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

Repair of complete atrioventricular septal defects continues to be a challenge. Several techniques have been described such as the single-patch, the modified single-patch and the two-patch technique. Each has its own pros and cons, and no technique is free from reoperation. Routine augmentation of the left atrioventricular valve during the repair has also been proposed; however, a repeat operation for recurrent left atrioventricular regurgitation continues to be a major concern. In this report, we describe a new strategy for the repair of a complete atrioventricular septal defect that combines the basics of several of the previously described techniques, eliminates some of the anatomical factors behind future left ventricular outflow tract obstruction and may improve competence of the left atrioventricular valve, and has the potential of decreasing the reoperation rate on both the left atrioventricular valve and the left ventricular outflow tract.

Sinus of Valsalva aneurysms are rare cardiac anomalies with life-threatening potential when ruptured. While most arise from the right coronary sinus and rupture into right-sided chambers, left-sided ruptures are exceptionally uncommon and surgically challenging. We report a 57-year-old male with multiple comorbidities and newly diagnosed stage 4 follicular lymphoma who presented with New York Heart Association class IV heart failure. Imaging revealed a large pseudoaneurysm of the left sinus of Valsalva with perforation into the left atrium and ventricle, disruption of the aorto-mitral curtain, and severe mitral regurgitation. A multidisciplinary team recommended surgery prior to chemotherapy. The operation included a mitral valve repair with autologous pericardial patch, reconstruction of the aorto-mitral curtain, aortic valve replacement, and ascending aortic replacement with a Dacron graft. Post-operatively, the patient developed tamponade, bacteraemia and required prolonged intensive care, but ultimately stabilized and proceeded with lymphoma therapy, and is currently doing well. This case highlights the rarity and complexity of left-sided sinus of Valsalva aneurysm rupture involving multiple cardiac structures. Definitive surgical repair remains the gold standard, and a multidisciplinary approach is essential in optimizing outcomes for high-risk patients with significant comorbidities.

Folding plasty is a valuable technique for reducing excessive posterior leaflet height and mitigating the risk of systolic anterior motion. It offers a simpler alternative to the classic quadrangular resection with sliding plasty and has demonstrated comparable long-term durability when applied in appropriate settings. We have adopted this technique widely and employ it frequently in both open and robotic mitral valve repair.

The treatment of pectus excavatum has historically been based on two main surgical techniques: the Ravitch procedure and the minimally invasive Nuss procedure. Both have demonstrated effectiveness over the years and have become well-established options in clinical practice. However, in recent years, a new approach known as the Pectus Up technique has emerged as an innovative and less invasive alternative for the correction of this congenital chest wall deformity. In this video tutorial, we present the case of a young male patient treated using the Pectus Up system, highlighting the surgical steps, clinical outcomes and potential advantages of this novel method compared to traditional techniques.

Interventricular septal aneurysm represents a rare cardiac anomaly traditionally associated with ischaemic heart disease or healed congenital ventricular septal defects. In this report, we present the first documented case of robot-assisted surgical repair of an interventricular septal aneurysm. Our 47-year-old male patient presented with symptomatic heart failure secondary to moderate aortic stenosis and severe aortic regurgitation. During pre-operative evaluation, imaging revealed an incidental membranous interventricular septal aneurysm without an associated shunt. The patient underwent successful robot-assisted transthoracic patch repair of the septal aneurysm concurrent with aortic valve replacement. This case demonstrates the feasibility of robot-assisted repair for complex cardiac anomalies, potentially expanding the horizons of minimally invasive cardiac surgery.

Porcelain aorta, though rare, is often considered a contraindication for open surgery due to the risk of associated neurological complications due to calcium embolization. We present the case of a 70-year-old female with a prior 19mm bioprosthetic aortic valve replacement who, during routine follow-up, was found to have significant aortic valve stenosis, severely reduced leaflet mobility and a mean gradient of 40mmHg. Pre-operative computed tomography angiography revealed a calcified 'porcelain aorta'. Transcatheter aortic valve-in-valve replacement was not possible due to the small 19mm valve and small aortic sinuses, leading to referral for open aortic surgery.

Commissuroplasty is a simple yet highly effective technique to address prolapse involving the mitral commissures, which can otherwise be technically challenging to repair using traditional resection or neochordae. We demonstrate our robotic approach and highlight key technical nuances, indications and expected outcomes relevant to mitral surgeons.

Systolic anterior motion remains a recognized complication of mitral valve repair, for which sliding valvuloplasty was originally developed as a preventive strategy. This technique is used in patients with a broad area of posterior leaflet prolapse and excessive leaflet height. We demonstrate our modification of the classic sliding plasty, including further adaptations to enable its reliable and efficient application via a minimally invasive robotic approach.

Cardiac fibromas are rare benign myocardial tumours, most commonly detected in infants and children. Presentations in adolescents are uncommon but clinically significant due to the associated arrhythmic risk. We report a case of a young female who presented with syncope and was subsequently diagnosed with a left ventricular fibroma on cardiac magnetic resonance imaging (MRI). The tumour was located near the papillary muscles. Surgical excision was performed via a left ventriculotomy, carefully avoiding distortion of the mitral valve. This video tutorial demonstrates the surgical approach to an left ventricular fibroma, a definitive treatment aimed at mitigating the life-threatening arrhythmogenic risks associated with these tumours, while preserving the mitral valve.

Uniportal video assisted thoracoscopic surgery is a widely adopted method for lung resections. One of the main advantages quoted in favour of this minimally invasive technique is the violation of only a single intercostal space and hence less post-operative pain. Fissureless lobectomy decreases the chances of post-operative air leak, especially when fissures are poorly formed. Tumour-abutting parietal pleura can be managed with uniportal video assisted thoracoscopic surgery, with resection of the cuff of the parietal pleura around the tumour, to achieve a negative margin. This video tutorial demonstrates a fissureless right upper lobectomy, in the presence of significant adhesions and pleural infiltration.