Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery最新文献

Robotic-assisted thoracic surgery has become increasingly utilized in recent years. Complex lung cancer resection surgery can be performed using a robotic approach. It facilitates 3-dimentional visualization of structures, enhanced manipulation of tissues and precise movements. Combined with other minimally invasive surgical techniques, robotic-assisted thoracic surgery in comparison to open thoracotomy has become increasingly favoured among surgeons for the treatment of lung cancer. Pre-existing data have shown that such minimally invasive approaches are associated with reduced postoperative morbidity, length of hospital stay and quicker post-surgical recovery. Robotic-assisted pulmonary segmental resection can be technically challenging; however, 3-dimensional reconstruction imaging enables detailed preoperative visualization of the tumour and surrounding bronchovascular anatomy. This preoperative tool can therefore facilitate enhanced and accurate anatomical lung resections. Nevertheless, the application of virtual 3-dimensional lung reconstruction within thoracic surgical practice is rarely documented in the pre-existing literature. We present a video atlas series of robotic-assisted segmentectomies guided by 3-dimensional reconstruction imaging. This video tutorial includes a step-by-step guide for performing a right S3 segmentectomy for a patient presenting with a right upper lobe tumour.

Pulmonary sequestration is a rare congenital anomaly, characterized by aberrant lung tissue supplied by an aberrant systemic artery or arteries coursing within the inferior pulmonary ligament. The intralobar variety is the most frequent form. Clinical presentation may include recurrent haemoptysis and infection. Standard treatment involves surgical resection of the affected tissue with maximal preservation of healthy lung. This video tutorial presents the surgical technique for resecting intralobar pulmonary sequestration involving the left lower lobe. Rather than attempting to skeletonize the frequently friable aberrant artery(ies), the lung is mobilized and the inferior pulmonary ligament containing the aberrant artery is isolated and  "thinned out" before being divided en masse; in this way, one may decrease the risk of intraoperative arterial injury and haemorrhage. Subsequent lung resection is performed in standard fashion, in this case a left lower lobectomy. Transarterial embolization has been described both as definitive treatment and as a preoperative intervention to decrease the risk of intraoperative bleeding. In the case of preoperative embolization, one must be wary of the possibility of embolic material interfering with the application of the vascular stapler when dividing the aberrant artery, and fine embolic material should be chosen.

The surgical procedure detailed in this case report focuses on the treatment of a large cardiac hydatid cyst located in the intraventricular septum. The surgical intervention comprised a comprehensive approach involving a median sternotomy and cardiopulmonary bypass. A localized mass below the tricuspid valve at the basal region of the interventricular septum was revealed. The hydatid cyst was punctured, the contents were aspirated and the cyst membrane was removed. The cyst cavity was closed by plicating it with Prolene sutures and eliminating the created space. Intraoperative transoesophageal echocardiography confirmed normal cardiac function. Regular follow-ups, with a three-month course of albendazole, showed no recurrence or issues.

Aortic pseudoaneurysm is a rare but life-threatening complication following aortic surgery. Although surgical repair remains the gold standard for treatment, alternative approaches such as transcatheter strategies are increasingly considered viable options, particularly in patients with high surgical risk due to comorbidities, anatomical challenges or technical constraints. We present the case of a 72-year-old male patient who developed a subaortic pseudoaneurysm during radiological follow-up after a previous Bentall operation. Given the high surgical risk, our multidisciplinary heart team opted for coil embolization via a transapical approach. The objective of this work was to present a step-by-step explanation of the transapical embolization with the coil as a landmark for all surgeons who want to perform it.

Pulmonary sequestration is a rare congenital anomaly, characterized by aberrant lung tissue supplied by an aberrant systemic artery or arteries coursing within the inferior pulmonary ligament. The intralobar variety is the most frequent form. Clinical presentation may include recurrent haemoptysis and infection. Standard treatment involves surgical resection of the affected tissue with maximal preservation of healthy lung. This video tutorial presents the surgical technique for resecting intralobar pulmonary sequestration involving the right lower lobe. Rather than attempting to skeletonize the frequently friable aberrant artery(ies), the lung is mobilized, and the inferior pulmonary ligament containing the aberrant artery is isolated before being divided en masse; in this way, one may decrease the risk of intraoperative arterial injury and haemorrhage. Subsequent lung resection is performed in the standard fashion, in this case, an S10 segmentectomy. Transarterial embolization has been described both as a definitive treatment and as a preoperative intervention to decrease the risk of intraoperative bleeding. In the case of preoperative embolization, one must be wary to avoid embolic material when positioning the vascular stapler to divide the aberrant artery.

A 2-week-old, 2.6-kg neonate without tuberous sclerosis presented with a severe right ventricular outflow tract obstruction secondary to a large mass. Transthoracic echocardiography revealed a maximum right ventricular outflow tract gradient of at least 95 mmHg. Given the level of obstruction, the decision was made to proceed with surgical resection.

The Ross procedure provides young patients with unrepairable aortic valve disease with a living pulmonary autograft that confers significant survival benefit and improved quality of life. However, the procedure is complicated, and surgeons can be reluctant to offer it as a solution, especially in complex re-operative scenarios. We present a young patient with symptomatic, severe aortic insufficiency who had undergone two failed aortic valve procedures for congenital bicuspid aortic valve disease within the prior year. They presented with recurrent congestive heart failure, patient prosthesis mismatch and a severe paravalvular leak. We performed a Ross procedure to restore aortic valve function and quality of life. Despite the increased re-operative complexity, these young patients have the most to benefit from pulmonary autograft reconstruction.

An adolescent with bicuspid aortic valve presented with severe aortic stenosis and underwent a balloon valvuloplasty, that resulted in severe acute aortic insufficiency. Herein we demonstrate an aortic valve repair using an autologous aortic wall patch and aortic root stabilisation.

Performing a posterior basal (S10) segmentectomy through a single port is challenging because of the dorsal location of the S10 segment in the lower lobe. The vessels and bronchi to be resected are located deep and away from the major fissure, which makes exposure from the interlobar fissure difficult. To avoid unnecessary parenchymal splitting and potential misrecognition of segmental structures, we performed a uniportal thoracoscopic S10 segmentectomy via a posterior approach without extensively separating the pulmonary parenchyma from the interlobar fissure. When using this approach, placement of an endostapler directed towards the targeted segmental structures is reasonable, and division of the parenchyma between segments S6 and S10 from the dorsal side of the lower lobe using a staple enables excellent exposure of the segmental pulmonary artery (A10).

Type A aortic dissection is a life-threatening condition that requires immediate surgical intervention. The goal of traditional approaches is to treat the disease promptly, regardless of invasiveness, in order to achieve the quickest surgical outcome. This strategy has been shown to be associated with significant morbidity, extended recovery and postoperative complications. A minimally invasive technique, in particular a mini-sternotomy, even in cases of type A aortic dissection, can be a viable alternative, reducing surgical trauma and postoperative complications. Despite technical challenges, minimally invasive techniques offer benefits, especially for older patients. Beyond the surgical approach, new technologies and devices (like the Ascyrus Medical Dissection Stent) have also emerged, designed to streamline the surgical process while also ensuring effective results. This case highlights the feasibility and safety of minimally invasive techniques in type A aortic dissection in elderly patients, emphasizing the potential of a more conservative yet effective surgical approach.