Advanced-stage atypical carcinoid tumors are seldom seen in the teenaged population. Comprehensive care, extending beyond mere cancer treatment, is essential. A 16-year-old boy received a diagnosis of a 13-mm nodule in the left S5 lung segment with signs suggesting interlobar pleural indentation. A surgical biopsy revealed a neuroendocrine tumor, which led to lingular segmentectomy and lymph node dissection. The pathologic diagnosis was atypical carcinoid with intrapulmonary metastasis, classified as pT3 N0 M0 stage IIB. In addition to oncologic management for the advanced-stage atypical carcinoid, genetic counseling and meticulous mental support were provided. The accumulation of clinical data on teenaged patients with lung cancer is urgently needed.
{"title":"Atypical Carcinoid With Pulmonary Metastasis in an Adolescent","authors":"Ryo Karita MD , Hironobu Wada MD, PhD , Yuki Onozato MD, PhD , Toshiko Kamata MD, PhD , Hajime Tamura MD, PhD , Takashi Anayama MD, PhD , Mina Komuta MD, PhD , Yuichiro Hayashi MD, PhD , Ichiro Yoshino MD, PhD , Shigetoshi Yoshida MD, PhD","doi":"10.1016/j.atssr.2024.05.023","DOIUrl":"10.1016/j.atssr.2024.05.023","url":null,"abstract":"<div><div>Advanced-stage atypical carcinoid tumors are seldom seen in the teenaged population. Comprehensive care, extending beyond mere cancer treatment, is essential. A 16-year-old boy received a diagnosis of a 13-mm nodule in the left S<sup>5</sup> lung segment with signs suggesting interlobar pleural indentation. A surgical biopsy revealed a neuroendocrine tumor, which led to lingular segmentectomy and lymph node dissection. The pathologic diagnosis was atypical carcinoid with intrapulmonary metastasis, classified as pT3 N0 M0 stage IIB. In addition to oncologic management for the advanced-stage atypical carcinoid, genetic counseling and meticulous mental support were provided. The accumulation of clinical data on teenaged patients with lung cancer is urgently needed.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"2 4","pages":"Pages 655-658"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959551","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.2024.05.006
Polyxeni Vlachea MD , Klaus Wenke MD , Kun Lu MD , Christian Hagl MD , Gerd Juchem MD , Florian E.M. Herrmann MD
Cardiac tumors are a rare entity with typically unspecific symptoms. We present the case of a 43-year old female patient with epigastric pain and palpitations with a long history of diagnostics prior to discovery of an epicardial mass. The epicardial tumor with arterial vascularization from the left anterior descending artery was resected in a beating heart procedure and was found to be a lipomatous soft tissue tumor. A lack of mouse double minute 2 gene amplification in fluorescent in situ hybridization confirmed the diagnosis of a benign cardiac lipoma. Resection led to a long-term resolution of symptoms.
{"title":"Butterfly-Shaped Epicardial Lipoma of the Heart","authors":"Polyxeni Vlachea MD , Klaus Wenke MD , Kun Lu MD , Christian Hagl MD , Gerd Juchem MD , Florian E.M. Herrmann MD","doi":"10.1016/j.atssr.2024.05.006","DOIUrl":"10.1016/j.atssr.2024.05.006","url":null,"abstract":"<div><div>Cardiac tumors are a rare entity with typically unspecific symptoms. We present the case of a 43-year old female patient with epigastric pain and palpitations with a long history of diagnostics prior to discovery of an epicardial mass. The epicardial tumor with arterial vascularization from the left anterior descending artery was resected in a beating heart procedure and was found to be a lipomatous soft tissue tumor. A lack of mouse double minute 2 gene amplification in fluorescent in situ hybridization confirmed the diagnosis of a benign cardiac lipoma. Resection led to a long-term resolution of symptoms.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"2 4","pages":"Pages 695-698"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141391935","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.2024.06.024
Desiree Steimer MD , Peter Tramontozzi BS , Patrick Gedeon MD, PhD , Matthew Pommerening MD, MS , Ariadne DeSimone MD, MPH , Raphael Bueno MD , Hisashi Tsukada MD, PhD
Background
Invasive mediastinal staging is a crucial component of the preoperative evaluation for potential surgical candidates with pleural mesothelioma (PM). Endobronchial ultrasound (EBUS) is less invasive than mediastinoscopy for staging; however, its accuracy in patients with PM remains undefined. We present our institutional experience with EBUS staging in patients with PM.
Methods
Patients with PM who underwent EBUS for mediastinal staging between January 2017 and February 2021 (Brigham and Women's Hospital, Boston, MA) followed by surgical resection were retrospectively reviewed. EBUS cytology was compared with final pathology reports for the corresponding lymph node removed at the time of pleurectomy to assess EBUS accuracy.
Results
During the study period, 91 patients with PM met inclusion criteria. EBUS diagnostic yield was highest at nodal station 7 (84%) and lowest at station 4L (40%). There were 74 patients taken for surgical resection, and 41 patients had matching lymph nodes for analysis. In our series, EBUS had a sensitivity of 81%, a specificity of 93%, a positive predictive value of 90%, and a negative predictive value of 84%.
Conclusions
EBUS is a reasonable alternative to mediastinoscopy for mediastinal staging in patients with mesothelioma.
{"title":"The Role of Endobronchial Ultrasound for Mediastinal Staging in Mesothelioma","authors":"Desiree Steimer MD , Peter Tramontozzi BS , Patrick Gedeon MD, PhD , Matthew Pommerening MD, MS , Ariadne DeSimone MD, MPH , Raphael Bueno MD , Hisashi Tsukada MD, PhD","doi":"10.1016/j.atssr.2024.06.024","DOIUrl":"10.1016/j.atssr.2024.06.024","url":null,"abstract":"<div><h3>Background</h3><div>Invasive mediastinal staging is a crucial component of the preoperative evaluation for potential surgical candidates with pleural mesothelioma (PM). Endobronchial ultrasound (EBUS) is less invasive than mediastinoscopy for staging; however, its accuracy in patients with PM remains undefined. We present our institutional experience with EBUS staging in patients with PM.</div></div><div><h3>Methods</h3><div>Patients with PM who underwent EBUS for mediastinal staging between January 2017 and February 2021 (Brigham and Women's Hospital, Boston, MA) followed by surgical resection were retrospectively reviewed. EBUS cytology was compared with final pathology reports for the corresponding lymph node removed at the time of pleurectomy to assess EBUS accuracy.</div></div><div><h3>Results</h3><div>During the study period, 91 patients with PM met inclusion criteria. EBUS diagnostic yield was highest at nodal station 7 (84%) and lowest at station 4L (40%). There were 74 patients taken for surgical resection, and 41 patients had matching lymph nodes for analysis. In our series, EBUS had a sensitivity of 81%, a specificity of 93%, a positive predictive value of 90%, and a negative predictive value of 84%.</div></div><div><h3>Conclusions</h3><div>EBUS is a reasonable alternative to mediastinoscopy for mediastinal staging in patients with mesothelioma.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"2 4","pages":"Pages 613-617"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141712121","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.2024.04.025
Joseph R. Nellis MD, MBA , Jacob C. Scherba BS , James M. Meza MD , Joseph W. Turek MD, PhD , Nicholas D. Andersen MD
Background
This study sought to determine the safety of primary and staged biventricular repair in neonates with interrupted aortic arch (IAA), ventricular septal defect (VSD), and severe left ventricular outflow tract obstruction (LVOTO).
Methods
Patients with a fundamental diagnosis of IAA and VSD between 2015 and 2020 were extracted from The Society of Thoracic Surgeons National Database by using a Participant User File. The objective was to compare outcomes for neonates undergoing primary and staged Yasui and Ross operations. Primary end points were operative morbidity and mortality.
Results
During the study period, 11.4% (123 of 1079) of neonates with a fundamental diagnosis of IAA and VSD underwent operations indicative of severe LVOTO. Of these patients, 42 (34%) underwent primary biventricular repair (Yasui or Ross/Ross-Konno), and 81 underwent a potential staging procedure (Norwood or hybrid stage I). No differences were observed in preoperative patient characteristics between groups. Neonates undergoing staged repair experienced fewer major complications (0 vs 1; P = .04) and total complications (2 vs 4; P = .02), but similar operative mortality (5% vs 12%; P = .27) as neonates undergoing primary repair. A total of 58 patients undergoing Rastelli, biventricular repair, Yasui, or Ross/Ross-Konno operations with a diagnosis of IAA and VSD and history of neonatal Norwood or hybrid stage I procedures were also identified. Operative mortality for second-stage biventricular conversion operations was 2% (1 of 58). Only 4 centers performed 1 or more complex biventricular repairs for IAA and VSD with LVOTO per year.
Conclusions
Primary and staged biventricular repairs for IAA and VSD with LVOTO are associated with low operative mortality in the modern era and may be favorable to long-term single-ventricle palliation.
{"title":"Primary vs Staged Biventricular Repair for Neonatal IAA with VSD and LVOTO","authors":"Joseph R. Nellis MD, MBA , Jacob C. Scherba BS , James M. Meza MD , Joseph W. Turek MD, PhD , Nicholas D. Andersen MD","doi":"10.1016/j.atssr.2024.04.025","DOIUrl":"10.1016/j.atssr.2024.04.025","url":null,"abstract":"<div><h3>Background</h3><div>This study sought to determine the safety of primary and staged biventricular repair in neonates with interrupted aortic arch (IAA), ventricular septal defect (VSD), and severe left ventricular outflow tract obstruction (LVOTO).</div></div><div><h3>Methods</h3><div>Patients with a fundamental diagnosis of IAA and VSD between 2015 and 2020 were extracted from The Society of Thoracic Surgeons National Database by using a Participant User File. The objective was to compare outcomes for neonates undergoing primary and staged Yasui and Ross operations. Primary end points were operative morbidity and mortality.</div></div><div><h3>Results</h3><div>During the study period, 11.4% (123 of 1079) of neonates with a fundamental diagnosis of IAA and VSD underwent operations indicative of severe LVOTO. Of these patients, 42 (34%) underwent primary biventricular repair (Yasui or Ross/Ross-Konno), and 81 underwent a potential staging procedure (Norwood or hybrid stage I). No differences were observed in preoperative patient characteristics between groups. Neonates undergoing staged repair experienced fewer major complications (0 vs 1; <em>P</em> = .04) and total complications (2 vs 4; <em>P</em> = .02), but similar operative mortality (5% vs 12%; <em>P</em> = .27) as neonates undergoing primary repair. A total of 58 patients undergoing Rastelli, biventricular repair, Yasui, or Ross/Ross-Konno operations with a diagnosis of IAA and VSD and history of neonatal Norwood or hybrid stage I procedures were also identified. Operative mortality for second-stage biventricular conversion operations was 2% (1 of 58). Only 4 centers performed 1 or more complex biventricular repairs for IAA and VSD with LVOTO per year.</div></div><div><h3>Conclusions</h3><div>Primary and staged biventricular repairs for IAA and VSD with LVOTO are associated with low operative mortality in the modern era and may be favorable to long-term single-ventricle palliation.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"2 4","pages":"Pages 815-819"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141132478","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}
The effect of coronary artery bypass grafting (CABG) on cardiac function improvement remains controversial. Furthermore, recent evidence suggests that improvement in cardiac function after CABG does not improve life expectancy. This study aimed to examine whether CABG improved cardiac function and how this improvement influenced all-cause mortality and to compare patient prognosis according to preoperative cardiac function.
Methods
This retrospective study included patients with a left ventricular ejection fraction (LVEF) of ≤35% who underwent CABG between January 1994 and December 2022. We compared patients with and without cardiac function improvement, defined as an increase in LVEF of ≥10%, to identify associated factors and assess the impact on all-cause mortality. We also compared outcomes according to the degree of preoperative LV dysfunction.
Results
Among the 166 patients included, 102 and 64 had a preoperative LVEF of 25%-35% and ≤25%, respectively. The mean follow-up duration was 79.9 ± 72.3 months. We observed significant LVEF improvement, from 28% (range, 23.3%-35%) preoperatively to 39% (range, 31%-46%) at 13.1 months postoperatively. The 7-year survival rates were similar in the ejection fraction ≤25% and 25%-35% groups (80.2% vs 73.8%, P = .11). However, patients with an LVEF improvement of ≥10% exhibited a markedly better prognosis than those without LVEF improvement at 7 years (85.9% vs 63.5%, P=.001).
Conclusions
Our findings suggest that CABG may enhance cardiac function in more than half of patients with ischemic cardiomyopathy, with a correlation to improved all-cause mortality. Moreover, LVEF improvement after CABG is associated with an improved prognosis.
{"title":"Does Cardiac Function Improvement With Coronary Artery Bypass Grafting Reduce All-Cause Mortality?","authors":"Akihiro Higashino MD , Yuya Tsuruta MD , Sadayuki Moriyama MD , Sumio Miura MD , Tsuyoshi Taketani MD, PhD , Takayuki Ohno MD, PhD","doi":"10.1016/j.atssr.2024.05.013","DOIUrl":"10.1016/j.atssr.2024.05.013","url":null,"abstract":"<div><h3>Background</h3><div>The effect of coronary artery bypass grafting (CABG) on cardiac function improvement remains controversial. Furthermore, recent evidence suggests that improvement in cardiac function after CABG does not improve life expectancy. This study aimed to examine whether CABG improved cardiac function and how this improvement influenced all-cause mortality and to compare patient prognosis according to preoperative cardiac function.</div></div><div><h3>Methods</h3><div>This retrospective study included patients with a left ventricular ejection fraction (LVEF) of ≤35% who underwent CABG between January 1994 and December 2022. We compared patients with and without cardiac function improvement, defined as an increase in LVEF of ≥10%, to identify associated factors and assess the impact on all-cause mortality. We also compared outcomes according to the degree of preoperative LV dysfunction.</div></div><div><h3>Results</h3><div>Among the 166 patients included, 102 and 64 had a preoperative LVEF of 25%-35% and ≤25%, respectively. The mean follow-up duration was 79.9 ± 72.3 months. We observed significant LVEF improvement, from 28% (range, 23.3%-35%) preoperatively to 39% (range, 31%-46%) at 13.1 months postoperatively. The 7-year survival rates were similar in the ejection fraction ≤25% and 25%-35% groups (80.2% vs 73.8%, <em>P</em> = .11). However, patients with an LVEF improvement of ≥10% exhibited a markedly better prognosis than those without LVEF improvement at 7 years (85.9% vs 63.5%, <em>P</em>=.001).</div></div><div><h3>Conclusions</h3><div>Our findings suggest that CABG may enhance cardiac function in more than half of patients with ischemic cardiomyopathy, with a correlation to improved all-cause mortality. Moreover, LVEF improvement after CABG is associated with an improved prognosis.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"2 4","pages":"Pages 737-741"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141390953","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}
The patient was a 66-year-old man who developed exacerbation of respiratory and heart failure that necessitated tracheal intubation. The exacerbation was considered to be largely caused by asthma-chronic obstructive pulmonary disease overlap syndrome and type 3 pulmonary hypertension. However, left diaphragmatic eventration and tracheal stenosis were also found. We hypothesized that diaphragmatic eventration and tracheal stenosis surgeries would improve the patient’s pulmonary function, pulmonary hypertension, and cardiac function. Postoperatively, he recovered well and was discharged home on room air, with a good performance status. He also showed improved pulmonary hypertension on echocardiography and improved pulmonary function test results.
{"title":"Improved Pulmonary Hypertension and Heart Failure by Diaphragmatic Plication and Tracheal Resection","authors":"Mitsuaki Kawashima MD, PhD , Chihiro Konoeda MD, PhD , Kazumichi Yamamoto MD, PhD , Masaaki Sato MD, PhD","doi":"10.1016/j.atssr.2024.05.016","DOIUrl":"10.1016/j.atssr.2024.05.016","url":null,"abstract":"<div><div>The patient was a 66-year-old man who developed exacerbation of respiratory and heart failure that necessitated tracheal intubation. The exacerbation was considered to be largely caused by asthma-chronic obstructive pulmonary disease overlap syndrome and type 3 pulmonary hypertension. However, left diaphragmatic eventration and tracheal stenosis were also found. We hypothesized that diaphragmatic eventration and tracheal stenosis surgeries would improve the patient’s pulmonary function, pulmonary hypertension, and cardiac function. Postoperatively, he recovered well and was discharged home on room air, with a good performance status. He also showed improved pulmonary hypertension on echocardiography and improved pulmonary function test results.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"2 4","pages":"Pages 636-639"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141399276","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}
Cellular schwannoma is a schwannoma subtype with histopathologic features resembling those of malignant tumors. We report a case of a cellular schwannoma arising at the resection margin of an anterior mediastinal leiomyosarcoma. An 88-year-old woman who had undergone resection of an anterior mediastinal leiomyosarcoma 2 years previously developed a mediastinal tumor at the resection margin, raising suspicion of leiomyosarcoma recurrence. Pathologic analysis after thoracoscopic resection confirmed a cellular schwannoma. This is an extremely rare cellular schwannoma arising in the anterior mediastinum, suggesting that nerve injury from previous surgery may have contributed to its development.
{"title":"Cellular Schwannoma Arising After the Resection of an Anterior Mediastinal Leiomyosarcoma","authors":"Masayuki Ishida MD , Atsushi Kagimoto MD, PhD , Kazuya Kuraoka MD, PhD , Takeshi Mimura MD, PhD","doi":"10.1016/j.atssr.2024.05.009","DOIUrl":"10.1016/j.atssr.2024.05.009","url":null,"abstract":"<div><div>Cellular schwannoma is a schwannoma subtype with histopathologic features resembling those of malignant tumors. We report a case of a cellular schwannoma arising at the resection margin of an anterior mediastinal leiomyosarcoma. An 88-year-old woman who had undergone resection of an anterior mediastinal leiomyosarcoma 2 years previously developed a mediastinal tumor at the resection margin, raising suspicion of leiomyosarcoma recurrence. Pathologic analysis after thoracoscopic resection confirmed a cellular schwannoma. This is an extremely rare cellular schwannoma arising in the anterior mediastinum, suggesting that nerve injury from previous surgery may have contributed to its development.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"2 4","pages":"Pages 692-694"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141406272","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}
The discussion of Fontan fenestration is difficult because many institutions have different strategies over time. In our institute, we performed a non-fenestrated Fontan procedure for single-ventricular physiology as our definitive strategy.
Methods
Between August 1999 and December 2007, 72 consecutive patients with single-ventricle physiology underwent extracardiac total cavopulmonary connection without fenestration as our definitive strategy. Primary outcomes were Fontan-related events, including death, reoperation, catheter intervention, and postoperative complications such as arrhythmias, protein-losing enteropathy, plastic bronchitis, thrombosis, bleeding, and drainage of pleural effusion after discharge.
Results
The median follow-up duration was 15.7 years (interquartile range, 15.3–18.4). The 1-, 2-, 3-, 5-, 10-, and 15-year occurrence of Fontan-related events was 24%, 43%, 44%, 55%, 67%, and 76%, respectively. The 1-, 2-, 3-, 5-, and 10-year occurrence of venovenous collaterals was 16%, 60%, 65%, 72%, and 81%, respectively. Ventricular end-diastolic pressure was higher in patients with venovenous collaterals (median, 5.0 mm Hg; interquartile range, 4.0-7.0 mm Hg) than in those without (median, 3.5 mm Hg; interquartile range, 3.0-4.25 mm Hg) (P = .01). Multivariable Cox regression analysis showed that higher ventricular end-diastolic pressure and younger age at Fontan completion significantly increased the risk of developing venovenous collaterals, with hazard ratios of 1.22 for each (95% CI, 1.052–1.41; P = .0085 and .016, respectively).
Conclusions
The occurrence rate of Fontan-related events was acceptable with the non-fenestrated Fontan strategy, whereby venovenous collateral development was common. The results suggest that patients with high ventricle end-diastolic pressure and young patients might benefit from fenestration.
背景：丰滩开窗的讨论是困难的，因为随着时间的推移，许多机构有不同的策略。在我们的研究所，我们对单心室生理学进行了无开窗Fontan手术作为我们的最终策略。方法：在1999年8月至2007年12月期间，72例连续的单心室生理患者行不开窗的心外全腔肺连接术。主要结局是fontan相关事件，包括死亡、再手术、导管介入和术后并发症，如心律失常、蛋白质丢失性肠病、可塑性支气管炎、血栓形成、出血和出院后胸腔积液引流。结果：中位随访时间为15.7年（四分位数间距为15.3-18.4）。1年、2年、3年、5年、10年和15年的丰坦相关事件发生率分别为24%、43%、44%、55%、67%和76%。1年、2年、3年、5年和10年静脉侧枝的发生率分别为16%、60%、65%、72%和81%。静脉静脉侧支患者的心室舒张末期压较高(中位数，5.0 mm Hg；四分位数范围，4.0-7.0 mm Hg)比未治疗组(中位数，3.5 mm Hg；四分位数范围为3.0 ~ 4.25 mm Hg) （P = 0.01）。多变量Cox回归分析显示，较高的心室舒张末期压和较年轻的Fontan完成手术年龄显著增加了发生静脉静脉侧枝的风险，两者的风险比为1.22 (95% CI, 1.052-1.41；P = 0.0085和0.016)。结论：非开窗Fontan策略的Fontan相关事件发生率是可以接受的，其中静脉-静脉侧枝发育是常见的。结果表明，高心室舒张末期压患者和年轻患者可能受益于开窗。
{"title":"Long-Term Outcomes of the Non-Fenestrated Strategy for Extracardiac Total Cavopulmonary Connection","authors":"Daisuke Takeyoshi MD , Takeshi Konuma MD, PhD , Ai Kojima MD , Kiyohiro Takigiku MD, PhD , Takamasa Takeuchi MD, PhD , Hiroyuki Kamiya MD, PhD , Yorikazu Harada MD, PhD","doi":"10.1016/j.atssr.2024.06.009","DOIUrl":"10.1016/j.atssr.2024.06.009","url":null,"abstract":"<div><h3>Background</h3><div>The discussion of Fontan fenestration is difficult because many institutions have different strategies over time. In our institute, we performed a non-fenestrated Fontan procedure for single-ventricular physiology as our definitive strategy.</div></div><div><h3>Methods</h3><div>Between August 1999 and December 2007, 72 consecutive patients with single-ventricle physiology underwent extracardiac total cavopulmonary connection without fenestration as our definitive strategy. Primary outcomes were Fontan-related events, including death, reoperation, catheter intervention, and postoperative complications such as arrhythmias, protein-losing enteropathy, plastic bronchitis, thrombosis, bleeding, and drainage of pleural effusion after discharge.</div></div><div><h3>Results</h3><div>The median follow-up duration was 15.7 years (interquartile range, 15.3–18.4). The 1-, 2-, 3-, 5-, 10-, and 15-year occurrence of Fontan-related events was 24%, 43%, 44%, 55%, 67%, and 76%, respectively. The 1-, 2-, 3-, 5-, and 10-year occurrence of venovenous collaterals was 16%, 60%, 65%, 72%, and 81%, respectively. Ventricular end-diastolic pressure was higher in patients with venovenous collaterals (median, 5.0 mm Hg; interquartile range, 4.0-7.0 mm Hg) than in those without (median, 3.5 mm Hg; interquartile range, 3.0-4.25 mm Hg) (<em>P</em> = .01). Multivariable Cox regression analysis showed that higher ventricular end-diastolic pressure and younger age at Fontan completion significantly increased the risk of developing venovenous collaterals, with hazard ratios of 1.22 for each (95% CI, 1.052–1.41; <em>P</em> = .0085 and .016, respectively).</div></div><div><h3>Conclusions</h3><div>The occurrence rate of Fontan-related events was acceptable with the non-fenestrated Fontan strategy, whereby venovenous collateral development was common. The results suggest that patients with high ventricle end-diastolic pressure and young patients might benefit from fenestration.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"2 4","pages":"Pages 820-824"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959681","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.2024.06.013
Jennifer Whiteley MD , Hongchao Shan MD , Jonathan C. Yeung MD, PhD
Ex vivo lung perfusion (EVLP) is used to evaluate donor lungs prior to lung transplantation. Development of pulmonary edema during EVLP is generally thought to represent inflammatory breakdown of the air-fluid barrier and these lungs are declined for transplant. We present the case of a donor lung that underwent stapled wedge resection during cold storage for air leak and the subsequent development of profound (∼650 mL) pulmonary edema around the staple line during EVLP. Nevertheless, the edema cleared shortly after implantation. This report illustrates the potential for significant alveolar fluid clearance and sealing of vascular injury after implantation when edema is not caused by inflammatory injury.
{"title":"Noninflammatory Causes of Pulmonary Edema During Ex Vivo Lung Perfusion","authors":"Jennifer Whiteley MD , Hongchao Shan MD , Jonathan C. Yeung MD, PhD","doi":"10.1016/j.atssr.2024.06.013","DOIUrl":"10.1016/j.atssr.2024.06.013","url":null,"abstract":"<div><div>Ex vivo lung perfusion (EVLP) is used to evaluate donor lungs prior to lung transplantation. Development of pulmonary edema during EVLP is generally thought to represent inflammatory breakdown of the air-fluid barrier and these lungs are declined for transplant. We present the case of a donor lung that underwent stapled wedge resection during cold storage for air leak and the subsequent development of profound (∼650 mL) pulmonary edema around the staple line during EVLP. Nevertheless, the edema cleared shortly after implantation. This report illustrates the potential for significant alveolar fluid clearance and sealing of vascular injury after implantation when edema is not caused by inflammatory injury.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"2 4","pages":"Pages 848-850"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959682","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}
Although segmentectomy is the standard surgical procedure for small-sized peripheral non-small cell lung cancer, reports on segmentectomy for right middle robe are rare because of the anatomical feature. We report a case of an 81-year-old woman with a history of left S4 segmentectomy, left basal segmentectomy, and right upper lobectomy for multiple primary lung cancer with a part solid nodule in S4a. Owing to the increased volume of the right middle lobe following a right upper lobectomy, a right S4 segmentectomy was performed. In patients with a large right middle lobe or dilated resulting from a previous lung resection, segmentectomy is an option for preserving the lung parenchyma.
{"title":"Robotic Portal Segmentectomy in the Right Middle Lobe After Right Upper Lobectomy","authors":"Ryusuke Sumiya MD, PhD , Takeshi Matsunaga MD, PhD , Yukio Watanabe MD, PhD , Mariko Fukui MD, PhD , Aritoshi Hattori MD, PhD , Kazuya Takamochi MD, PhD , Kenji Suzuki MD, PhD","doi":"10.1016/j.atssr.2024.07.015","DOIUrl":"10.1016/j.atssr.2024.07.015","url":null,"abstract":"<div><div>Although segmentectomy is the standard surgical procedure for small-sized peripheral non-small cell lung cancer, reports on segmentectomy for right middle robe are rare because of the anatomical feature. We report a case of an 81-year-old woman with a history of left S4 segmentectomy, left basal segmentectomy, and right upper lobectomy for multiple primary lung cancer with a part solid nodule in S4a. Owing to the increased volume of the right middle lobe following a right upper lobectomy, a right S4 segmentectomy was performed. In patients with a large right middle lobe or dilated resulting from a previous lung resection, segmentectomy is an option for preserving the lung parenchyma.</div></div>","PeriodicalId":72234,"journal":{"name":"Annals of thoracic surgery short reports","volume":"2 4","pages":"Pages 640-642"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11708698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959719","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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