Cardiovascular surgery (London, England)最新文献

英文中文

Which strategy should be chosen for ischemic free wall rupture on-pump or off-pump? 缺血游离壁破裂在泵上或泵外应选择哪种策略?

Cardiovascular surgery (London, England)

Pub Date : 2018-01-01 DOI: 10.35841/CARDIOVASCULAR-SURGERY.1.2.48-49

Y. Misawa

In 2017, I reported sutureless repair as a treatment for ischemic heart rupture, and found that an offpump technique using fibrin glue sheets or other materials might contribute to excellent clinical results. In a similar case, Ishii and colleagues reported a patient who underwent sutureless repair with hemostat materials on the bleeding site without cardiopulmonary bypass. Even today, conventional repair under cardiopulmonary bypass leads to unsatisfactory results. A case of a huge pseudoaneurysm after such a repair of left ventricular wall rupture was reported. Although this kind of repair is a simple procedure for ischemic rupture of the left ventricle, clinicians should consider that it carries a potential risk of aneurysmal formation after surgery.

在2017年，我报道了无缝线修复作为缺血性心脏破裂的治疗方法，并发现使用纤维蛋白胶片或其他材料的offpump技术可能有助于取得出色的临床效果。在一个类似的病例中，Ishii和他的同事报告了一个病人在没有体外循环的情况下，在出血部位使用止血材料进行了无缝线修复。即使在今天，传统的体外循环修复术也不能令人满意。本文报告一例巨大假性动脉瘤在左心室壁破裂修复后发生。虽然这种修复对于缺血性左心室破裂是一种简单的方法，但临床医生应该考虑到手术后动脉瘤形成的潜在风险。

引用次数: 0

Commentary: Transcatheter aortic valve implantation in morphologically complex root-aneurysms. 评论:经导管主动脉瓣植入术治疗形态复杂的根状动脉瘤。

Cardiovascular surgery (London, England)

Pub Date : 2018-01-01 DOI: 10.35841/cardiovascular-surgery.1.2.44-45

B. Winkler, M. Grabenwöger, M. Mach

引用次数: 1

Chest wall desmoid tumor after double lung transplantation 双肺移植后胸壁硬纤维瘤

Cardiovascular surgery (London, England)

Pub Date : 2018-01-01 DOI: 10.35841/CARDIOVASCULAR-SURGERY.2.1.1-5

Matthew P. Fahrenkopf, John P. Kelpin, Edward Murphy, E. Komorowska‐Timek

Desmoid tumors pose a number of unique challenges to treating physicians. They have an unpredictable clinical course, aggressive nature, and predilection for recurrence after resection. They frequently develop in areas of previous trauma and have also been thought to be sensitive to hormonal stimuli. Conservative management is often recommended as a primary therapeutic option. Surgery becomes necessary for those patients with symptomatic and/or progressively enlarging lesions. Complete resection is often considered the “gold standard”, but surgeons should always consider minimizing morbidity and maximizing function. There are a limited number of reports in the literature describing desmoid tumors after solid organ transplantation. Here, we report a 66-year-old gentleman who was found to have a mass on his right chest wall two years after lung transplantation. The patient was initially monitored with serial radiographic imaging. Rapid growth prompted a tissue biopsy, revealing a desmoid tumor. Continued expansion and invasion of the lesion into the surrounding osteocutaneous structures required surgical intervention. En bloc resection of the mass with immediate chest wall reconstruction was performed. New lesions developing after transplantation must be monitored with scrutiny. Desmoid tumors, though rare, should be considered in this differential diagnosis. Early diagnosis may decrease patient morbidity by reducing the extent of resection.

硬纤维瘤对治疗医生提出了许多独特的挑战。它们具有不可预测的临床病程、侵袭性和切除后复发的倾向。它们经常在以前的创伤区域发展，也被认为对激素刺激敏感。保守治疗通常被推荐为主要的治疗选择。对于有症状和/或病变逐渐扩大的患者，手术是必要的。完全切除通常被认为是“金标准”，但外科医生应始终考虑最小化发病率和最大化功能。文献中描述实体器官移植后硬纤维瘤的报道数量有限。在此，我们报告一位66岁的男士，在肺移植两年后发现右胸壁有肿块。患者最初通过一系列放射成像进行监测。快速生长促使组织活检，发现一个硬纤维瘤。病变持续扩大并侵入周围的骨皮结构需要手术干预。整块切除肿块并立即重建胸壁。移植后发生的新病变必须仔细监测。硬纤维瘤虽然罕见，但在鉴别诊断中应予以考虑。早期诊断可以通过减少切除的范围来降低患者的发病率。

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引用次数: 2

Surgery of extensive defects of the anterior wall of the trachea and soft tissues of the neck after laryngo-tracheostomy 喉气管切开术后气管前壁及颈部软组织广泛缺损的外科治疗

Cardiovascular surgery (London, England)

Pub Date : 2018-01-01 DOI: 10.35841/cardiovascular-surgery.1.3.63-70

Eshonhodjaev Otabek Djuraevich, Khudaybergenov Shukhrat Nurmatovich, Hayaliev Rustem Yakubovich, Tuhtaev Denis, Mirsidikov Mirabbos, Egamov Faruh

The authors present the results of treatment of 103 patients with extensive defects of the trachea and soft tissues of the neck after laringo-tracheostomy or tracheostomy. The article shows a differentiated approach to the plastic of the anterior wall of the trachea depending on the size of the defect. The efficiency of two-stage reconstructive plastic surgery with the installation of T-stent in the stenosis zone with exposure of 6 months to 8 months is proved. Microsurgical aid was needed for patients who had previously undergone multiple interventions on the trachea in other hospitals.

本文报告103例经气管造瘘或气管造瘘后气管及颈部软组织广泛缺损的治疗结果。这篇文章展示了一种不同的方法来塑料的气管前壁取决于大小的缺陷。在狭窄区放置t型支架，暴露时间6 ~ 8个月的两期重建整形手术的有效性得到了证实。以前在其他医院接受过多次气管介入治疗的患者需要显微外科辅助。

引用次数: 0

Endovascular treatment of a carotid pseudoaneurysm with covered stents: Case report and review of the literature. 有盖支架血管内治疗颈动脉假性动脉瘤:病例报告及文献回顾。

Cardiovascular surgery (London, England)

Pub Date : 2018-01-01 DOI: 10.35841/CARDIOVASCULAR-SURGERY.1.1.11-14

M. A. Hosn

Although endovascular placement of covered stent grafts has emerged as the primary treatment modality for arterial aneurysms, pseudoaneurysms and traumatic arterial injuries especially in high risk patients and in those with surgically inaccessible lesions, their use in carotid pseudoaneurysms remains uncommon and is limited to case reports and small case series. We report a successful endovascular treatment of a spontaneous right carotid pseudoaneurysm with a covered stent with no immediate perioperative complication and complete exclusion of the pseudoaneurysm on follow up imaging. We also review the literature on the treatment of carotid pseudoaneurysms with covered stents.

尽管血管内置入覆膜支架已成为动脉动脉瘤、假性动脉瘤和外伤性动脉损伤的主要治疗方式，特别是在高风险患者和手术无法到达病变的患者中，但其在颈动脉假性动脉瘤中的应用仍然不常见，仅限于病例报告和小病例系列。我们报告一个成功的血管内治疗自发性右颈假性动脉瘤的覆盖支架，没有立即围手术期并发症和完全排除假性动脉瘤的随访成像。我们也回顾了用覆盖支架治疗颈动脉假性动脉瘤的文献。

引用次数: 1

Survival analysis and postoperative complications after ventricular assist device implantation; prognostic value of INTERMACS scale 心室辅助装置植入术后的生存分析及术后并发症INTERMACS量表的预后价值

Cardiovascular surgery (London, England)

Pub Date : 2018-01-01 DOI: 10.35841/cardiovascular-surgery.1.1.15-23

Ahmed Ahmed, Pizanis Nikolaus, Koch Achim, Carstens Henning, Rassaf Tienush, Ludike Peter, Kamler Markus

Background: Ventricular assist devices (VADs) improve survival and quality of life in patients with refractory heart failure. This study retrospectively evaluates patients’ profiles, clinical outcome in patients who underwent LVAD implantation in regard to their INTERMACS level. Methods: In a single center analysis, data of 104 patients after LVAD implantation between August 2010 and March 2015 were analyzed retrospectively. According to INTERMACS level, 3 groups were compared: Group A (INTERMCAS level 1, n=27 patients), group B (INTERMACS level 2/3, n=47) and group C (INTERMACS level 4-6, n=30). Preoperative parameters and postoperative outcome were compared between groups. Results: Mortality was higher in group A compared to group B (p=0.017) and group C (p=0.017). Sepsis was the most common post-operative complication after LVAD implantation. Conclusion: INTERMACS level was related to outcome after LVAD implantation. Optimization of preoperative volume status, preload and sepsis management are recommended to lower mortality in these patients.

背景:心室辅助装置(VADs)改善难治性心力衰竭患者的生存和生活质量。本研究回顾性评估了LVAD植入患者的临床结果和INTERMACS水平。方法:采用单中心分析方法，对2010年8月至2015年3月104例LVAD植入术患者的资料进行回顾性分析。根据INTERMACS水平比较3组:A组(INTERMACS水平1,n=27例)、B组(INTERMACS水平2/3,n=47例)和C组(INTERMACS水平4-6,n=30例)。比较两组术前参数及术后结果。结果:A组死亡率高于B组(p=0.017)和C组(p=0.017)。脓毒症是LVAD植入后最常见的术后并发症。结论:INTERMACS水平与LVAD植入后的预后有关。建议优化术前容量状态、预负荷和脓毒症管理，以降低这些患者的死亡率。

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引用次数: 2

Commentary: Shone complex. 评论:闪耀的情结。

Cardiovascular surgery (London, England)

Pub Date : 2018-01-01 DOI: 10.35841/CARDIOVASCULAR-SURGERY.1.2.46-47

Jaffar S. Shehatha

引用次数: 0

Innovative mirror image transatrial techniques for biventricular repair in inverted dextrocardia 革新镜像经房技术用于右心内翻性双室修复

Cardiovascular surgery (London, England)

Pub Date : 2018-01-01 DOI: 10.35841/CARDIOVASCULAR-SURGERY.1.2.30-38

G. Salve, Shreepal Jain, Manglesh S Nimbalkar, ip S Katkade, Jeril Kurien, Himanshu Choudhury, B. Dalvi, R. Kumar, K. Shivaprakash

Background: Correction of hearts with situs inversus dextrocardia represent technical challenges due to mirror image anatomy and altered conduction pathway. Ventriculotomy has been the traditional approach for biventricular repair. We report our experience of trans-atrial approach in these patients employing an easily reproducible preoperative delineation of the anatomy. In addition we also discuss our way of surgical execution for these complex subsets. Methods and Findings: 15 patients (M:F=7:8) with situs inversus dextrocardia with diverse congenital cardiac anomalies underwent biventricular repair through our trans-atrial approach from left side of patient with detailed pre-operative evaluation of the anomalies. Orientation of intra-cardiac anatomy was obtained pre-operatively by rendering standard illustrations in reversed and inverted way. Median age and weight were 12 months (4.5 months-31 years) and 5.8 kg (3.4-59 kg) respectively. The surgical spectrum included closure of ventricular septal defects (n=6), repair of double outlet right ventricle (n=3), repair of tetralogy of Fallot (n=5) and double switch operation for congenitally corrected transposition of great arteries, routable ventricular septal defect and pulmonary stenosis. Tricuspid valve leaflet detachment was performed frequently to aid the repair (n=7). Mean hospital stay was 12.4 ± 2.6 days with no hospital mortality. On follow-up, all patients remained in sinus rhythm and in New York Heart Association class I. One patient had a small residual ventricular septal defect with insignificant shunt. Another patient with tetralogy of Fallot correction underwent right pulmonary artery balloon plasty. Patient with double switch operation needed re-admission for supraventricular tachycardia and medical management. Another patient of tetralogy of Fallot re-developed infundibular gradient, awaiting intervention. Conclusions: Trans-atrial biventricular repair is feasible and reproducible in these subsets. The inverted illustrations facilitate in enabling successful repairs while avoiding heart blocks and ventriculotomy. Short-term results are satisfactory.

背景:由于镜像解剖和传导途径的改变，心脏右位逆位矫正是技术上的挑战。脑室切开术一直是双心室修复的传统方法。我们报告我们的经验，经心房入路在这些患者采用一个容易重复的术前解剖描绘。此外，我们还讨论了这些复杂子集的手术执行方法。方法和结果:15例(M:F=7:8)先天性右心位畸形患者经左心房入路行双心室修复术，术前对畸形进行详细评估。术前通过逆行和倒行方式绘制标准图，获得心内解剖的方位。中位年龄和体重分别为12个月(4.5个月-31岁)和5.8公斤(3.4-59公斤)。手术谱包括室间隔缺损封闭术(n=6)、双出口右心室修复术(n=3)、法洛四联症修复术(n=5)以及先天性大动脉转位、可达性室间隔缺损和肺动脉狭窄双开关手术。经常进行三尖瓣小叶剥离以帮助修复(n=7)。平均住院时间为12.4±2.6天，无院内死亡。在随访中，所有患者保持窦性心律和纽约心脏协会i级。1例患者有小的残余室间隔缺损和轻微的分流。另一名法洛四联症患者接受了右肺动脉球囊成形术。双开关手术患者因室上性心动过速需再次入院治疗。另一名法洛四联症患者再次出现漏斗梯度，等待治疗。结论:经房双心室修复在这些亚群中是可行且可重复的。倒置插图有助于成功修复，同时避免心脏阻滞和脑室切开术。短期效果令人满意。

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引用次数: 0

Experiences in robotically enhanced IMA-preparation as initial step towards totally endoscopic coronary artery bypass grafting 机器人增强ima准备作为全内窥镜冠状动脉旁路移植术的第一步的经验

Cardiovascular surgery (London, England)

Pub Date : 2003-12-01 DOI: 10.1016/S0967-2109(03)00114-5

O Reuthebuch, M Comber, J Grünenfelder, G Zünd, M Turina

Aim: To evaluate the feasibility of robotically enhanced preparation of internal mammary arteries (IMA).

Method: Via three trocars in left thoracic wall the left, right or both IMA were skeletonized under CO₂ insufflation and single lung ventilation using electrocautery.

Results: In 12 months, 26 LIMA, five BIMA and one RIMA were dissected. In five patients, the procedure had to be determined (IMA injury (two), respiratory insufficiency (two), and heart penetration (one)). Mean intrathoracic pressure was 9.7±1.5 mmHg. Mean time for LIMA and RIMA dissection was 66.7±21.1 and 99.2±8.7 min, respectively. In 10 patients, pericardium was incised and course of LAD assessed. However, in two patients, this coronary did not correlate with LAD. Time for instrument change depended on type of tool (cautery blade: 24.9±13.1 s, clip applier 72.8±28.4 s).

Conclusion: Robotic dissection of IMA is reasonable. However, life-threatening complications can barely be managed due to inadequate tools and excessive time for instrument change. Incorrect determination of coronaries can result in misplaced anastomoses.

目的:探讨机器人增强乳腺内动脉预备术的可行性。方法:在CO2灌注和单肺通气的情况下，采用电灼法对左、右或双侧IMA进行骨化。结果:12个月内，共切除LIMA 26例，BIMA 5例，RIMA 1例。在5例患者中，必须确定手术方法(2例IMA损伤，2例呼吸功能不全，1例心脏穿透)。平均胸内压为9.7±1.5 mmHg。LIMA和RIMA的平均解剖时间分别为66.7±21.1 min和99.2±8.7 min。10例患者切开心包，评估LAD病程。然而，在2例患者中，冠状动脉与LAD无关。换刀时间随刀具类型的不同而不同(烧灼刀:24.9±13.1 s，夹钳:72.8±28.4 s)。结论:机器人切割IMA是合理的。然而，由于工具不足和更换器械的时间过长，危及生命的并发症几乎无法得到控制。不正确的冠状动脉测定可导致吻合错位。

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引用次数: 0

Cardiovascular surgery: A reflection 心血管外科:反思

Cardiovascular surgery (London, England)

Pub Date : 2003-12-01 DOI: 10.1016/j.cardiosur.2003.10.001

James S.T Yao

引用次数: 1

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全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

期刊

Cardiovascular surgery (London, England)

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