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

Coronary artery aneurysms are exceedingly rare and are most often discovered incidentally. Rupture of such aneurysms is even more uncommon. In this case report, we describe an 82-year-old patient who presented with sudden-onset chest pain and was diagnosed with a fissurating aneurysm of the right coronary artery. The aneurysm was associated with a congenital abnormality of the coronary venous sinus return. The patient underwent emergency surgery. Given her advanced age, the surgical strategy focused solely on addressing the imminent risk of rupture. A 10-mm Gore-Tex graft was implanted because direct suture repair or vein grafting was deemed unsuitable. The patient recovered well postoperatively and was given dual antiplatelet therapy. At nine months of follow-up, she remains asymptomatic, with no recurrence of chest pain.

We present a 12-year-old patient with periosteal osteosarcoma and bilateral pulmonary arterial tumour thrombi. The utility of a three-dimensional model to assess the feasibility of segmental resection is demonstrated.

This video tutorial demonstrates the minimally invasive closure of a left atrial appendage (LAA) using the WATCHMAN device in a patient with a prior history of heart surgery. Given the failure of anticoagulation therapy, the decision was made to perform surgical closure of the LAA. Due to the patient's previous heart surgery, our standard LAA closure device, the AtriClip, could not be used. As an alternative, the WATCHMAN device was chosen. This device is FDA- and EMA-approved and is designed for implantation via a transcatheter-based approach.

We present a case report detailing the surgical management of a cardiac paraganglioma in a 57-year-old man with a succinate dehydrogenase subunit B mutation and family history of paragangliomas. These neuroendocrine tumours arise from chromaffin cells and account for less than 3% of cardiac tumours. Succinate dehydrogenase subunit B mutations are associated with aggressive disease patterns and require a multidisciplinary approach for optimal management. The patient had multifocal disease involving the neck, abdomen and heart, yet was asymptomatic aside from a palpable neck mass. Positron emission tomography with fluorodeoxyglucose, echocardiography and coronary angiography identified a mass within the right atrial wall and concurrent significant narrowing of the left anterior descending coronary artery. The video tutorial demonstrates excision of the cardiac paraganglioma via median sternotomy, establishment of cardiopulmonary bypass, and right atrial exploration. No tumour was visualized within the chamber, and further inspection revealed a firm lesion in the right atrioventricular groove, infiltrating the myocardium and encasing the right coronary artery. The artery was transected and bypassed using a saphenous vein graft, allowing for complete tumour resection. A graft to the left anterior descending artery was also performed. Postoperative recovery was uncomplicated, and histopathology confirmed a cardiac paraganglioma with clear margins.

The rising number of people with heart failure is leading to a corresponding increase in heart failure-related deaths. End-of-life care for these patients involves supplementing standard treatments with therapies aimed at managing symptoms that don't respond to guideline-directed medical care. The INCOR, a lightweight (200 g), implantable, magnetically levitated axial flow pump (providing non-pulsatile flow), is designed for long-term left ventricular support. This video tutorial details the initial single-centre clinical experience with this device.

An anterior mediastinal mass can comprise a wide variety of benign and malignant tumours that can present with diverse clinical symptoms. Diagnosis often requires multiple imaging modalities along with laboratory tests and, in specific cases, tissue biopsies. Upfront tumour resection is often preferred in cases with a substantial suspicion of malignancy whenever complete resection is deemed possible. We present a relatively common case of a substantial anterior mediastinal mass with a high suspicion of thymoma in a 73-year-old male patient without myasthenia gravis. Based on his computed tomography scan, a 3-dimensional model was built. Upfront resection without neo-adjuvant therapy was deemed feasible and therefore preferable. A DaVinci robot-assisted 3-port resection of the tumour was performed from the patient's left side. The intra- and postoperative courses were uneventful, after which the patient was discharged home on postoperative day 3.

We present a case of a young male with severe aortic regurgitation and an aortic root aneurysm who underwent a valve-sparing aortic root replacement using a remodelling technique with annuloplasty, and bicuspid aortic valve repair.

Robotic-assisted thoracic surgery is increasingly recognized for its utility in complex pulmonary resections, offering enhanced dexterity, superior 3-dimensional visualization and precise, 'tremor-free' tissue manipulation. Compared to open thoracotomy, minimally invasive robotic techniques are associated with reduced perioperative morbidity, shorter hospital stays and faster recovery. Sublobar lung resections, however, remain technically demanding, especially in the deep anatomical segments such as S8. Three-dimensional reconstructive imaging provides detailed preoperative visualization of the pulmonary anatomy, allowing for precise surgical planning and identification of individual bronchovascular structures. Despite its advantages, the integration of virtual 3-dimensional imaging into routine thoracic practice remains limited and under-reported in the literature. This video tutorial contributes to a growing video atlas series on robotic segmentectomy guided by high-resolution three-dimensional reconstruction. We demonstrate a robotic-assisted left S8 segmentectomy for a deep pulmonary metastasis, where three-dimensional reconstruction enabled identification of an alternative, 'parenchyma-sparing' approach via the inferior pulmonary vein. This video tutorial provides a step-by-step guide, from port placement to segmental dissection and resection, illustrating how advanced imaging technologies can enhance anatomical precision and optimize outcomes in robotic segmental lung surgery.

We present an enhanced percutaneous decannulation technique for a patient undergoing veno-arterial extracorporeal membrane oxygenation. This innovative approach uses two distinct percutaneous vascular devices, offering a more reliable and more effective method for decannulation.

Surgical isolation of left atrial posterior wall (box lesion) with left atrial appendage closure are good options for treating patients with atrial fibrillation concomitant with another cardiac surgical procedure in case we prefer not to open the left atrium. We describe a full box ablation, left atrial appendage closure and aortic valve replacement through a J-shaped ministernotomy through the fourth intercostal space. The box lesion ablation is performed using the Isolator Synergy and Bipolar RF Ablation Clamp with the jaws placed in the oblique and transverse sinuses from the right side. The left appendage is excluded and electrically isolated with the AtriClip Flex-V; the aortic valve is replaced by a sutureless Perceval bioprosthesis. This technique allows us to perform a complete box lesion and left atrial appendage  closure easily for patients with paroxysmal or persistent atrial fibrillation in which we do not open the left atrium, such as those with aortic valve surgery and/or coronary artery bypass grafting.