Interdisciplinary cardiovascular and thoracic surgery最新文献

Objectives: To investigate the application of a mechanical side-to-side oesophagogastric anastomosis in the reconstruction of the digestive tract of beagles after an oesophagectomy.

Methods: Eighteen beagles were randomly divided into 3 groups: the hand-sewn (HS) group, the linear-stapled anastomosis in the oesophagus and anterior portion of the stomach (LESA) group and the linear-stapled anastomosis in the oesophagus and the posterior portion of the stomach (LESP) group. The gastro-oesophageal reflux, anastomotic area, anastomotic bursting pressure and the breaking strength in the beagles at 1 week and 12 weeks after the operations were compared. The histopathological morphology was observed using haematoxylin-eosin staining and Masson staining, and the expression of the vascular endothelial growth factor (VEGF) was detected by immunohistochemical analysis.

Results: At 1 and 12 weeks after the operation, the percentage of gastro-oesophageal reflux time and the longest reflux time in the HS group and the LESP group were higher than those in the LESA group (P < .05). The anastomotic areas in the HS group were significantly smaller than those in the LESA and LESP groups at 1 and 12 weeks postoperatively (P < .05); there were no differences in the anastomotic areas in the LESA and LESP groups. At 1 and 12 weeks postoperatively, the bursting pressure and breaking strength of the anastomosis, the collagen-fibre area ratio and VEGF positive expression in the LESA group were significantly higher than those in the HS group (P < .05).

Conclusions: The mechanical side-to-side oesophagogastric anastomosis of the oesophagus and the anterior wall of the stomach can reduce the occurrence of gastro-oesophageal reflux, increase the bursting pressure and breaking strength, promote collagen fibre and VEGF expression, to promote healing of the anastomosis.

This case series reports four paediatric patients (aged 2-11 years old) who sustained traumatic cardiac rupture following blunt trauma, all of whom were successfully treated at our institution. In contrast to common adult presentations, each case featured a rupture localized specifically to the superior vena cava-right atrial (SVC-RA) junction. Diagnosis was confirmed by echocardiography on the presence of cardiac tamponade. All patients underwent urgent median sternotomy, during which primary repair was accomplished without cardiopulmonary bypass. Postoperatively, both shock index and mean arterial pressure showed significant improvement (P = 0.003 and P = 0.028, respectively), and all children recovered fully without complications. This series highlights the SVC-RA junction as a uniquely vulnerable site in paediatric blunt cardiac injury and demonstrates that rapid diagnosis coupled with timely surgical intervention is paramount for survival.

We report a rare case of a 52-year-old woman with a recurrent intimal sarcoma adjacent to the mitral prosthesis in the left atrium. She had previously undergone initial surgery for mitral valve intimal sarcoma at age 48. At this presentation, we resected a 25-mm tumour as well as the surrounding lesions. Cryoablation was applied using cryoICE on all resection margins and the posterior mitral annulus. The use of a malleable probe facilitated the redo surgery. The patient has remained alive for more than five years following the initial operation and for 11 months after the subsequent redo surgery. Cryoablation may play an important role in improving surgical radicality in cardiac sarcoma.

Objectives: The high intubation rate due to COVID-19 infection has increased the prevalence of post-intubation tracheal stenosis (PITS). We aimed to compare PITS induced by COVID-19 infection with PITS from non-COVID-19 etiologies.

Methods: This cohort study utilized PITS data collected prospectively between January 2018 and May 2023. 337 PITS patients were identified and those with direct neck trauma, burn inhalation injuries, and a prior history of tracheal surgery were excluded. Sixty-one COVID-19-related (CR) and 243 non-COVID-19-related (NCR) patients were compared before and after Propensity Score Matching (PSM) including demographics, comorbidities, intubation duration, clinical presentation, stenosis characteristics, the need for resectional airway surgery, and outcomes.

Results: Before matching, CR patients were older, more diabetic, less smoker, and they experienced longer intubation durations. After PSM, 59 CR and 59 NCR PITS patients, were included for comparison.Although no statistically significant differences were observed in stenosis, CR PITS patients required significantly more airway resection (81.4%) for definitive management than NCR (42.4%), P-value < 0.001. Postoperative complications, recurrence, and outcomes revealed no significant differences after PSM.

Conclusions: Given the increased need for surgical resection in CR PITS patients, thoracic surgeons should consider the increased likelihood of conservative therapy failure in them. Considering this finding and that no statistically significant difference was observed in postoperative outcomes in our study, we recommend a sooner decision for resectional airway surgery in CR than NCR PITS patients.

This case report presents a instance of pleural epithelioid hemangioendothelioma (EHE), a vascular tumour with an incidence of less than 1% among vascular tumors. The patient, a 43-year-old man, presented with a right-sided pleural effusion, longstanding neck and shoulder pain, and worsening pleuritic chest pain. Initial imaging revealed a left infra-clavicular soft tissue mass, pleural thickening, and pulmonary nodules suggestive of metastases. Despite inconclusive initial biopsies, immunohistochemistry and an international pathology review confirmed EHE, characterised by CAMTA1 expression and WWTR1 CAMTA1 fusion. The pleural involvement indicated metastatic disease, leading to a poor prognosis. Treatment with the MEK inhibitor trametinib was initiated, but the patient died within three months. This case underscores the diagnostic challenges of EHE due to its rarity and variable clinical presentation, which often delays diagnosis until advanced stages. The report highlights the aggressive nature of pleural EHE and lack of standardised treatments, emphasising the need for early recognition.

Objectives: Repair of common arterial trunk (CAT) involves establishing the right ventricular outflow tract (RVOT) using either a conduit or a direct right ventricle-pulmonary artery (RVPA) anastomosis (DA). Conduits offer a valved pathway but are limited by durability and availability. The comparative outcomes of these two techniques remain uncertain. This work assessed whether DA improves survival, reduces complications and reinterventions outcomes compared to conduit repair.

Methods: PubMed, Web of Science, EMBASE, and Cochrane Central were searched for studies comparing conduit versus DA for RVOT reconstruction from 20 February 2025 to 30 March 2025. Primary outcome was early mortality; secondary outcomes included haemodynamics, recovery, and complications. Time-to-event data were reconstructed from Kaplan-Meier curves. Pooled hazard ratios (HR), risk ratios (RR), or mean differences (MD) with 95% confidence intervals were calculated using random-effects models.

Results: Eleven studies (767 patients; 419 conduit, 348 DA) were included. Early mortality (RR = 0.61, 95% CI 0.26-1.44, p = 0.220) and long-term survival (HR = 1.11, 95% CI 0.61-2.02, p = 0.738) were similar. Reoperation was more frequent in the conduit group (HR = 1.77, 95% CI 1.05-3.01, p = 0.034). Conduit repair required longer ventilation (MD = 3.44 days, p = 0.010) and hospitalisation (MD = 4.77 days, p = 0.030), with comparable ICU stay and RVOT growth. Truncal valve insufficiency (RR = 0.13, p = 0.130 for Truncal valve vs Conduit) was similar in incidence following DA.

Conclusions: Conduit and DA repairs yield similar survival and postoperative complications in CAT, while DA offers fewer reoperations and faster recovery. Data from future prospective multicentre trials will support decision-making.

A neonate who underwent corrective surgery for cardiac-type total anomalous pulmonary venous connection (TAPVC) was suspected of having a pseudoaneurysm of the left ventricular (LV) free wall on transthoracic echocardiography (TTE) on postoperative day 11. Emergency surgery was performed the following day, revealing LV rupture due to a congenital partial defect of the LV free wall. The defect was successfully repaired using double patches closure reinforced with BioGlue. The postoperative course was uneventful. This case highlights that left ventricular rupture may occur due to an unrecognized congenital defect after neonatal cardiac surgery, particularly in conditions such as TAPVC where the left ventricle is underfilled preoperatively.

The patient was diagnosed with unguarded tricuspid orifice (UGTO), functional pulmonary atresia, and left pulmonary artery hypoplasia. In view of the severe right ventricular dysfunction, the staged single ventricular palliation procedure was selected. The surgical procedure on Starnes operation and left pulmonary artery augmentation, was performed one month after birth. As left pulmonary artery stenosis was diagnosed, secondly, the bidirectional cavopulmonary shunt with additional systemic to pulmonary shunt and intrapulmonary patch septation and left pulmonary artery augmentation with in-situ pericardium were performed. Despite the necessity for additional balloon dilation and surgical blunt dilation, the total cavopulmonary connection operation was ultimately performed, resulting in the successful implementation of staged single-ventricle palliation in conjunction with left pulmonary artery rehabilitation.

Objectives: Selective pulmonary artery perfusion with blood flow occlusion (SPAP-BFO), an experimental endovascular technique, has shown potential to enhance pulmonary drug delivery to the lung. Therefore, it becomes a potential minimally invasive technique for lung cancer and pulmonary metastases. Prior studies predominantly used animal models which do not adequately replicate human vascular anatomy, leaving the clinical feasibility of SPAP-BFO underexplored. To address this gap, we developed a patient-specific 3 D model of the human venous system to evaluate the technical feasibility of SPAP-BFO.

Methods: A 1:1 scale 3 D model of the human venous system was developed and printed based on computed tomography scans of a patient. This model was connected to a perfusion system to simulate blood flow, enabling testing of the catheterization procedure under realistic clinical conditions. Two commercially available balloon catheters, Coda (Cook) and Reliant (Medtronic), were selected based on length and balloon diameter, and their feasibility of reaching and occluding the left and right pulmonary arteries were assessed.

Results: The model effectively simulated human anatomy and blood flow, allowing for both visual and fluoroscopic assessment of the procedure. Both Coda and Reliant catheters successfully reached the target location, when introduced via the femoral vein, and occluded the left and right pulmonary arteries without physically blocking contralateral flow or extending beyond the first bifurcation.

Conclusions: This patient-specific 3 D model provided a valuable platform to evaluate the clinical feasibility of SPAP-BFO. The Coda and Reliant balloon catheters demonstrated effective occlusion of the pulmonary arteries, supporting their potential use in SPAP-BFO procedures.