Objective: Minimally invasive multivessel coronary bypass performed through a left anterior minithoracotomy may be associated with early postoperative respiratory events related to thoracotomy, one-lung ventilation, and perioperative ventilatory management. This study aimed to describe the early postoperative pulmonary complication profile in our center and to report the use of selective postoperative non-invasive mechanical ventilation (NIMV) in routine clinical practice. Method: This single-center retrospective descriptive study included 77 consecutive patients who underwent minimally invasive on-pump multivessel coronary bypass surgery through a left anterior mini-thoracotomy between January 2022 and December 2024. Patients were evaluated for early postoperative pulmonary complications documented in the clinical record and chest radiography, including atelectatic changes, pleural effusion, pneumonia, decreased partial oxygen pressure (PaO2), and blunting of the costophrenic angle. Preoperative spirometry was obtained when clinically feasible. Results: Seventy-seven patients (44-79 years; mean age 58.2 years) were included. Preoperative spirometry was available in 51 patients. Five patients required postoperative NIMV because of radiographic and/or oxygenation findings during follow-up; in two of these patients, intermittent ward NIMV was administered for SpO(2) <92% and PaO2 <70 mmHg, with subsequent improvement in oxygen saturation to >94% after NIMV sessions and mobilization. Postoperative pneumonia occurred in one patient and pleural effusion in two patients; no thoracentesis was required. Mean room-air discharge values were acceptable at cohort level (Table 5), with PaO2 99 mmHg, PaCO2 34 mmHg, and SpO(2) 94%. Conclusion: In this selected retrospective cohort, early postoperative pulmonary complications after minimally invasive multivessel bypass surgery were infrequent and were managed predominantly with conservative treatment; selective NIMV was used in a small subset of patients as rescue support. The present data support feasibility reporting only and do not establish NIMV efficacy. Prospective comparative studies with standardized postoperative pulmonary assessments are needed.
Minimally invasive techniques are increasingly being adopted in cardiac surgery. Although thoracotomy-based approaches are well established for selected coronary and mitral operations, median sternotomy remains the standard access for most combined pathologies because of technical complexity and limited evidence. In this case series, we describe two highly selected patients who underwent combined coronary artery bypass grafting and mitral valve repair via bilateral mini-thoracotomy without sternotomy. We report the operative strategy, perioperative course, and early outcomes as a feasibility-focused technical experience. In both patients, the procedures were completed without conversion to sternotomy, mitral repair was confirmed intraoperatively by transesophageal echocardiography, and no major perioperative adverse events listed in Table 1 were observed. In conclusion, bilateral mini-thoracotomy appears technically feasible in carefully selected patients treated by an experienced minimally invasive team; however, this two-patient case series does not permit comparative claims regarding superiority, complication reduction, or long-term effectiveness.
Background: Secondary amenorrhea, defined as the absence of menstruation for three or more consecutive months in women with previously regular cycles, has a broad differential diagnosis that includes endocrine, metabolic, psychosocial, and systemic causes. Heart failure (HF) is a multisystem syndrome that may alter neurohormonal signaling and physiologic stress responses, creating a biologically plausible context for menstrual disturbance. We report a case in which menstrual function resumed after treatment and clinical stabilization of HF. Case Report: A 25-year-old female with a two-year history of secondary amenorrhea presented with exertional dyspnea, orthopnea, and bilateral lower extremity edema. Physical examination showed elevated jugular venous pressure and a systolic murmur. Echocardiography demonstrated mildly reduced left ventricular ejection fraction (44%), dextrocardia, left atrial enlargement, and moderate mitral regurgitation. She was diagnosed with congestive heart failure and treated with intravenous diuretics followed by guideline-directed medical therapy (beta-blocker, angiotensin-converting enzyme inhibitor, and mineralocorticoid receptor antagonist). Her symptoms improved clinically, and by the third month of follow-up she reported return of menstruation, with continued regular cycles during 9 months of follow-up. Conclusion: This case demonstrates a temporal association between HF treatment/clinical improvement and resolution of secondary amenorrhea, but it does not establish causality. The observation is hypothesis-generating and should be interpreted in the context of an incomplete endocrine-gynecologic etiologic evaluation and the absence of serial hormonal measurements. Nevertheless, the case supports clinical awareness of menstrual health in women with HF and motivates prospective studies using standardized reproductive and cardiovascular assessments to clarify mechanisms and determine whether this association is reproducible. (c) 2026 The Author's. Published by Insuficiencia Cardiaca. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/)
Background: Radiotherapy (RT) for breast cancer could be associated with subclinical cardiac dysfunction that cannot be identified by conventional echocardiographic parameters. Transthoracic echocardiography (TTE) using Global longitudinal strain (GLS) is a valuable predictor of sub-clinical myocardial dysfunction. Objective: Using transthoracic echocardiography with global longitudinal strain analysis to evaluate whether post-radiotherapy alterations in left ventricular (LV) strain reflect early evidence of cardiac remodeling in breast cancer patients. Study Design: Cohort study. Place and Duration of Study: this prospective cohort study was conducted at Al-Najaf Center for Cardiac Surgery and Transcatheter Therapy, Al-Sader Teaching Hospital in Al-Najaf city from December 2024 to September 2025. Methods: This cohort study was consisted of 40 females with breast cancer between the ages of 20 and 65 years were split into two groups: left sided breast cancer patients (n=18) and right sided breast cancer patients (n=22). Left ventricular global longitudinal strain (LVGLS) Was assessed using standard 2D transthoracic echocardiography pre-radiotherapy and within10 days post-radiotherapy. Independent t-test, paired t-test and ANOVA test were used for statistical comparisons. Results: Compared to pre radiotherapy, post radiotherapy left ventricular global longitudinal strain was significantly decreased (-16.34 +/- 1.44% vs.-18.09%+/- 1.6%, p<0.001). left sided breast cancer patients had a significantly higher reduction in LV GLS compared to right sided (-15.7%+/- 0.9% vs.-16.9%+/- 1.5%, p=0.006). Higher body mass index (BMI) was associated with higher reduction in LV GLS. Conclusion: Even before the presence of obvious clinical symptoms, LVGLS is an early indicator of post radiotherapy sub clinical cardio-toxicity in breast cancer patients. Left side irritation is associated with a higher reduction in LVGLS. The early changes in GLS high light the importance of closer cardiac monitoring in breast cancer patients.
Background: Dextrocardia is a rare congenital anomaly, seen in about 1 in 12,000 births, characterized by abnormal cardiac position and thought to result from early cardiac developmental disturbances. This report presents the unusual coexistence of dextrocardia and a posterior fossa arachnoid cyst, a combination seldom described. Case summary: A 25-year-old woman presented with exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea, fatigue, and bilateral peripheral edema. Examination revealed elevated jugular venous pressure, tachycardia, a systolic murmur, ascites, and lower limb edema. Chest X-ray showed dextrocardia and cardiomegaly, while brain CT identified an arachnoid cyst. Laboratory tests demonstrated mild anemia with normal renal function and serum proteins. She was diagnosed with congestive heart failure, started on medical therapy, and chose outpatient follow-up for the cyst without further intervention. Discussion: The coexistence of dextrocardia and an arachnoid cyst suggests a potential genetic link and supports comprehensive genetic evaluation in patients with congenital anomalies. Recognizing such associations may improve understanding of underlying developmental mechanisms and help refine diagnostic and management strategies.
