Introduction: Treatments for cardiovascular diseases have increasingly evolved with the tendency to offer minimally invasive or transcatheter procedures instead of conventional sternotomy surgery. In this context, we highlight minimally invasive mitral valve surgery (MIMVS), which has been shown to be an increasingly solid option with some superior results when compared to the conventional technique: better pain control, shorter hospital stays, shorter recovery time, shorter readmission rate in the first postoperative year, better aesthetic results, and lower overall cost. Aim: This study aims to evaluate the stages of MIMVS, by primary mitral valve consultation, in our service and compare these results with data from the literature. Methods: All electronic medical records of patients who underwent MIMVS for primary mitral valve injury in the Encore Hospital from January 2020 to February 2023 were analyzed. Tabulation and statistical analysis were performed using the Microsoft Excel® program. Quantitative variables were presented as means, standard deviations. Results: 46 patients were enrolled in our study (Age: 59.1 ± 12.4 years old; 60.8% Female, BMI: 26 ± 4.4 Kg/m2, Low risk STS score: 82.6%). The observed 30-day mortality was 2.1%, plastic rate of 23.9%, blood transfusion rate of 41.3%, length of stay in an intensive care bed (ICB) of 3.3 ± 3.3 days and hospital stay of 6.4 ± 5.1 days. Conclusions: We noticed that the MIMVS results carried out in our service agree with data from national and international literature with approximately 1.3 days more hospitalization in ICB.
Ganglioneuroma is an extremely rare tumor that is derived from neural crest. Many ganglioneuroma cases are detected incidentally unless they are large enough to cause compressive symptoms. We report an 18-year-old patient with posterior mediastinal ganglioneuroma which was abutting the descending aorta. The patient underwent successful resection by thoracoscopic approach and was followed up for one year with no complications. In summary, a detailed review with experts in both radiology and pathology is mandated to diagnose these tumors. Informed consent was obtained from the patient.
Background: Costal fracture surgical is still a debate, therefore we shall select between early and delay surgical management.Case Report: We are reporting two cases of post road traffic clash delay ribs fractures osteosynthesis involving a 63-year-old man with multistage fractures on the left and pulmonary pinning of one of the costal arches, complicated by a homolateral haemothorax and a 41-year-old man with a bilateral flail chest.Conclusion: The simple postoperative course and the immediate postoperative improvement in the patient's clinical respiratory condition enabled us to discuss the time frame for management, in this case the indication for early or later surgery.
Amyloidosis is a rare spectrum of disease which involves deposition of misfolded extracellular proteins (amyloids) in various body organs leading to progressive organ dysfunction. Clinical presentation can be variable depending on the organ involved and type of protein. Amyloidosis can be classified based on quantity, type, and location of these proteins. Amyloid light-chain amyloidosis develops in the bone marrow, producing abnormal forms of light-chain proteins, which cannot be broken down. These proteins transform into amyloid fibrils and form amyloid deposits in different organs. Pulmonary amyloidosis is uncommonly diagnosed since it is rarely symptomatic. Diagnosis of pulmonary amyloidosis is usually made in the setting of systemic amyloidosis; however, it may present as localised pulmonary disease. Localized pulmonary Amyloidosis can present as nodular, cystic, or tracheobronchial amyloidosis. Depending on the degree of the interstitial involvement, it may affect alveolar gas exchange and cause respiratory symptoms. This is a case of a 47-year-old female with background history of interstitial lung disease presenting with progressive shortness of breath. Computed tomography scan revealed bilateral pulmonary nodules. The patient was referred to our thoracic surgery team with the suspicion of bronchogenic malignancy with metastasis. Diagnostic video assisted wedge resection was performed for this patient, and histology confirmed pulmonary amyloidosis of nodular type. Amyloid deposition simulates both inflammatory and neoplastic conditions. Definitive diagnosis requires biopsy confirmation therefore early detection and commencing the patient on appropriate treatment pathway may help in symptomatic relief and better outcome.
Objective: The great saphenous vein (GSV) is commonly used as a conduit for grafting during CABG surgery, and open GSV harvesting (OVH), commonly used with long incision to expose the vein. However, endoscopic vein harvesting (EVH) is an alternative approach, utilizing specialized instruments and small incisions to harvest the vein. Methods: A retrospective analysis was conducted on a cohort of patients who underwent Coronary artery bypass graft (CABG) requiring great saphenous vein (GSV) harvesting which was done by EVH or OVH procedures. Demographic variables, including age and gender, were assessed for both groups. Intraoperative variables such as the number of grafts, cardiopulmonary bypass time, X clamp time, and type of procedure were analyzed. Postoperative variables, including infection and bleeding rates, were also evaluated. Results: The study included 30 patients each undergoing Coronary artery bypass graft (CABG) with need of great saphenous vein harvesting which was done by EVH and OVH. Demographic variables were well-matched between the two groups in terms of age, while a significant difference in gender distribution was observed. Obesity and smoking were more prevalent in the OVH group, and EVH was associated with a higher mean number of grafts compared to OVH. Conversion to an open technique occurred in a portion of the EVH cases, and infection rates did not significantly differ between the EVH and OVH groups. However, the incidence of postoperative bleeding was significantly higher in the EVH group. Conclusion: This study provides valuable insights into the demographic, intraoperative, and postoperative variables associated with EVH and OVH techniques. EVH demonstrated advantages in terms of reduced infection rates compared to OVH. However, the higher incidence of postoperative bleeding associated with EVH raises concerns about potential risks.
Background: Isolated tricuspid valve disease remains a controversial indication for surgical intervention.Many patients referred for surgery already have a poor clinical condition and an advanced New York Heart Association functional class.There is no consensus on the optimal surgical technique for this condition, including on whether to perform the procedure on a beating or an arrested heart and whether to perform valve repair or replacement.Methods: We analyzed four case series between 2015 and 2022 in which patients with secondary tricuspid regurgitation (TR) underwent valve repair on a beating heart and right atrial plication for a dilated right atrium.The TRI-SCORE was calculated for each patient.Results: All patients experienced a favorable postoperative course with significant improvements in heart failure symptoms.TR was markedly reduced; however, in one patient with concomitant mitral regurgitation (MR) and a high TRI-SCORE, MR worsened postoperatively.This patient later died from unknown causes due to multiple comorbidities in the late phase.Conclusions: Tricuspid valve repair on a beating heart was effective for improving the cardiac function, and the TRI-SCORE proved useful as a preoperative risk assessment tool.The underlying mechanism by which TR exacerbates MR requires further investigation.
Arteriovenous fistulas have a substantial impact on systemic hemodynamics, however their effect on extracorporeal circulation is not well understood.We report our clinical observation on the management under extracorporeal circulation of a patient with renal insufficiency with a high-flow arteriovenous fistula.This is a 59-year-old man who was referred to us for surgical treatment of ischemic coronary artery disease in a context of anuric chronic renal failure.Hypothermia at 32˚C is started from the start in CEC due to hyperflow at the level of the arteriovenous fistula.We performed two coronary artery bypasses of the marginal and IVA via the two internal thoracic arteries.The patient is hemofiltered in order to avoid hyperkalaemia and possibly avoid fluid overload related to filling per CEC.The clamping time was 71 minutes and the SCC lasted 141 minutes.There was no homologous transfusion in the operating room.It turns out that the input/output balance is zero at the end of the CEC.The postoperative course was simple.
Background: The aim of this study is to assess the necessity of temporary cardiac pacing and identify the predictors of pacing after coronary artery bypass graft (CABG). Methods: This was a retrospective observational study of 150 patients who had isolated CABG between November 2013 and December 2021. Patients were classified into two groups: group A, (n = 135) who did not need to be paced and group B, (n = 15) who needed temporary epicardial pacing. Only 10% (15/150) of patients in the study needed pacing. The primary outcome variable was assessment of the need for postoperative temporary cardiac pacing (TCP) (patients were paced during chest closure or at any time during hospital admission). The incidence of pacing during the postoperative period was observed. Univariate and multivariate predictors for postoperative pacing were determined and specicific predictors for cardiac pacing were found. Results: In both univariate and multivariate analysis, Old age > 65 years, diabetes mellitus, pacing to come off cardiopulmonary bypass (CPB), CPB time > 100 min, cardioversion to leave OR, antiarrhythmics to leave OR and new onset of atrial fibrillation (AF), were found to be significant predictors for the need to cardiac pacing. Conclusion: After coronary artery bypass surgery, a small percentage of patients require TCP. We emphasize unique predictors for postoperative pacing in this study.
Background: Ultrasonic energy devices are utilized for transection, incision, and hemostasis in traditional open and laparoscopic procedures. The Harmonic HD 1000i Shears, designed to deliver a precise amount of thermal energy during tissue transection and vessel sealing, has been utilized in many specialties. This study aimed to confirm real-world safety and performance of the Harmonic device in two thoracoscopic procedures: lobectomy and segmentectomy. Methods: The primary endpoint of this retrospective, observational, single-arm study was rate of post-operative blood transfusions related to study device or procedure. Secondary endpoints included occurrence of intra- and post-operative adverse events (AEs) or complications device- or procedure-related, and rate of required additional hemostatic measures. Adults included those who underwent thoracoscopic lobectomy or segmentectomy where HD 1000i shears were used while excluding those where additional advanced energy devices were used. The study was conducted at Severance Hospital, Yonsei University Health System, South Korea from May 1, 2018, to November 30, 2020. Results: Subjects included n = 766 lobectomies (mean age 63.79, 52% male) and n = 215 segmentectomies (mean age 63.19, 54% male). Estimated blood loss was 50 mL (0 min, 3200 max) and 20 mL (0 min, 800 max), intraoperative transfusion rate 0.001% and 0%, intraoperative complication/AE rate 1% and 2%, and post-operative complication/AE rate 9% and 4% in the lobectomy and segmentectomy groups, respectively. Median operative times were 108 min. (35 min, 395 max) for lobectomies and 105 min. (32 min, 574 max) for segmentectomies. Conclusion: Given the low rate of blood loss and intra- and post-operative complication/AE rates, HD 1000i can be used confidently for thoracoscopic pulmonary resection in adults.
Central airway injury is a very rare entity during blunt chest trauma.It is serious and may be fatal.Usually, it has fundamental manifestations but in some cases, it is insidious and has been discovered lately.It's suspected when major air leaks from the chest tube and the lung fail to expand despite adequate chest drainage.Right main bronchus injuries are the most frequent.Diagnosis can be suspected clinically and confirmed by Ct scan and bronchoscopy.Conservative management can be applied in special cases but the majority of cases need surgical intervention which depends on primary reconstruction.An early diagnosis and treatment can avoid dramatic complications and provide complete recovery.Associated other organ injury is common and is an important mortality factor.Close cooperation with the emergency team and anesthesiologists is necessary.Here I presented a case of right main bronchus disruption discovered after one year of blunt chest trauma with complete lung atelectasis, managed successfully by resection of the fibrotic injured bronchus and primary reconstruction saving the lung.
Among chronic pulmonary infections, pulmonary actinomycosis is a rare one, caused by a gram-positive microaerophilic bacterium called Actinomyces. Aside from cervicofacial or abdominopelvic actinomycosis, pulmonary involvement is rare, and sometimes this type of infection results in a misdiagnosis of pulmonary tuberculosis or carcinoma. Clinical presentation of pulmonary actinomycosis could be acute or subacute, with lobar involvement. However, the disease is most commonly diagnosed at the chronic phase, with patients presenting mild fever, weight loss, and occasional hemoptysis. Here, we described the case of a 30-year-old male patient, presented with a history of respiratory complaints for more than three years and was diagnosed clinically and radiologically as a case of a destroyed left lung. Later on, post-operative tissue diagnosis was confirmed—pulmonary actinomycosis.
We aimed to investigate the risk factors and reason for initiation of high-flow nasal cannula (HFNC), its benefit on re-intubation rate, mortality, and length of stay (LOS) in the postoperative cardiac surgery patient in the ICU. Methods: In a retrospective and descriptive study, 200 patients, who underwent cardiac surgery, were randomly included, and screened for initiation of postoperative respiratory support. Demographic patient data and pre-operative patient measurements were sampled. Data concerning the P/F ratio at arrival- and post-extubation, LOS at ICU and overall mortality were sampled. A comparison of those variables was performed between patients with and without need of respiratory support. Results: HFNC was initiated in approximately 22.45% in 2018, and 25% in 2020, of the patients. Comparing both years didn’t reveal a significant rise, but we saw a quicker use of HFNC in 2020. The all-case re-intubation rate and mortality was approximately 3%. The body mass index (BMI) was the only correlation with a higher chance of initiation of HFNC. Other data like age, pre-operative renal- or left ventricle function didn’t show a correlation. Conclusion: In case of respiratory insufficiency in the postoperative cardiac surgery setting, HFNC is a worthy first line treatment option which is initiated if conventional oxygen therapy doesn’t suffice. The mortality was low, and the mean LOS was 4.38 days. If respiratory support was started with HFNC mean LOS rose to 8.35 days. The BMI seems to have a correlation with the development of respiratory failure, which confirms the latest recommendation to start preventive HFNC in the post-extubation cardiac surgery setting and which could be implemented in the daily practice.
Background: Vanishing lung is a rare syndrome.It mainly affects young males who are smokers, it considered an advanced stage of bullous disease, where the entire lobe or lung paranchym is replaced by bullae, it appears radiologically as a hyperlucency due to air trapping and destruction of interstitial tissue and vascularity in alveolar wall's.Misdiagnosed usually as pneumothorax so must be differentiated from other causes of Hyperlucency lung syndrom.Hereby a case of vanishing lung diagnosed primarily as a post TB lung destruction.Case Report: A sixteenth-year-old virgin female patient, with treated for TB for six months without radilogical improvement.CXR and CT scan revealed diffuse left lung hyperlucency, TB work up (sputum exam, washing by bronchoscopy) appears no active disease.Left pneumenctomy had done, grossly there are no lung pranchyma and microscopically no signs of TB in the specimen.The findings are consistent with Vanishing lung.Conclusions: An understanding of the broad differential diagnosis of pulmonary hyperlucency is necessary to determine the underlying cause and provide appropriate patient care.
Background: Aspiration of foreign body is popular in pediatric age group and is considered as an important cause of respiratory distress and chocking in these children. Management strategies are different according to the mode of presentation. This study aims to assess the efficacy of rigid bronchoscopy and the role of bronchotomy as a safe alternative for failed removal of inhaled foreign body. Methods: We enrolled 254 patients with foreign body aspiration (FBA) up to 14 years old in a retrospective observational study. Our patients were reviewed from the Cardiothoracic Surgery Department and cases referred from Otorhinolaryngology Department, Menoufia University Hospital between June 2010 and July 2017. Using jet ventilation technique, foreign body was removed by the rigid bronchoscopy with either extracting forceps or postural drainage. Surgical interference such as bronchotomy needed in distally impacted foreign bodies (FBs). Results: Our study included 254 patients prepared for bronchoscopic FBs extraction. Most of cases (68.8%) presented early within first week (174 cases). No FBs detected in 44 cases by rigid bronchoscopy, although it was successful in 176 (69.5%) cases with non- impacted inhaled FBs. 14 cases only needed postural drainage due to inaccessible FBs, another 12 cases failed to extract FB with rigid bronchoscopy but they were managed with flexible bronchoscopy. Bronchotomy was needed for impacted FBs in eight cases (3%). Conclusion: This study's findings support that rigid bronchoscopy is the gold standard in the diagnosis and removal of foreign body aspirations in pediatrics, but rigid bronchoscopy demonstrated less capability in the diagnosis and removal of small distally located foreign bodies. Bronchotomy is safe and effective alternative.
