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Intraoperative intra-aortic balloon pump insertion: step by step. 术中插入主动脉内球囊泵:逐步进行。
Carla Gotsens-Asenjo, Constanza Fernández-De Vinzenzi, Elena Roselló-Díez, César Piedra, Marta Molina, Juan Francisco Tabilo, Manel Tauron, Sandra Casellas, Ángela Irabién, Laura Corominas, Antonino Ginel, Jose Montiel

A 76-year-old patient with non-ST elevation myocardial infarction was admitted to our hospital. Coronary angiography revealed significant left main and two-vessel coronary artery disease. Preoperative testing indicated severe left ventricular dysfunction. The patient was scheduled for urgent off-pump coronary artery bypass grafting. Due to the low ejection fraction, an intra-aortic balloon pump was inserted in the operating theatre before sternotomy, to enhance the patient's haemodynamic stability during surgery. A 6 Fr introducer was inserted into the femoral artery under echocardiographic guidance. Using a 150-cm guidewire, the intra-aortic balloon catheter was advanced through the introducer to the descending thoracic aorta. The catheter's tip position, just distal to the origin of the left subclavian artery, was confirmed via transoesophageal echocardiography. The external part of the catheter was secured to the skin and connected to the balloon console. Therapy was initiated, and the inflation/deflation parameters were optimized. A double off-pump coronary artery bypass was performed via median sternotomy. The patient remained haemodynamically stable throughout the surgery, aided by the intra-aortic balloon pump, and careful volume and vasoactive management. The patient was extubated promptly, and the device was removed on the second postoperative day without complications.

我院收治了一名 76 岁的非 ST 段抬高型心肌梗死患者。冠状动脉造影显示患者左主干和双腔冠状动脉病变严重。术前检查显示左心室功能严重障碍。患者被紧急安排接受体外循环冠状动脉旁路移植术。由于患者射血分数较低,在手术室进行胸骨切开术前插入了主动脉内球囊泵,以增强患者术中血流动力学的稳定性。在超声心动图引导下,将 6 Fr 导管插入股动脉。使用 150 厘米长的导丝,通过导引器将主动脉内球囊导管推进到降胸主动脉。通过经食道超声心动图确认导管顶端的位置,即左锁骨下动脉起源的远端。将导管外部固定在皮肤上,并连接到球囊控制台。治疗开始,充气/放气参数得到优化。经胸骨正中切口进行了双腔外冠状动脉搭桥术。在主动脉内球囊泵的帮助下,患者在整个手术过程中保持了血流动力学稳定,并进行了仔细的容量和血管活性管理。患者被及时拔管,术后第二天就取出了装置,没有出现并发症。
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引用次数: 0
Removal of an intra-aortic thrombus. 清除主动脉内血栓。
Benedikt Mayr, Ulf Herold, Christian Noebauer, Markus Krane

A 70-year-old female patient was referred from a peripheral hospital to our department with an incidental finding of an intra-aortic mass. Chest access was gained by a median sternotomy, and visualization of the intra-aortic mass was achieved using epiaortic ultrasound. After systemic heparinization, arterial cannulation was performed in the distal aortic arch. The right atrium was cannulated; the patient was cooled to a target temperature of 22°C. With the patient under hypothermic circulatory arrest, a transverse aortotomy was performed 3 cm proximal to the brachiocephalic trunk, and prompt removal of the tumour was achieved. After establishing antegrade cerebral perfusion, proper visualization of the aortic wall was achieved, and no pathological alterations of the aortic wall were encountered. After closure of the aorta and complete rewarming, the patient was easily weaned from cardiopulmonary bypass. Chest closure was performed in the usual fashion. The postoperative course was uneventful, and the histopathological diagnosis was thrombus formation. Consequently, the patient was placed on lifelong phenprocoumon therapy.

一名 70 岁的女性患者因意外发现主动脉内肿块而从外围医院转诊至我科。通过胸骨正中切口进入胸腔,利用主动脉外超声检查发现了主动脉内肿块。全身肝素化后,在主动脉弓远端进行了动脉插管。对右心房进行了插管;将患者的体温降至目标温度 22°C。在患者低体温循环停止的情况下,在肱动脉主干近端3厘米处进行了横向主动脉切开术,并迅速切除了肿瘤。在建立前向脑灌注后,主动脉壁得到了正确的观察,主动脉壁没有发生病理改变。在关闭主动脉和完全复温后,病人很容易就从心肺旁路手术中脱离出来。胸腔闭合按常规方式进行。术后恢复顺利,组织病理学诊断为血栓形成。因此,患者接受了终身苯丙酮治疗。
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引用次数: 0
Coronary orifice rotation for symmetric bicuspidization of a paediatric unicuspid aortic valve. 对小儿单尖主动脉瓣进行对称双尖瓣化的冠状动脉口旋转。
Shunsuke Matsushima, Sara Kubo, Akihiko Higashida, Yoshihiro Oshima, Hironori Matsuhisa

Bicuspidization is a valid option for unicuspid aortic valve repair, in which creating symmetrical commissural orientation is essential for improved outcomes. However, the right coronary orifice often interferes with symmetrical attachment of the neocommissure. In a paediatric patient without aortic root dilation, we rotated the right coronary orifice clockwise by cutting out a triangular piece of the non-coronary sinus wall and augmenting it between the left and right coronary sinuses. A neocommissure with patching was sewn to the left side of the right coronary orifice, and the symmetrical bicuspidized configuration was adjusted in a standardized fashion according to the cusp effective height measurement.

双尖瓣成形术是单尖主动脉瓣修复术的一种有效选择,在这种手术中,形成对称的合瓣方向对改善预后至关重要。然而,右冠状动脉口往往会影响新合瓣的对称附着。在一名没有主动脉根部扩张的儿科患者身上,我们顺时针旋转了右冠状动脉口,方法是在非冠状动脉窦壁切出一块三角形区域,并在左右冠状动脉窦之间将其增大。在右冠状动脉口左侧缝合了一个带补片的新腔隙,并根据尖部有效高度测量结果,以标准化方式调整了对称双尖结构。
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引用次数: 0
Robotic right lower lobectomy following neoadjuvant nivolumab combined with platinum-based chemotherapy. 新辅助nivolumab联合铂类化疗后的机器人右下叶切除术。
Hitoshi Igai, Akinobu Ida, Kazuki Numajiri, Kazuhito Nii, Mitsuhiro Kamiyoshihara

Despite the prognostic benefits for patients, surgical resection following nivolumab combined with platinum-based chemotherapy is technically challenging due to the inflammation or fibrosis in the thoracic cavity, particularly around the hilar structures. Performing this complex surgical resection using a minimally invasive approach requires the advantages offered by robotic surgery, including a high-definition 3-dimensional surgical view, precise, tremor-free motion and articulated forceps, which facilitate safe resection following neoadjuvant immunochemotherapy. In this video tutorial, we demonstrate a robotic right lower lobectomy performed after neoadjuvant nivolumab combined with platinum-based chemotherapy, highlighting the specific techniques and nuances involved. The console time was 138 minutes, with minimal blood loss. The patient's postoperative course was uneventful; the chest tube was removed on postoperative day (POD) 1, and the patient was discharged on POD 2. The final pathological report revealed pTisN0M0, stage 0, squamous cell carcinoma.

尽管nivolumab联合铂类化疗对患者的预后有好处,但由于胸腔尤其是肺门结构周围的炎症或纤维化,手术切除在技术上具有挑战性。使用微创方法进行这种复杂的手术切除需要机器人手术提供的优势,包括高清三维手术视野、精确、无震颤的运动和铰接式镊子,这有助于新辅助免疫化疗后的安全切除。在本视频教程中,我们演示了在新辅助尼夫单抗联合铂类化疗后进行的机器人右下肺叶切除术,重点介绍了其中涉及的具体技术和细微差别。手术时间为138分钟,失血量极少。患者术后恢复顺利;术后第 1 天(POD)拔除胸管,第 2 天出院。最终病理报告显示为 pTisN0M0,0 期,鳞状细胞癌。
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引用次数: 0
Homograft implant for prosthetic aortic endocarditis with paravalvular abscess in a patient with persistent left superior vena cava. 在一名左上腔静脉持续存在的患者体内植入同种异体移植物,以治疗伴有腔旁脓肿的人工主动脉瓣膜心内膜炎。
Martina Rizzo, Roberto Lorusso, Giuseppe Davoli, Daniele Marianello, Gianfranco Montesi, Sandro Gelsomino

We present a case report detailing the surgical intervention in a patient with prosthetic aortic valve endocarditis complicated by a paravalvular abscess extending to the mitral-aortic fibrosa. Urgent surgery was required due to severe detachment of the prosthetic aortic valve, marking her third cardiac surgical procedure. Notably, preoperative imaging revealed the presence of a persistent left superior vena cava, a rare vascular anomaly requiring specialized cannulation techniques. The surgical approach involved removal of the infected tissue and prosthetic valve, followed by replacement with a cryopreserved aortic homograft, chosen for its anatomical adaptability.

我们在本病例报告中详细介绍了一名人工主动脉瓣心内膜炎患者的手术治疗情况,该患者并发腔旁脓肿,并延伸至二尖瓣-主动脉纤维。由于人工主动脉瓣严重脱落,患者需要进行紧急手术,这也是她的第三次心脏手术。值得注意的是,术前造影显示存在持续性左上腔静脉,这是一种罕见的血管异常,需要专门的插管技术。手术方法包括切除受感染的组织和人工瓣膜,然后用低温保存的主动脉同种异体移植物进行置换。
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引用次数: 0
Robotic-assisted carinal reconstruction using cross-table ventilation. 机器人辅助下的椎动脉重建,采用跨台通气。
Aishah Z Mughal, Ahmed El-Zeki, Deepak Ravindran, Ramesh Giri, Ahmed M Habib

Carinal reconstruction remains a technically challenging procedure for thoracic surgeons due to the complexity of airway resection and management. This is typically performed in the setting of tumour resection affecting the carina and distal trachea. Airway management of patients undergoing surgical resection of tumours involving the carina is highly challenging. This is due to an open, shared airway and the need for single-lung ventilation to facilitate surgery. Common modalities used for intraoperative ventilation include cross-table ventilation, veno-venous extra-corporeal membrane oxygenation and cardiopulmonary bypass. Cardiopulmonary bypass is usually avoided due to the requirement of full heparinization, which increases the demands of a technically challenging procedure, in addition to its contraindication in oncological resections. Extra-corporeal membrane oxygenation is not readily available in most thoracic units. This leaves cross-table ventilation, which is commonly used for open thoracotomy and sternotomy cases, but has never been reported for minimally invasive procedures.  Specifically, to the best of our knowledge, cross-table ventilation has never been used for minimally invasive robotic carinal reconstruction. We present a step-by-step video tutorial in performing surgical resection of a mediastinal tumour that was found invading the carina. This was performed in a young patient who underwent carinal reconstruction using a novel technique combining cross-table ventilation and robotic-assisted surgery.

由于气道切除和管理的复杂性,心管重建对于胸外科医生来说仍然是一项具有技术挑战性的手术。这种手术通常是在肿瘤切除影响到心尖和气管远端时进行的。对接受涉及心尖肿瘤手术切除的患者进行气道管理极具挑战性。这是因为气道是开放的、共用的,需要单肺通气以方便手术。术中通气的常用模式包括跨台通气、静脉体外膜肺氧合和心肺旁路。心肺旁路通常是避免使用的,因为需要完全肝素化,这增加了手术技术难度的要求,此外心肺旁路也是肿瘤切除术的禁忌症。体外膜肺氧合技术在大多数胸外科都无法使用。因此,跨台通气常用于开胸手术和胸骨切开术病例,但在微创手术中却从未报道过。 具体来说,据我们所知,跨台通气从未用于微创机器人椎体重建。我们通过视频教程逐步介绍如何对侵犯心窝的纵隔肿瘤进行手术切除。该手术是在一名年轻患者身上进行的,该患者使用了一种结合了跨台通气和机器人辅助手术的新技术进行了心窝重建。
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引用次数: 0
Technique for surgical replacement of the ascending aorta with concomitant aortic valve and hemiarch replacement: a procedural guide. 手术置换升主动脉并同时置换主动脉瓣和半主动脉瓣的技术:手术指南。
Djamila Abjigitova, Samuel A Max, Amir H Sadeghi, Jelena Sjatskig, Edris A F Mahtab

In this video tutorial case report, we show how to perform an open surgical correction of an ascending aortic aneurysm in a 74-year-old patient requiring concomitant aortic valve and hemiarch replacements, presenting with symptomatic stenosis of the aortic valve and moderate dilatation of the ascending aorta.

在本视频教程病例报告中,我们展示了如何为一名需要同时进行主动脉瓣和半主动脉瓣置换术的 74 岁患者实施升主动脉瘤开放手术矫治,患者表现为主动脉瓣无症状狭窄和升主动脉中度扩张。
{"title":"Technique for surgical replacement of the ascending aorta with concomitant aortic valve and hemiarch replacement: a procedural guide.","authors":"Djamila Abjigitova, Samuel A Max, Amir H Sadeghi, Jelena Sjatskig, Edris A F Mahtab","doi":"10.1510/mmcts.2024.045","DOIUrl":"10.1510/mmcts.2024.045","url":null,"abstract":"<p><p>In this video tutorial case report, we show how to perform an open surgical correction of an ascending aortic aneurysm in a 74-year-old patient requiring concomitant aortic valve and hemiarch replacements, presenting with symptomatic stenosis of the aortic valve and moderate dilatation of the ascending aorta.</p>","PeriodicalId":53474,"journal":{"name":"Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery","volume":"2024 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Pulmonary endarterectomy for subacute on top of chronic thromboembolic disease. 针对慢性血栓栓塞性疾病的亚急性肺动脉内膜切除术。
Nicholas A Oh, Mina Estafanos, Gustavo A Heresi, Michael Z Y Tong, Haytham Elgharably

Our objective is to describe our approach for a case of subacute on top of chronic thromboembolic disease and highlight operative learning points. Prior to incision, appropriate monitoring equipment, including an arterial line, Swan-Ganz catheter, brain saturation monitor and bispectral index monitor, is placed for proper management of haemodynamics. Sternotomy was performed, and the ascending aorta was cannulated, followed by bicaval cannulation for venous drainage. The patient was cooled to deep hypothermia. Once target temperature was achieved, circulatory arrest commenced. The left pulmonary artery was opened and the subacute component was removed without disrupting the plane of the chronic thromboembolic disease. An endarterectomy plane was then created proximally and dissected into the distal segmental/subsegmental branches. Once the endarterectomy was completed, the left pulmonary artery was closed. Circulation was resumed for end-organ perfusion. Once the right pulmonary artery was ready for dissection, circulatory arrest was restarted. Similarly to the left side, the subacute component was removed without disrupting the plane of the chronic thromboembolic disease. An endarterectomy plane was then created proximally and dissected into the distal segmental/subsegmental branches. Circulation was then resumed. Once rewarmed to 35.5°C, the patient was decannulated and the sternum was closed.

我们的目的是描述我们在处理一例慢性血栓栓塞性疾病的亚急性病例时所采用的方法,并强调手术学习要点。切开前,放置适当的监测设备,包括动脉管路、Swan-Ganz 导管、脑饱和度监测仪和双频谱指数监测仪,以妥善管理血流动力学。进行了消毒手术,并为升主动脉插管,然后为静脉引流进行了双腔插管。患者被降温至深度低体温。达到目标体温后,开始停止循环。打开左肺动脉,在不破坏慢性血栓栓塞病平面的情况下切除亚急性成分。然后在近端创建一个内膜切除平面,并解剖远端节段/亚节段分支。动脉内膜切除术完成后,关闭左肺动脉。恢复循环以进行内脏灌注。右肺动脉准备好解剖后,循环停止重新开始。与左侧类似,在不破坏慢性血栓栓塞病平面的情况下切除了亚急性成分。然后在近端创建内膜切除平面,并解剖远端节段/亚节段分支。然后恢复血液循环。待体温恢复到35.5°C后,为患者拔管并缝合胸骨。
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引用次数: 0
Cardiac transplantation after HeartMate3. 心脏移植后的 HeartMate3。
Maksym Rzhanyi, Gustavo Woll, Elena Sandoval Martínez, Maria Ascaso, Anton Pechenenko, Eduard Quintana

Heart transplant remains the gold standard treatment for patients with end-stage heart failure. However, given the limited availability of donor hearts, alternative approaches and strategies are required. The development of a variety of mechanical circulation support options, including left ventricular assist devices and total artificial heart, have allowed improved quality of life and eventually have facilitated a bridge to heart transplantation strategies for certain patients. However, the presence of an intracorporeal left ventricular assist device poses a technical challenge at the time of heart transplantation. In this video tutorial, we describe the surgical strategy and removal technique for a patient who had received a HeartMate 3 (Abbott, North Chicago, IL, USA) using a classic implantation technique via sternotomy, who underwent concomitant orthotopic heart transplant.

心脏移植仍然是治疗终末期心力衰竭患者的金标准。然而,由于供体心脏有限,因此需要采取其他方法和策略。包括左心室辅助装置和全人工心脏在内的各种机械循环支持方案的发展改善了患者的生活质量,并最终为某些患者提供了通往心脏移植的桥梁。然而,体外左心室辅助装置的存在给心脏移植手术带来了技术挑战。在本视频教程中,我们将介绍一位通过胸骨切开术采用经典植入技术接受了 HeartMate 3(雅培,美国伊利诺斯州北芝加哥)并同时进行了正位心脏移植的患者的手术策略和移除技术。
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引用次数: 0
How to treat systolic anterior motion of the anterior mitral valve leaflet during endoscopic minimally invasive surgery. 如何在内窥镜微创手术中治疗二尖瓣前叶收缩期前移。
Gianpiero Buttiglione, Can Gollmann-Tepeköylü, Lukas Stastny, Leo Pölzl, Clemens Engler, Daniel Höfer, Michael Grimm, Nikolaos Bonaros

Systolic anterior motion is characterized by the displacement of the anterior mitral leaflet towards the left ventricle outflow tract. Iatrogenic systolic anterior motion occurs after mitral valve repair as a result of mitral annuloplasty. Possible causes include excess height of a redundant posterior mitral leaflet and/or the use of an undersized ring. The condition is usually diagnosed after weaning from cardiopulmonary bypass by transoesophageal echocardiography. Apart from conservative measures, the treatment of systolic anterior motion may require the restoration of cardiopulmonary bypass and further surgical valve repair. Strategies for systolic anterior motion correction include an edge-to-edge repair or the use of a larger annuloplasty ring. In this tutorial, we present two ways of reducing posterior leaflet height as a simple option to move the leaflet coaptation more posteriorly.

收缩期前移的特点是二尖瓣前叶向左心室流出道移位。二尖瓣环成形术导致二尖瓣修复后出现先天性收缩期前移。可能的原因包括多余的二尖瓣后叶高度过高和/或使用了过小的环。这种情况通常在心肺旁路术后通过经食道超声心动图检查确诊。除保守治疗外,收缩期前移的治疗可能需要恢复心肺旁路和进一步的瓣膜修复手术。收缩期前移矫正策略包括边缘到边缘修复或使用较大的瓣环成形术。在本教程中,我们将介绍两种降低瓣叶后部高度的方法,这是一种将瓣叶瓣合更向后移动的简单选择。
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引用次数: 0
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Multimedia manual of cardiothoracic surgery : MMCTS / European Association for Cardio-Thoracic Surgery
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