Pub Date : 2025-12-01DOI: 10.1016/j.atssr.2025.05.025
Naqibullah Nasar MS , Qin Fu MS , Heming Chen MD , Zhiyuan Zhang MD , Yangzhao Zhou MD , Min Wang MD , Xiaobo Liao MD
This case highlights a modified Bentall combined with Commando procedure in a patient with extensive cardiac calcification. Preoperative imaging revealed severe valvular dysfunction, a low left coronary ostium, and heavy calcification of the intervalvular fibrous body. Given the patient’s small, calcified annuli, reconstruction of the intervalvular fibrous body was required. Aortic annular enlargement was achieved with a patch, thus allowing implantation of a tilted aortic valve-conduit prosthesis. Dual incisions were used for optimal exposure. This case demonstrates the feasibility of combining Bentall and Commando procedures in complex valvular disease.
{"title":"A Modified Approach to Bentall Plus Commando Surgery in Case of Extensive Cardiac Calcification","authors":"Naqibullah Nasar MS , Qin Fu MS , Heming Chen MD , Zhiyuan Zhang MD , Yangzhao Zhou MD , Min Wang MD , Xiaobo Liao MD","doi":"10.1016/j.atssr.2025.05.025","DOIUrl":"10.1016/j.atssr.2025.05.025","url":null,"abstract":"<div><div>This case highlights a modified Bentall combined with Commando procedure in a patient with extensive cardiac calcification. Preoperative imaging revealed severe valvular dysfunction, a low left coronary ostium, and heavy calcification of the intervalvular fibrous body. Given the patient’s small, calcified annuli, reconstruction of the intervalvular fibrous body was required. Aortic annular enlargement was achieved with a patch, thus allowing implantation of a tilted aortic valve-conduit prosthesis. Dual incisions were used for optimal exposure. This case demonstrates the feasibility of combining Bentall and Commando procedures in complex valvular disease.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 4","pages":"Pages 1060-1063"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145645712","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}
Pub Date : 2025-12-01DOI: 10.1016/j.atssr.2025.04.022
T.K. Susheel Kumar MD , Daniel M. Pasternack DO , Maya T. Crawford BS , Thomas Beaulieu BS , Michael J. Martinez MD , Sujata Chakravarti MD , Catherine Bull MSN , Isabella M. Vlassis BS , Leslie James MD , Steven J. Staffa MS , David Zurakowski MS, PhD , Ralph Mosca MD
Background
Polytetrafluoroethylene (PTFE), traditionally used for construction of Blalock-Taussig-Thomas (BTT) shunt, is associated with complications such as perioperative bleeding, thrombosis, and stenosis. Saphenous vein homografts (SVHs) are theoretically more hemostatic and less thrombogenic.
Methods
A retrospective chart review was conducted of all infants who underwent BTT shunt placement between January 2015 and May 2023 to compare the use of blood and blood products in the operating room and within the first 24 hours after cardiac intensive care unit admission. Morbidity (unplanned reoperations, extracorporeal membrane oxygenation requirement, or dialysis) was also compared.
Results
Of 78 infants who underwent BTT shunt placement, 26 (33%) received SVH and 52 (67%) received PTFE. Patients receiving SVH were more often premature (30.8% vs 15.4%; standardized mean difference [SMD], 0.37) and had more extracardiac anomalies (15.4% vs 5.8%; SMD, 0.32). Cardiopulmonary bypass times were longer with SVH (median, 102 [interquartile range, 89-113] minutes vs 68 [interquartile range, 55-89] minutes; SMD, 0.84). Multivariable regression analysis demonstrated a decreased requirement for blood (adjusted coefficient, −42.7; 95% CI, −59.1 to −26.2; P < .001) and blood products (adjusted coefficient, −19.8; 95% CI, −33 to −6.6; P = .004) with SVH. There were no group differences in rate of shunt thrombosis or need for percutaneous intervention. Interstage mortality (8% vs 13%) and morbidity (8% vs 10%) were similar, as were hemodynamic data before shunt takedown.
Conclusions
SVH as BTT shunt is associated with significantly less perioperative bleeding compared with PTFE, with no differences in risk of thrombosis or need for percutaneous intervention.
{"title":"Reduced Perioperative Bleeding With Use of Saphenous Vein Homograft as Blalock-Taussig-Thomas Shunt","authors":"T.K. Susheel Kumar MD , Daniel M. Pasternack DO , Maya T. Crawford BS , Thomas Beaulieu BS , Michael J. Martinez MD , Sujata Chakravarti MD , Catherine Bull MSN , Isabella M. Vlassis BS , Leslie James MD , Steven J. Staffa MS , David Zurakowski MS, PhD , Ralph Mosca MD","doi":"10.1016/j.atssr.2025.04.022","DOIUrl":"10.1016/j.atssr.2025.04.022","url":null,"abstract":"<div><h3>Background</h3><div>Polytetrafluoroethylene (PTFE), traditionally used for construction of Blalock-Taussig-Thomas (BTT) shunt, is associated with complications such as perioperative bleeding, thrombosis, and stenosis. Saphenous vein homografts (SVHs) are theoretically more hemostatic and less thrombogenic.</div></div><div><h3>Methods</h3><div>A retrospective chart review was conducted of all infants who underwent BTT shunt placement between January 2015 and May 2023 to compare the use of blood and blood products in the operating room and within the first 24 hours after cardiac intensive care unit admission. Morbidity (unplanned reoperations, extracorporeal membrane oxygenation requirement, or dialysis) was also compared.</div></div><div><h3>Results</h3><div>Of 78 infants who underwent BTT shunt placement, 26 (33%) received SVH and 52 (67%) received PTFE. Patients receiving SVH were more often premature (30.8% vs 15.4%; standardized mean difference [SMD], 0.37) and had more extracardiac anomalies (15.4% vs 5.8%; SMD, 0.32). Cardiopulmonary bypass times were longer with SVH (median, 102 [interquartile range, 89-113] minutes vs 68 [interquartile range, 55-89] minutes; SMD, 0.84). Multivariable regression analysis demonstrated a decreased requirement for blood (adjusted coefficient, −42.7; 95% CI, −59.1 to −26.2; <em>P</em> < .001) and blood products (adjusted coefficient, −19.8; 95% CI, −33 to −6.6; <em>P</em> = .004) with SVH. There were no group differences in rate of shunt thrombosis or need for percutaneous intervention. Interstage mortality (8% vs 13%) and morbidity (8% vs 10%) were similar, as were hemodynamic data before shunt takedown.</div></div><div><h3>Conclusions</h3><div>SVH as BTT shunt is associated with significantly less perioperative bleeding compared with PTFE, with no differences in risk of thrombosis or need for percutaneous intervention.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 4","pages":"Pages 1081-1086"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145645724","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}
Posttraumatic pseudoaneurysms of the left ventricle are exceptionally rare. An 19-year-old African man presented with excruciating left-sided chest pain radiating to his left arm 8 years after sustaining a chest injury in a severe motor vehicle accident. Initially misdiagnosed with Takotsubo cardiomyopathy, he was later found to have a left ventricle pseudoaneurysm with a 2.5- × 4.0- cm defect, which was successfully repaired using a pericardial patch. This case highlights the importance of investigating prior chest trauma in patients with echocardiographic findings resembling Takotsubo cardiomyopathy. Moreover, educating the public to seek detailed medical examinations after serious motor traffic crashes is of paramount importance.
{"title":"Posttraumatic Left Ventricular Pseudoaneurysm Initially Misdiagnosed as Takotsubo Cardiomyopathy","authors":"Sigfrid Casmir Shayo MD, PhD , Musa Machibya MD , Khairoon Abdulkadir Mohamed MD , Donato Dan Sisto MD, PhD , Sahithi Bhavana MBBS , Amour Mwinyi MD, MMed , Mwajuma M. Jumbe MD, MMed , Angela Mhozya MD, MMed , Evarist M. Nyawawa MD, MMed , YiMin Liu MD, PhD","doi":"10.1016/j.atssr.2025.04.010","DOIUrl":"10.1016/j.atssr.2025.04.010","url":null,"abstract":"<div><div>Posttraumatic pseudoaneurysms of the left ventricle are exceptionally rare. An 19-year-old African man presented with excruciating left-sided chest pain radiating to his left arm 8 years after sustaining a chest injury in a severe motor vehicle accident. Initially misdiagnosed with Takotsubo cardiomyopathy, he was later found to have a left ventricle pseudoaneurysm with a 2.5- × 4.0- cm defect, which was successfully repaired using a pericardial patch. This case highlights the importance of investigating prior chest trauma in patients with echocardiographic findings resembling Takotsubo cardiomyopathy. Moreover, educating the public to seek detailed medical examinations after serious motor traffic crashes is of paramount importance.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 4","pages":"Pages 1005-1008"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145646001","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}
Pub Date : 2025-12-01DOI: 10.1016/j.atssr.2025.04.021
Andrew Behrmann BS , Kate Appleman MS , Katarina Lettner BS , Balaji Cherupala BS , Jessica Cayton DVM , Shamik Bhattacharya PhD , Pirooz Eghtesady MD, PhD
Background
Pediatric pulmonic and aortic valve insufficiency has recently been treated with novel procedures that use autologous right atrial appendage tissue. Whether atrial tissue’s tensile strength correlates with pressures it can withstand to function as a neo–semilunar valve has not been studied. We therefore studied these properties using an ex vivo porcine heart model.
Methods
Aortic cusps, pulmonic cusps, and right and left atrial appendage tissues were excised from 10 porcine hearts. Native leaflets and atrial appendage samples underwent circumferential and radial stretching by a uniaxial tensile machine. Right atrial appendage tissue from 14 additional porcine hearts was used to reconstruct neo-pulmonic and neo-aortic valves that were hydrostatically pressurized until failure.
Results
The modulus of elasticity was significantly greater in aortic (3.11 ± 0.53 MPa circumferential; 1.31 ± 0.29 MPa radial) and pulmonic (2.99 ± 0.46 MPa circumferential; 1.12 ± 0.24 MPa radial) cusps than in right (0.36 ± 0.06 MPa circumferential; 0.30 ± 0.04 MPa radial) and left (0.41 ± 0.07 MPa circumferential; 0.36 ± 0.06 MPa radial) atrial appendage tissues. The average hydrostatic pressure at valve failure was similar between neo-pulmonic (104.9 ± 4.9 mm Hg) and neo-aortic (102.7 ± 2.4 mm Hg) valves.
Conclusions
Atrial appendage tissue’s greater distensibility may allow greater leaflet coaptation and accommodate expansion over time, enhancing growth potential. However, the greater pliability may predispose to valve prolapse if too much tissue is used or in the setting of elevated diastolic pressures. Longitudinal studies are warranted to further explore the potential of atrial tissue for valve reconstructions.
背景：儿童肺动脉瓣和主动脉瓣功能不全最近被应用自体右心房附件组织治疗。心房组织的抗张强度是否与其作为新半月瓣所能承受的压力相关尚未研究。因此，我们使用离体猪心脏模型研究了这些特性。方法取10只猪心脏，分别切除主动脉尖、肺动脉尖和左右心房附件组织。原生小叶和心房附件样本经单轴拉伸机进行周向和径向拉伸。从另外14个猪心脏中提取右心房附件组织用于重建新肺动脉瓣和新主动脉瓣，静液加压直至失效。结果主动脉瓣（3.11±0.53 MPa周向，1.31±0.29 MPa径向）和肺动脉瓣（2.99±0.46 MPa周向，1.12±0.24 MPa径向）瓣尖的弹性模量显著高于右心房附件（0.36±0.06 MPa周向，0.30±0.04 MPa径向）和左心房附件（0.41±0.07 MPa周向，0.36±0.06 MPa径向）。新肺动脉瓣（104.9±4.9 mm Hg）和新主动脉瓣（102.7±2.4 mm Hg）失效时的平均静水压力相似。结论附属物组织具有较大的膨胀性，可使小叶覆盖更大，随时间的推移可适应扩张，提高生长潜力。然而，如果使用过多的组织或在舒张压升高的情况下，较大的柔韧性可能易导致瓣膜脱垂。纵向研究有必要进一步探索心房组织在瓣膜重建中的潜力。
{"title":"Mechanical Explanation for the Hemodynamic Efficacy of Right Atrial Appendage Autografts Used in Neo–Semilunar Valve Leaflet Reconstruction","authors":"Andrew Behrmann BS , Kate Appleman MS , Katarina Lettner BS , Balaji Cherupala BS , Jessica Cayton DVM , Shamik Bhattacharya PhD , Pirooz Eghtesady MD, PhD","doi":"10.1016/j.atssr.2025.04.021","DOIUrl":"10.1016/j.atssr.2025.04.021","url":null,"abstract":"<div><h3>Background</h3><div>Pediatric pulmonic and aortic valve insufficiency has recently been treated with novel procedures that use autologous right atrial appendage tissue. Whether atrial tissue’s tensile strength correlates with pressures it can withstand to function as a neo–semilunar valve has not been studied. We therefore studied these properties using an ex vivo porcine heart model.</div></div><div><h3>Methods</h3><div>Aortic cusps, pulmonic cusps, and right and left atrial appendage tissues were excised from 10 porcine hearts. Native leaflets and atrial appendage samples underwent circumferential and radial stretching by a uniaxial tensile machine. Right atrial appendage tissue from 14 additional porcine hearts was used to reconstruct neo-pulmonic and neo-aortic valves that were hydrostatically pressurized until failure.</div></div><div><h3>Results</h3><div>The modulus of elasticity was significantly greater in aortic (3.11 ± 0.53 MPa circumferential; 1.31 ± 0.29 MPa radial) and pulmonic (2.99 ± 0.46 MPa circumferential; 1.12 ± 0.24 MPa radial) cusps than in right (0.36 ± 0.06 MPa circumferential; 0.30 ± 0.04 MPa radial) and left (0.41 ± 0.07 MPa circumferential; 0.36 ± 0.06 MPa radial) atrial appendage tissues. The average hydrostatic pressure at valve failure was similar between neo-pulmonic (104.9 ± 4.9 mm Hg) and neo-aortic (102.7 ± 2.4 mm Hg) valves.</div></div><div><h3>Conclusions</h3><div>Atrial appendage tissue’s greater distensibility may allow greater leaflet coaptation and accommodate expansion over time, enhancing growth potential. However, the greater pliability may predispose to valve prolapse if too much tissue is used or in the setting of elevated diastolic pressures. Longitudinal studies are warranted to further explore the potential of atrial tissue for valve reconstructions.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 4","pages":"Pages 1077-1080"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145646002","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}
A supraclavicular approach for arteria lusoria has not been popular, likely due to the presumptive difficulties surgeons may face. We present 3 pediatric patients in whom the approach was successfully applied.
{"title":"Supraclavicular Approach for Arteria Lusoria in Pediatric Patients","authors":"Yuki Nakamura MD , Bijoy Thattaliyath MD , Umang Gupta MD","doi":"10.1016/j.atssr.2025.04.009","DOIUrl":"10.1016/j.atssr.2025.04.009","url":null,"abstract":"<div><div>A supraclavicular approach for arteria lusoria has not been popular, likely due to the presumptive difficulties surgeons may face. We present 3 pediatric patients in whom the approach was successfully applied.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 4","pages":"Pages 1104-1107"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145646012","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}
Pub Date : 2025-12-01DOI: 10.1016/j.atssr.2025.04.020
Scott DeRoo MD , Arjune Dhanekula MD , Bret DeGraaff MD , Rachel Flodin MS , Anne Gray BS , Samhitha Koruko , Manuel De La Garza BA , Sara Zettervall MD, MPH , Matthew P. Sweet MD , Christopher R. Burke MD
Background
Reoperative surgery to replace the aortic arch is perceived as technically complex and high risk. However, this procedure is often necessary to treat primary disease or to create an endovascular landing zone for distal aortic disease. We investigated our institutional outcomes in patients who underwent reoperative open arch (RA) surgery compared with patients who underwent primary arch (PA) replacement.
Methods
All adult patients who underwent open arch surgery from January 2019 to May 2023 at a single academic institution were queried for inclusion. The final cohort was 142 patients; 59 patients underwent RA surgery, and 83 patients received an open arch replacement as their index cardiac operation (PA).
Results
The average age of the entire cohort was 61.5 years. Preoperative demographics were largely similar between the groups. Illicit drug use was higher in the PA group (12.1% [n = 10] vs 0%; P < .05). The distribution of disease was different between the groups; the RA group had a high preponderance of prior type A repair (66.1% [n = 39]), whereas the PA group was largely a combination of acute type A dissection (41.0% [n = 34]) and elective aneurysm repair (28.9% [n = 24]; P < .05). Perioperative outcomes were similar between the groups, including rate of stroke, dialysis initiation, and mortality. Overall stroke rate for the entire cohort was 9.2% (n = 13). Overall, in-hospital mortality was 7.0% (n = 10); 3-year survival was similar between the groups (P = .969).
Conclusions
In an experienced aortic center, RA replacement demonstrated similar short-term and 3-year outcomes compared with PA replacement.
背景：外科手术替代主动脉弓被认为是技术复杂和高风险的。然而，对于治疗原发性疾病或为远端主动脉疾病建立血管内着陆区，这种手术通常是必要的。我们调查了再手术开弓（RA）手术患者与原弓（PA）置换术患者的机构结果。方法对2019年1月至2023年5月在同一学术机构接受开放弓手术的所有成年患者进行查询并纳入。最后的队列是142例患者；59例患者接受RA手术，83例患者接受开放弓置换术作为其指标心脏手术（PA）。结果整个队列的平均年龄为61.5岁。两组术前人口统计学基本相似。PA组违禁药物使用率较高（12.1% [n = 10] vs 0%; P < 0.05）。两组间疾病分布不同；RA组既往a型修复优势较高（66.1% [n = 39]），而PA组以急性a型夹层（41.0% [n = 34]）和择期动脉瘤修复（28.9% [n = 24]; P < 05）为主。两组围手术期结果相似，包括卒中发生率、透析起始率和死亡率。整个队列的总卒中率为9.2% （n = 13）。总体而言，住院死亡率为7.0% (n = 10)；两组3年生存率相似（P = .969）。结论：在经验丰富的主动脉中心，RA置换术与PA置换术相比具有相似的短期和3年预后。
{"title":"Outcomes of Primary vs Reoperative Aortic Arch Surgery","authors":"Scott DeRoo MD , Arjune Dhanekula MD , Bret DeGraaff MD , Rachel Flodin MS , Anne Gray BS , Samhitha Koruko , Manuel De La Garza BA , Sara Zettervall MD, MPH , Matthew P. Sweet MD , Christopher R. Burke MD","doi":"10.1016/j.atssr.2025.04.020","DOIUrl":"10.1016/j.atssr.2025.04.020","url":null,"abstract":"<div><h3>Background</h3><div>Reoperative surgery to replace the aortic arch is perceived as technically complex and high risk. However, this procedure is often necessary to treat primary disease or to create an endovascular landing zone for distal aortic disease. We investigated our institutional outcomes in patients who underwent reoperative open arch (RA) surgery compared with patients who underwent primary arch (PA) replacement.</div></div><div><h3>Methods</h3><div>All adult patients who underwent open arch surgery from January 2019 to May 2023 at a single academic institution were queried for inclusion. The final cohort was 142 patients; 59 patients underwent RA surgery, and 83 patients received an open arch replacement as their index cardiac operation (PA).</div></div><div><h3>Results</h3><div>The average age of the entire cohort was 61.5 years. Preoperative demographics were largely similar between the groups. Illicit drug use was higher in the PA group (12.1% [n = 10] vs 0%; <em>P</em> < .05). The distribution of disease was different between the groups; the RA group had a high preponderance of prior type A repair (66.1% [n = 39]), whereas the PA group was largely a combination of acute type A dissection (41.0% [n = 34]) and elective aneurysm repair (28.9% [n = 24]; <em>P</em> < .05). Perioperative outcomes were similar between the groups, including rate of stroke, dialysis initiation, and mortality. Overall stroke rate for the entire cohort was 9.2% (n = 13). Overall, in-hospital mortality was 7.0% (n = 10); 3-year survival was similar between the groups (<em>P</em> = .969).</div></div><div><h3>Conclusions</h3><div>In an experienced aortic center, RA replacement demonstrated similar short-term and 3-year outcomes compared with PA replacement.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 4","pages":"Pages 967-973"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145646020","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}
Pub Date : 2025-12-01DOI: 10.1016/j.atssr.2025.04.012
Susana Fortich MD , Jose I. Ortiz De Elguea-Lizarraga MD , Junji Tsukagoshi MD , Mitchell W. Cox MD , Andre Y. Son MD , Abe DeAnda MD
Acute type A aortic dissection (ATAAD) with cerebral malperfusion presents a significant surgical challenge. This report describes a novel approach involving initial right carotid artery repair with interposition grafting and selective cerebral perfusion, followed by total aortic arch replacement using deep hypothermic circulatory arrest. This strategy optimized cerebral perfusion and facilitated successful aortic repair. The patient experienced partial neurologic recovery despite an initial ischemic stroke with hemorrhagic conversion. This case highlights the importance of a tailored, multidisciplinary approach in patients with complex ATAAD.
{"title":"Surgical Management of Type A Aortic Intramural Hematoma With Cerebral Malperfusion: Carotid Revascularization and Arch Replacement","authors":"Susana Fortich MD , Jose I. Ortiz De Elguea-Lizarraga MD , Junji Tsukagoshi MD , Mitchell W. Cox MD , Andre Y. Son MD , Abe DeAnda MD","doi":"10.1016/j.atssr.2025.04.012","DOIUrl":"10.1016/j.atssr.2025.04.012","url":null,"abstract":"<div><div>Acute type A aortic dissection (ATAAD) with cerebral malperfusion presents a significant surgical challenge. This report describes a novel approach involving initial right carotid artery repair with interposition grafting and selective cerebral perfusion, followed by total aortic arch replacement using deep hypothermic circulatory arrest. This strategy optimized cerebral perfusion and facilitated successful aortic repair. The patient experienced partial neurologic recovery despite an initial ischemic stroke with hemorrhagic conversion. This case highlights the importance of a tailored, multidisciplinary approach in patients with complex ATAAD.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 4","pages":"Pages 979-981"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145646022","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}
Lung abscesses pose diagnostic and management challenges, particularly when they are associated with underlying causes, such as lymphoma. We report the case of a previously healthy adolescent with a lung abscess and lymphadenopathy. Despite antibiotics, improvement was minimal, and biopsy results were inconclusive. Surgery revealed an enlarged, adherent lymph node. Pathologic examination confirmed classic Hodgkin lymphoma invading the hilum and causing bronchial and vascular obstruction and secondary abscesses. This case highlights the importance of including lymphoma in the differential diagnosis of persistent lung infections and the surgical challenges arising from lymphoma-related lymph nodes with irregular enlargement and firm adhesion to surrounding tissues.
{"title":"Surgical Resection of a Refractory Lung Abscess Secondary to Classic Hodgkin Lymphoma","authors":"Wakako Nagase MD, PhD , Junichi Maeda MD, PhD , Shigeki Morita MD, PhD , Shunsuke Shigefuku MD, PhD , Tatsuhiro Hoshino MD , Yuji Minegishi MD, PhD , Shingo Ikeda MD","doi":"10.1016/j.atssr.2025.04.026","DOIUrl":"10.1016/j.atssr.2025.04.026","url":null,"abstract":"<div><div>Lung abscesses pose diagnostic and management challenges, particularly when they are associated with underlying causes, such as lymphoma. We report the case of a previously healthy adolescent with a lung abscess and lymphadenopathy. Despite antibiotics, improvement was minimal, and biopsy results were inconclusive. Surgery revealed an enlarged, adherent lymph node. Pathologic examination confirmed classic Hodgkin lymphoma invading the hilum and causing bronchial and vascular obstruction and secondary abscesses. This case highlights the importance of including lymphoma in the differential diagnosis of persistent lung infections and the surgical challenges arising from lymphoma-related lymph nodes with irregular enlargement and firm adhesion to surrounding tissues.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 4","pages":"Pages 889-892"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145646052","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}
Chronic thromboembolic pulmonary hypertension is a rare but serious condition caused by pulmonary artery thrombi. Pulmonary thromboendarterectomy through median sternotomy is the “gold standard,” but minimally invasive approaches are emerging. We describe a 22-year-old female athlete with May-Thurner syndrome and factor V Leiden and prothrombin mutations in whom pulmonary embolism developed. After failed thrombectomy, she underwent pulmonary thromboendarterectomy by J-shaped upper hemisternotomy. Circulatory arrest time was 24 minutes; cardiopulmonary bypass time, 131 minutes; and cross-clamp time, 51 minutes. This technique is feasible and safe, achieving comparable outcomes to full sternotomy while improving cosmesis, making it an appealing option for selected patients.
{"title":"Minimally Invasive Pulmonary Thromboendarterectomy by a J-Shaped Upper Hemisternotomy","authors":"Yoshiya Toyoda MD, PhD , Mikiko Senzai MD , Akshay Chauhan MBBS , Sriram Vijayapuri MBBS , Suyog Mokashi MD , Roh Yanagida MD, PhD , Kewal Krishan MD , Hiromu Kehara MD, PhD","doi":"10.1016/j.atssr.2025.05.017","DOIUrl":"10.1016/j.atssr.2025.05.017","url":null,"abstract":"<div><div>Chronic thromboembolic pulmonary hypertension is a rare but serious condition caused by pulmonary artery thrombi. Pulmonary thromboendarterectomy through median sternotomy is the “gold standard,” but minimally invasive approaches are emerging. We describe a 22-year-old female athlete with May-Thurner syndrome and factor V Leiden and prothrombin mutations in whom pulmonary embolism developed. After failed thrombectomy, she underwent pulmonary thromboendarterectomy by J-shaped upper hemisternotomy. Circulatory arrest time was 24 minutes; cardiopulmonary bypass time, 131 minutes; and cross-clamp time, 51 minutes. This technique is feasible and safe, achieving comparable outcomes to full sternotomy while improving cosmesis, making it an appealing option for selected patients.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 4","pages":"Pages 893-896"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145646053","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}
Pub Date : 2025-12-01DOI: 10.1016/j.atssr.2025.05.020
Na Wu MD , Yu Zeng MD , Zhenzhong Zhang MD , Qi Xia MD , Zheng Liu MD , Wen Yang MD , Yang Hu MD
Background
Intussuscepted anastomoses in esophagectomy reduce the risks of anastomotic leakage and gastroesophageal reflux, but anastomotic stricture remains a significant concern. This study presents a novel hand-sewn technique, “H anastomosis,” designed to minimize stricture formation while preserving antileakage and antireflux functionality.
Methods
H anastomosis was simulated by using the esophagus and stomach of a Bama pig. The patency and antireflux function were assessed by injecting water into the ex vivo organs to stimulate the flow of food through the anastomotic stoma. Clinical data from 32 patients with esophageal squamous cell carcinoma who underwent minimally invasive esophagectomy with H anastomosis were retrospectively reviewed. Postoperative follow-up included reflux and dysphagia evaluations, as well as 24-hour pH monitoring.
Results
In the animal model, H anastomosis allowed smooth water flow with a maximum antireflux capacity of 90 mm H2O. Clinically, 30 of 32 patients (93.8%) reported no gastroesophageal reflux in the supine position postprandially, as confirmed by normal DeMeester scores. The most common postoperative complication was pneumonia (34.4%), and only 1 patient experienced anastomotic leakage, which healed with conservative management. No significant anastomotic stricture was observed.
Conclusions
H anastomosis effectively prevents anastomotic leakage and gastroesophageal reflux without causing stricture. Further validation through larger studies is necessary to confirm its long-term efficacy.
背景：食管切除术中吻合口叠塞可降低吻合口漏和胃食管反流的风险，但吻合口狭窄仍是一个值得关注的问题。这项研究提出了一种新的手工缝合技术，“H吻合”，旨在最大限度地减少狭窄的形成，同时保持防渗漏和抗反流功能。方法采用巴马猪食管和胃模拟吻合。通过向离体器官注射水来刺激食物通过吻合口的流动，评估其通畅性和抗反流功能。回顾性分析32例食管鳞状细胞癌行微创食管切除术H吻合术的临床资料。术后随访包括反流和吞咽困难评估，以及24小时pH监测。结果在动物模型中，H吻合口水流通畅，最大抗反流能力为90 mm H2O。临床上，32例患者中有30例（93.8%）报告餐后仰卧位无胃食管反流，DeMeester评分正常。术后最常见的并发症是肺炎（34.4%），仅有1例发生吻合口漏，经保守处理均痊愈。未见明显吻合口狭窄。结论吻合术能有效防止吻合口漏和胃食管反流，且不引起狭窄。需要通过更大规模的研究进一步验证以确认其长期疗效。
{"title":"H Anastomosis: The Ultimate Version of Intussuscepted Anastomosis Technique Used in Alimentary Reconstruction of Esophagectomy","authors":"Na Wu MD , Yu Zeng MD , Zhenzhong Zhang MD , Qi Xia MD , Zheng Liu MD , Wen Yang MD , Yang Hu MD","doi":"10.1016/j.atssr.2025.05.020","DOIUrl":"10.1016/j.atssr.2025.05.020","url":null,"abstract":"<div><h3>Background</h3><div>Intussuscepted anastomoses in esophagectomy reduce the risks of anastomotic leakage and gastroesophageal reflux, but anastomotic stricture remains a significant concern. This study presents a novel hand-sewn technique, “H anastomosis,” designed to minimize stricture formation while preserving antileakage and antireflux functionality.</div></div><div><h3>Methods</h3><div>H anastomosis was simulated by using the esophagus and stomach of a Bama pig. The patency and antireflux function were assessed by injecting water into the ex vivo organs to stimulate the flow of food through the anastomotic stoma. Clinical data from 32 patients with esophageal squamous cell carcinoma who underwent minimally invasive esophagectomy with H anastomosis were retrospectively reviewed. Postoperative follow-up included reflux and dysphagia evaluations, as well as 24-hour pH monitoring.</div></div><div><h3>Results</h3><div>In the animal model, H anastomosis allowed smooth water flow with a maximum antireflux capacity of 90 mm H<sub>2</sub>O. Clinically, 30 of 32 patients (93.8%) reported no gastroesophageal reflux in the supine position postprandially, as confirmed by normal DeMeester scores. The most common postoperative complication was pneumonia (34.4%), and only 1 patient experienced anastomotic leakage, which healed with conservative management. No significant anastomotic stricture was observed.</div></div><div><h3>Conclusions</h3><div>H anastomosis effectively prevents anastomotic leakage and gastroesophageal reflux without causing stricture. Further validation through larger studies is necessary to confirm its long-term efficacy.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"3 4","pages":"Pages 924-928"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145646061","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}
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