Pub Date : 2024-12-01DOI: 10.1016/j.atssr.2024.05.015
Jonathan B. Livezey MD , Caitlin E. Jones Sayyid MD , Daniel L. Miller MD
Traumatic tracheobronchial tree injuries are rarely survivable. We present the case of a 31-year-old male patient who had a delayed discovery of a complete right mainstem bronchus avulsion following a motor vehicle collision. Despite initial respiratory stability, the patient rapidly deteriorated on hospital day 4. Flexible bronchoscopy was performed and demonstrated a right mainstem bronchus avulsion with endobronchial mediastinal adipose tissue partially obstructing and stabilizing the transected airway. The patient successfully underwent a right posterolateral thoracotomy with primary anastomosis of the right mainstem bronchus. High clinical suspicion for tracheobronchial injuries is required after high-speed acceleration-deceleration mechanisms resulting in blunt chest trauma.
{"title":"Surgical Management of a Traumatic Mainstem Bronchus Avulsion","authors":"Jonathan B. Livezey MD , Caitlin E. Jones Sayyid MD , Daniel L. Miller MD","doi":"10.1016/j.atssr.2024.05.015","DOIUrl":"10.1016/j.atssr.2024.05.015","url":null,"abstract":"<div><div>Traumatic tracheobronchial tree injuries are rarely survivable. We present the case of a 31-year-old male patient who had a delayed discovery of a complete right mainstem bronchus avulsion following a motor vehicle collision. Despite initial respiratory stability, the patient rapidly deteriorated on hospital day 4. Flexible bronchoscopy was performed and demonstrated a right mainstem bronchus avulsion with endobronchial mediastinal adipose tissue partially obstructing and stabilizing the transected airway. The patient successfully underwent a right posterolateral thoracotomy with primary anastomosis of the right mainstem bronchus. High clinical suspicion for tracheobronchial injuries is required after high-speed acceleration-deceleration mechanisms resulting in blunt chest trauma.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"2 4","pages":"Pages 652-654"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141403256","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}
Sternal chondrosarcoma is a rare malignant condition. Although surgical resection is crucial, the reconstruction of sternal defects is challenging. A 64-year-old male patient with a history of 2 separate sternal tumor resections received a diagnosis of sternal chondrosarcoma recurrence. Because the tumor caused bone destruction and invasion into the sternum, the sternum and tumor were resected. Sternal reconstruction with autologous ribs was performed. Although the tumor was diagnosed as a recurrent chondrosarcoma, the patient had a long disease-free survival postoperatively. Local control is important in chondrosarcomas, and autogenous rib grafts may be an option for patients with sternal defects.
{"title":"Autologous Rib Grafts for Sternal Reconstruction After Excision of a Chondrosarcoma","authors":"Ryusuke Sumiya MD , Mariko Fukui MD , Yukio Watanabe MD , Takeshi Matsunaga MD , Aritoshi Hattori MD , Tsuyoshi Saito MD , Kazuya Takamochi MD , Kenji Suzuki MD","doi":"10.1016/j.atssr.2024.03.005","DOIUrl":"10.1016/j.atssr.2024.03.005","url":null,"abstract":"<div><div>Sternal chondrosarcoma is a rare malignant condition. Although surgical resection is crucial, the reconstruction of sternal defects is challenging. A 64-year-old male patient with a history of 2 separate sternal tumor resections received a diagnosis of sternal chondrosarcoma recurrence. Because the tumor caused bone destruction and invasion into the sternum, the sternum and tumor were resected. Sternal reconstruction with autologous ribs was performed. Although the tumor was diagnosed as a recurrent chondrosarcoma, the patient had a long disease-free survival postoperatively. Local control is important in chondrosarcomas, and autogenous rib grafts may be an option for patients with sternal defects.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"2 4","pages":"Pages 688-691"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959656","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 : 2024-12-01DOI: 10.1016/j.atssr.2024.05.025
Basilio Angulo-Lara MD , Manuel Jiménez-Mena MD , Luisa Salido-Tahoces MD , Javier Ortega-Marcos MD
We report a case of a woman who underwent mitral ring and tricuspid annuloplasty. Two months later, she presented with acute heart failure secondary to severe aortic regurgitation, which was a complication of the cardiac surgery. Given the high surgical risk of reoperation in this the patient, she underwent transcatheter aortic valve implantation, with a good result. Aortic regurgitation is a rare and severe complication after valve repair surgery. Our case showed that off-label transcatheter aortic valve implantation in a high-risk patient after iatrogenic aortic regurgitation is safe and feasible.
{"title":"Iatrogenic Aortic Regurgitation After Tricuspid Annuloplasty Treated by Transcatheter Valve Repair","authors":"Basilio Angulo-Lara MD , Manuel Jiménez-Mena MD , Luisa Salido-Tahoces MD , Javier Ortega-Marcos MD","doi":"10.1016/j.atssr.2024.05.025","DOIUrl":"10.1016/j.atssr.2024.05.025","url":null,"abstract":"<div><div>We report a case of a woman who underwent mitral ring and tricuspid annuloplasty. Two months later, she presented with acute heart failure secondary to severe aortic regurgitation, which was a complication of the cardiac surgery. Given the high surgical risk of reoperation in this the patient, she underwent transcatheter aortic valve implantation, with a good result. Aortic regurgitation is a rare and severe complication after valve repair surgery. Our case showed that off-label transcatheter aortic valve implantation in a high-risk patient after iatrogenic aortic regurgitation is safe and feasible.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"2 4","pages":"Pages 791-794"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959674","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 : 2024-12-01DOI: 10.1016/j.atssr.2024.04.034
Darshak S. Thosani MD , Brian M. Till MD , Luke T. Meredith MD , Andrew Kalra BS , Julie A. Barta MD , Olugbenga T. Okusanya MD , Nathaniel R. Evans MD , Tyler R. Grenda MD, MS
Background
Medicaid expansion began in 2014 after passage of the Affordable Care Act; however, the impact and durability of the effects on lung cancer treatment utilization are poorly defined. We aimed to determine whether there is a persistent difference in utilization of lung resection, lung biopsy, and nonoperative treatment of lung cancer in states participating in Medicaid expansion compared with states that are not.
Methods
A retrospective cohort study was completed analyzing the difference in utilization between Medicaid expansion states and non-expansion states in 2012-2013, 2016-2017, and 2019. Patients diagnosed with and treated for lung cancer in the states of North Carolina and Florida (non-expansion states) and Maryland and New Jersey (expansion states) were included. A difference-in-difference (DID) analysis was used.
Results
In the immediate postexpansion period (2016-2017), DID analysis revealed increased utilization in expansion states with an adjusted DID of 0.50 lung resections/100,000 persons (P = .002) and an adjusted DID of 0.76 lung biopsies/100,000 persons (P = .001). A persistent increase in utilization was found in the delayed postexpansion period (2019), with an adjusted DID of 0.51 lung resections/100,000 persons (P = .008) and an adjusted DID of 0.84 lung biopsies/100,000 persons (P = .021). No significant difference between groups was observed in the utilization of stereotactic body radiation therapy or chemotherapy.
Conclusions
In our cohort, Medicaid expansion was associated with increased utilization of procedural care for the management of lung cancer, including percutaneous biopsies and surgical resection.
{"title":"Impact and Durability of the Affordable Care Act Medicaid Expansion on Lung Cancer Treatment","authors":"Darshak S. Thosani MD , Brian M. Till MD , Luke T. Meredith MD , Andrew Kalra BS , Julie A. Barta MD , Olugbenga T. Okusanya MD , Nathaniel R. Evans MD , Tyler R. Grenda MD, MS","doi":"10.1016/j.atssr.2024.04.034","DOIUrl":"10.1016/j.atssr.2024.04.034","url":null,"abstract":"<div><h3>Background</h3><div>Medicaid expansion began in 2014 after passage of the Affordable Care Act; however, the impact and durability of the effects on lung cancer treatment utilization are poorly defined. We aimed to determine whether there is a persistent difference in utilization of lung resection, lung biopsy, and nonoperative treatment of lung cancer in states participating in Medicaid expansion compared with states that are not.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was completed analyzing the difference in utilization between Medicaid expansion states and non-expansion states in 2012-2013, 2016-2017, and 2019. Patients diagnosed with and treated for lung cancer in the states of North Carolina and Florida (non-expansion states) and Maryland and New Jersey (expansion states) were included. A difference-in-difference (DID) analysis was used.</div></div><div><h3>Results</h3><div>In the immediate postexpansion period (2016-2017), DID analysis revealed increased utilization in expansion states with an adjusted DID of 0.50 lung resections/100,000 persons (<em>P</em> = .002) and an adjusted DID of 0.76 lung biopsies/100,000 persons (<em>P</em> = .001). A persistent increase in utilization was found in the delayed postexpansion period (2019), with an adjusted DID of 0.51 lung resections/100,000 persons (<em>P</em> = .008) and an adjusted DID of 0.84 lung biopsies/100,000 persons (<em>P</em> = .021). No significant difference between groups was observed in the utilization of stereotactic body radiation therapy or chemotherapy.</div></div><div><h3>Conclusions</h3><div>In our cohort, Medicaid expansion was associated with increased utilization of procedural care for the management of lung cancer, including percutaneous biopsies and surgical resection.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"2 4","pages":"Pages 895-900"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708614/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959676","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 : 2024-12-01DOI: 10.1016/j.atssr.2024.06.004
Kanhua Yin MD, MPH , Katelyn Monaghan BS , Bo Yang MD, PhD
The Y-incision aortic annular enlargement (AAE) has been established as a safe and effective technique for upsizing the aortic annulus by 3 to 4 valve sizes. However, concerns have been raised regarding its technical complexity during reoperations, particularly given the extensive enlargement of the aortic annulus and root. We present a case of reoperative aortic valve replacement after previous Y-incision AAE for prosthetic valve endocarditis and aortic root abscess. Our case highlights the simplicity and effectiveness of using a rectangular patch for root reconstruction and implanting the “roof” technique for aortotomy closure in reoperations after Y-incision AAE.
{"title":"Prosthetic Valve Endocarditis After Y-Incision Aortic Annular Enlargement: A Simple Solution","authors":"Kanhua Yin MD, MPH , Katelyn Monaghan BS , Bo Yang MD, PhD","doi":"10.1016/j.atssr.2024.06.004","DOIUrl":"10.1016/j.atssr.2024.06.004","url":null,"abstract":"<div><div>The Y-incision aortic annular enlargement (AAE) has been established as a safe and effective technique for upsizing the aortic annulus by 3 to 4 valve sizes. However, concerns have been raised regarding its technical complexity during reoperations, particularly given the extensive enlargement of the aortic annulus and root. We present a case of reoperative aortic valve replacement after previous Y-incision AAE for prosthetic valve endocarditis and aortic root abscess. Our case highlights the simplicity and effectiveness of using a rectangular patch for root reconstruction and implanting the “roof” technique for aortotomy closure in reoperations after Y-incision AAE.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"2 4","pages":"Pages 732-734"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959705","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 44-year-old man with a history of facioscapulohumeral muscular dystrophy and pectus excavatum presented with multiyear history of progressive, severe respiratory dysfunction, pain, recurrent respiratory infection, and chest wall deformity. With bioprosthetic engineers, the surgical team customized a 3-dimensional printed model of a sternal implant interacting with the patient’s anatomy. After approval from the Food and Drug Administration, the customized sternal plates were created and implanted in a sternal reconstruction operation. We report on the successful implantation of a customized sternal plate in the treatment of a patient with refractory pectus excavatum in the context of facioscapulohumeral muscular dystrophy.
{"title":"Sternal Reconstruction for Refractory Pectus Excavatum From Facioscapulohumeral Muscular Dystrophy","authors":"Daniel Kyrillos Ragheb MD , Sigrid Johannesen MD , Erin Gillaspie MD","doi":"10.1016/j.atssr.2024.06.006","DOIUrl":"10.1016/j.atssr.2024.06.006","url":null,"abstract":"<div><div>A 44-year-old man with a history of facioscapulohumeral muscular dystrophy and pectus excavatum presented with multiyear history of progressive, severe respiratory dysfunction, pain, recurrent respiratory infection, and chest wall deformity. With bioprosthetic engineers, the surgical team customized a 3-dimensional printed model of a sternal implant interacting with the patient’s anatomy. After approval from the Food and Drug Administration, the customized sternal plates were created and implanted in a sternal reconstruction operation. We report on the successful implantation of a customized sternal plate in the treatment of a patient with refractory pectus excavatum in the context of facioscapulohumeral muscular dystrophy.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"2 4","pages":"Pages 685-687"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959725","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 : 2024-12-01DOI: 10.1016/j.atssr.2024.06.002
Katie J. Hogan PhD , Christopher B. Sylvester MD, PhD , Travis J. Miles MD , Matthew Wall MD , Todd K. Rosengart MD , Marc R. Moon MD , Joseph S. Coselli MD , Subhasis Chatterjee MD , Ravi K. Ghanta MD
Background
Rising rates of substance use (SU) have resulted in an increasing need for left-sided valve surgery for SU-associated infective endocarditis (SU-IE). We compared outcomes, readmissions, and costs between IE patients with and without SU-IE in a national cohort.
Methods
Using the Nationwide Readmissions Database (2016-2018), we identified 10,098 patients with infective endocarditis (IE) who underwent isolated aortic or mitral valve replacement. Outcomes within the same calendar year as the index operation were compared between patients with and without SU-IE. Multivariable logistic regressions were used to identify factors associated with in-hospital mortality and 30-day and 90-day readmissions. Kaplan-Meier analysis and a Cox proportional hazards model were used to compare freedom from calendar-year readmission between the groups.
Results
Of the 10,098 patients with IE, 2145 (21%) had SU-IE. Although patients with SU-IE were younger (38 years vs 60 years; P < .001) and had fewer comorbidities (Elixhauser score: 12 vs 20; P < .001) than patients who did not have SU-IE, patients with SU-IE had longer hospital stays (25 days vs 18 days; P < .001) and costlier admissions ($84,949 vs $74,122; P < .001). Patients with SU-IE had less in-hospital mortality (3.0% vs 5.8%; P < .001) but more often died when readmitted (9.6% vs 4.6%; P < .001). Readmissions were similar at 30 days (18.5% vs 18.9%; P = .8) and 90 days (31.8% vs 29.3%; P = .2), but patients with SU-IE had more calendar-year readmissions (35.1% vs 31.0%; P < .018).
Conclusions
Despite their younger age and fewer comorbidities, patients who undergo valve surgery for SU-IE use more resources and more often have calendar-year readmissions than patients with IE but without SU. Strategies are needed to expedite discharge and prevent readmission in patients with SU-IE.
背景：药物使用（SU）率的上升导致SU相关感染性心内膜炎（SU- ie）左侧瓣膜手术的需求增加。我们在一个国家队列中比较了伴有和不伴有SU-IE的IE患者的结局、再入院率和费用。方法：使用全国再入院数据库（2016-2018），我们确定了10098例接受孤立主动脉瓣或二尖瓣置换术的感染性心内膜炎（IE）患者。比较有和没有SU-IE的患者在同一日历年内与指数手术的结果。采用多变量logistic回归来确定与住院死亡率、30天和90天再入院率相关的因素。Kaplan-Meier分析和Cox比例风险模型用于比较两组间历年再入院的自由度。结果：10098例IE患者中，2145例（21%）为SU-IE。虽然SU-IE患者较年轻(38岁vs 60岁；P < 0.001)，合并症较少(Elixhauser评分：12 vs 20；P < 0.001)和更昂贵的入场费(84,949美元vs 74,122美元；P < 0.001)。SU-IE患者的住院死亡率较低(3.0% vs 5.8%；P < 0.001)，但再入院时死亡的比例更高(9.6% vs 4.6%；P = 0.8)和90天(31.8% vs 29.3%；P = 0.2)，但SU-IE患者的历年再入院率更高(35.1% vs 31.0%；P < .018)。结论：尽管年龄更小，合并症更少，但接受瓣膜手术治疗的SU-IE患者比患有IE但没有SU的患者使用更多的资源，并且更经常有日历年再入院。需要采取策略来加快出院并防止SU-IE患者再入院。
{"title":"Substance Use and Outcomes of Left-Sided Valve Replacement in Patients With Infective Endocarditis","authors":"Katie J. Hogan PhD , Christopher B. Sylvester MD, PhD , Travis J. Miles MD , Matthew Wall MD , Todd K. Rosengart MD , Marc R. Moon MD , Joseph S. Coselli MD , Subhasis Chatterjee MD , Ravi K. Ghanta MD","doi":"10.1016/j.atssr.2024.06.002","DOIUrl":"10.1016/j.atssr.2024.06.002","url":null,"abstract":"<div><h3>Background</h3><div>Rising rates of substance use (SU) have resulted in an increasing need for left-sided valve surgery for SU-associated infective endocarditis (SU-IE). We compared outcomes, readmissions, and costs between IE patients with and without SU-IE in a national cohort.</div></div><div><h3>Methods</h3><div>Using the Nationwide Readmissions Database (2016-2018), we identified 10,098 patients with infective endocarditis (IE) who underwent isolated aortic or mitral valve replacement. Outcomes within the same calendar year as the index operation were compared between patients with and without SU-IE. Multivariable logistic regressions were used to identify factors associated with in-hospital mortality and 30-day and 90-day readmissions. Kaplan-Meier analysis and a Cox proportional hazards model were used to compare freedom from calendar-year readmission between the groups.</div></div><div><h3>Results</h3><div>Of the 10,098 patients with IE, 2145 (21%) had SU-IE. Although patients with SU-IE were younger (38 years vs 60 years; <em>P</em> < .001) and had fewer comorbidities (Elixhauser score: 12 vs 20; <em>P</em> < .001) than patients who did not have SU-IE, patients with SU-IE had longer hospital stays (25 days vs 18 days; <em>P</em> < .001) and costlier admissions ($84,949 vs $74,122; <em>P</em> < .001). Patients with SU-IE had less in-hospital mortality (3.0% vs 5.8%; <em>P</em> < .001) but more often died when readmitted (9.6% vs 4.6%; <em>P</em> < .001). Readmissions were similar at 30 days (18.5% vs 18.9%; <em>P</em> = .8) and 90 days (31.8% vs 29.3%; <em>P</em> = .2), but patients with SU-IE had more calendar-year readmissions (35.1% vs 31.0%; <em>P</em> < .018).</div></div><div><h3>Conclusions</h3><div>Despite their younger age and fewer comorbidities, patients who undergo valve surgery for SU-IE use more resources and more often have calendar-year readmissions than patients with IE but without SU. Strategies are needed to expedite discharge and prevent readmission in patients with SU-IE.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"2 4","pages":"Pages 759-764"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959727","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}
{"title":"Addressing Lung Cancer Screening Disparities: More Work To Be Done","authors":"Hollis Hutchings MD, Olivia Aspiras PhD, Todd Lucas PhD, Ikenna Okereke MD","doi":"10.1016/j.atssr.2024.07.023","DOIUrl":"10.1016/j.atssr.2024.07.023","url":null,"abstract":"","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"2 4","pages":"Page 673"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959230","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 : 2024-12-01DOI: 10.1016/j.atssr.2024.05.002
Tomoki Sakata MD, PhD , Douglas Pfeil MD, PhD , Rakesh M. Suri MD, DPhil
A 53-year-old male individual with chronic severe mitral regurgitation presented with biventricular dysfunction, pulmonary hypertension, and atrial fibrillation. Echocardiography demonstrated a posterior leaflet prolapse with malcoaptation. Mitral valve repair and Maze procedure were performed, revealing absent chordae and direct connection from the anterolateral papillary muscle to the posterior leaflet, consistent with partial mitral arcade. Post bypass, left ventricular dysfunction was addressed by intraaortic balloon pump placement and delayed sternal closure. Post chest closure echocardiography showed no residual mitral regurgitation and restored biventricular function. This case highlights a rare presentation of mitral regurgitation with unique anatomical anomaly, successfully managed with a comprehensive surgical approach.
{"title":"Biventricular Dysfunction Due to Chronic Mitral Valve Regurgitation Caused by Aberrant Mitral Arcade","authors":"Tomoki Sakata MD, PhD , Douglas Pfeil MD, PhD , Rakesh M. Suri MD, DPhil","doi":"10.1016/j.atssr.2024.05.002","DOIUrl":"10.1016/j.atssr.2024.05.002","url":null,"abstract":"<div><div>A 53-year-old male individual with chronic severe mitral regurgitation presented with biventricular dysfunction, pulmonary hypertension, and atrial fibrillation. Echocardiography demonstrated a posterior leaflet prolapse with malcoaptation. Mitral valve repair and Maze procedure were performed, revealing absent chordae and direct connection from the anterolateral papillary muscle to the posterior leaflet, consistent with partial mitral arcade. Post bypass, left ventricular dysfunction was addressed by intraaortic balloon pump placement and delayed sternal closure. Post chest closure echocardiography showed no residual mitral regurgitation and restored biventricular function. This case highlights a rare presentation of mitral regurgitation with unique anatomical anomaly, successfully managed with a comprehensive surgical approach.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"2 4","pages":"Pages 783-786"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959659","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}
Postoperative cerebral infarction, a serious complication of surgery, is occasionally experienced with pulmonary vein stump thrombosis (PVST), which is frequently observed after left upper lobectomy (LUL). Herein, we prospectively investigated whether PVST could be safely prevented by intrapericardial ligation of the superior pulmonary vein (SPV) to shorten the SPV stump during LUL.
Methods
In a consecutive 21 patients who underwent LUL, we ligated the proximal intrapericardial SPV with 1-0 silk suture and divided the distal hilar SPV by an automatic stapling device. We measured the SPV stump length from the left atrium to the point of ligation and evaluated the presence of PVST on postoperative computed tomography. The procedure time was measured as the time from pericardial treatment initiation to the distal SPV division. Furthermore, the safety of the procedure and postoperative complications were evaluated and compared with those of 76 historical control patients who underwent LUL without intrapericardial SPV ligation.
Results
The median procedure time was 8.8 minutes, and the median blood loss was 3 g. The median length of the SPV stump after the procedure was 5.0 mm. The 30- and 90-day mortality rates were both 0% for patients who underwent LUL with SPV ligation. None of the patients in the SPV ligation group showed signs of PVST on postoperative contrast-enhanced computed tomography images or had cerebrovascular disease. No significant difference in postoperative complications was observed between the groups.
Conclusions
Intrapericardial SPV ligation is safe and has a potential to prevent cerebral infarction after LUL.
{"title":"Intrapericardial Pulmonary Vein Ligation to Prevent Stump Thrombosis During Left Upper Lobectomy","authors":"Shunta Ishihara MD, PhD , Masanori Shimomura MD, PhD , Hiroaki Tsunezuka MD, PhD , Satoru Okada MD, PhD , Tatsuo Furuya MD, PhD , Tatsuya Yoshikawa MD, PhD , Masayoshi Inoue MD, PhD","doi":"10.1016/j.atssr.2024.04.032","DOIUrl":"10.1016/j.atssr.2024.04.032","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative cerebral infarction, a serious complication of surgery, is occasionally experienced with pulmonary vein stump thrombosis (PVST), which is frequently observed after left upper lobectomy (LUL). Herein, we prospectively investigated whether PVST could be safely prevented by intrapericardial ligation of the superior pulmonary vein (SPV) to shorten the SPV stump during LUL.</div></div><div><h3>Methods</h3><div>In a consecutive 21 patients who underwent LUL, we ligated the proximal intrapericardial SPV with 1-0 silk suture and divided the distal hilar SPV by an automatic stapling device. We measured the SPV stump length from the left atrium to the point of ligation and evaluated the presence of PVST on postoperative computed tomography. The procedure time was measured as the time from pericardial treatment initiation to the distal SPV division. Furthermore, the safety of the procedure and postoperative complications were evaluated and compared with those of 76 historical control patients who underwent LUL without intrapericardial SPV ligation.</div></div><div><h3>Results</h3><div>The median procedure time was 8.8 minutes, and the median blood loss was 3 g. The median length of the SPV stump after the procedure was 5.0 mm. The 30- and 90-day mortality rates were both 0% for patients who underwent LUL with SPV ligation. None of the patients in the SPV ligation group showed signs of PVST on postoperative contrast-enhanced computed tomography images or had cerebrovascular disease. No significant difference in postoperative complications was observed between the groups.</div></div><div><h3>Conclusions</h3><div>Intrapericardial SPV ligation is safe and has a potential to prevent cerebral infarction after LUL.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"2 4","pages":"Pages 608-612"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708331/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959678","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}
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