact etiology of calcified amorphous tumors remains uncertain.
Case presentation: A 77-year-old female with lung cancer showed a tumor with large mobility in the left ventricular outflow tract on transthoracic echocardiography. She had mitral annular calcification, although her renal function was normal. The tumor was excised surgically. Pathologically, the extracted specimen consisted of a calcified lesion without tumor tissue and was diagnosed as a calcified amorphous tumor.
Conclusions: As the patient had no other risk factors for calcified amorphous tumor except mitral annular calcification, we considered the association of blood coagulation abnormalities due to cancer-related thrombosis. This case suggests that calcified amorphous tumors may be associated with malignant tumors.
{"title":"Cardiac calcified amorphous tumor in a patient with lung cancer.","authors":"Kyohei Hatori, Jun Mohara, Satoru Shibata, Miyuki Murata, Nobuaki Fukuda, Shitoshi Hiroi, Tetsuya Koyano","doi":"10.1186/s44215-024-00161-7","DOIUrl":"10.1186/s44215-024-00161-7","url":null,"abstract":"<p><strong>Background: </strong>Calcified amorphous tumor of the heart is a rare non-neoplastic cardiac mass composed of calcified nodules over amorphous fibrous tissue with degeneration and some chronic inflammation. Calcified amorphous tumor is often associated with mitral annular calcification in patients with end-stage renal disease on dialysis. However, the exact etiology of calcified amorphous tumors remains uncertain.</p><p><strong>Case presentation: </strong>A 77-year-old female with lung cancer showed a tumor with large mobility in the left ventricular outflow tract on transthoracic echocardiography. She had mitral annular calcification, although her renal function was normal. The tumor was excised surgically. Pathologically, the extracted specimen consisted of a calcified lesion without tumor tissue and was diagnosed as a calcified amorphous tumor.</p><p><strong>Conclusions: </strong>As the patient had no other risk factors for calcified amorphous tumor except mitral annular calcification, we considered the association of blood coagulation abnormalities due to cancer-related thrombosis. This case suggests that calcified amorphous tumors may be associated with malignant tumors.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"3 1","pages":"35"},"PeriodicalIF":0.0,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11533507/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635621","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 : 2024-06-20DOI: 10.1186/s44215-024-00158-2
Kota Itagaki, Shintaro Katahira, Katsuhiro Hosoyama, Yusuke Suzuki, Hiromichi Niikawa, Masayuki Otani, Ryuichi Taketomi, Koki Ito, Goro Takahashi, Kiichiro Kumagai, Yoshinori Okada, Yoshikatsu Saiki
Background: The operative field in subclavian vessel surgery is limited by thoracic inlet and outlet structures. Although endovascular therapy for the subclavian artery could be an option, open repair management is occasionally required in cases of large aneurysms, infectious vasculopathy, and trauma. The transmanubrial osteomuscular sparing approach, commonly used in thoracic surgery area to resect superior sulcus tumors, is a simple and safe procedure providing an excellent view of the operative field. Herein, we present three cases that underwent open repair of the subclavian artery using the transmanubrial osteomuscular sparing approach, and we also highlight the utility of the technique along with the procedural details.
Case presentation: Case 1: A 54-year-old man presented with a true aneurysm of the proximal portion of the right subclavian artery. The aneurysm measured 50 × 80 mm and compressed the right lung and trachea. We performed an aneurysm resection and a right subclavian artery reconstruction via the transmanubrial osteomuscular sparing approach under cardiopulmonary bypass support. Case 2: A 72-year-old man who presented with an abscess that formed around the left subclavian artery due to an unremoved guidewire during thoracic endovascular aortic repair for an aortic arch aneurysm in another hospital. After the antibiotics administration, debridement and axillary-axillary bypass were performed, and the guidewire was removed via a transmanubrial osteomuscular sparing approach with a use of cardiopulmonary bypass. Case 3: A 60-year-old man presented with misplacement of an indwelling dialysis catheter inserted for acute renal failure and hyperkalemia. The catheter was placed through the right neck, but had penetrated the right internal jugular vein and was misplaced from the right subclavian artery into the proximal aortic arch. Emergently, we removed the catheter using the transmanubrial osteomuscular sparing approach.
Conclusions: The transmanubrial osteomuscular sparing approach to the subclavian artery provides an excellent view and a wide surgical field, even in different pathological situations. This is a simple, safe, and highly useful procedure and could be the standard approach for subclavian artery surgeries.
{"title":"Utility of transmanubrial osteomuscular sparing approach and its modification in vascular surgery: a case series study of surgeries related to subclavian artery.","authors":"Kota Itagaki, Shintaro Katahira, Katsuhiro Hosoyama, Yusuke Suzuki, Hiromichi Niikawa, Masayuki Otani, Ryuichi Taketomi, Koki Ito, Goro Takahashi, Kiichiro Kumagai, Yoshinori Okada, Yoshikatsu Saiki","doi":"10.1186/s44215-024-00158-2","DOIUrl":"10.1186/s44215-024-00158-2","url":null,"abstract":"<p><strong>Background: </strong>The operative field in subclavian vessel surgery is limited by thoracic inlet and outlet structures. Although endovascular therapy for the subclavian artery could be an option, open repair management is occasionally required in cases of large aneurysms, infectious vasculopathy, and trauma. The transmanubrial osteomuscular sparing approach, commonly used in thoracic surgery area to resect superior sulcus tumors, is a simple and safe procedure providing an excellent view of the operative field. Herein, we present three cases that underwent open repair of the subclavian artery using the transmanubrial osteomuscular sparing approach, and we also highlight the utility of the technique along with the procedural details.</p><p><strong>Case presentation: </strong>Case 1: A 54-year-old man presented with a true aneurysm of the proximal portion of the right subclavian artery. The aneurysm measured 50 × 80 mm and compressed the right lung and trachea. We performed an aneurysm resection and a right subclavian artery reconstruction via the transmanubrial osteomuscular sparing approach under cardiopulmonary bypass support. Case 2: A 72-year-old man who presented with an abscess that formed around the left subclavian artery due to an unremoved guidewire during thoracic endovascular aortic repair for an aortic arch aneurysm in another hospital. After the antibiotics administration, debridement and axillary-axillary bypass were performed, and the guidewire was removed via a transmanubrial osteomuscular sparing approach with a use of cardiopulmonary bypass. Case 3: A 60-year-old man presented with misplacement of an indwelling dialysis catheter inserted for acute renal failure and hyperkalemia. The catheter was placed through the right neck, but had penetrated the right internal jugular vein and was misplaced from the right subclavian artery into the proximal aortic arch. Emergently, we removed the catheter using the transmanubrial osteomuscular sparing approach.</p><p><strong>Conclusions: </strong>The transmanubrial osteomuscular sparing approach to the subclavian artery provides an excellent view and a wide surgical field, even in different pathological situations. This is a simple, safe, and highly useful procedure and could be the standard approach for subclavian artery surgeries.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"3 1","pages":"32"},"PeriodicalIF":0.0,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11533635/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142635187","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}