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General Thoracic and Cardiovascular Surgery

Hideki Tatewaki, Akira Shiose
In this review article, we describe pulmonary valve replacement (PVR) late after repaired Tetralogy of Fallot (TOF). Since the introduction of surgical intervention for patients with TOF in 1945, surgical management of TOF has dramatically improved early survival with mortality rates, less than 2-3%. However, the majority of these patients continue to experience residual right ventricular outflow tract pathology, most commonly pulmonary valve regurgitation (PR). The patients are generally asymptomatic during childhood and adolescence and, however, are at risk for severe PR later which can result in exercise intolerance, heart failure, arrhythmias, and sudden death...
May 19, 2018: General Thoracic and Cardiovascular Surgery
Athanasios Antoniou, Mohamad Bashir, Amer Harky, Carmelo Di Salvo
Reoperations on the proximal thoracic aorta represent a challenge. The mortality rate is at least three times higher than it is for the initial surgery and the complications after such procedures occur with disappointingly high frequency, leading to substantial morbidity and delayed recovery. This article aims to present the early and the late outcomes of these kinds of operations, to identify the causes for failure of the primary surgery, to underline the critical points during the perioperative management of those patients and finally to emphasize on the rapid evolution and advent of techniques over the last few years...
May 18, 2018: General Thoracic and Cardiovascular Surgery
Mohamad Bashir, Amer Harky, Haris Bilal
The surge of endovascular repair of aortic aneurysm in current modern aortic surgery practice has been the key for surgical management of elective cases of thoracic aortic aneurysms. This has paved way for the combined hybrid approach to be amongst the armamentarium for the management of aortic arch disease. The pivotal understanding of the aortic arch natural history coupled with device technology advancement allowed surgeons insight into delivery of hybrid surgery with acceptable morbidity and mortality results...
May 16, 2018: General Thoracic and Cardiovascular Surgery
Shin Yajima, Daisuke Yoshioka, Satsuki Fukushima, Koichi Toda, Shigeru Miyagawa, Yasushi Yoshikawa, Hiroki Hata, Shunsuke Saito, Keitaro Domae, Yoshiki Sawa
OBJECTIVES: We aimed to elucidate the relationship between the magnitude of myocardial recovery after coronary artery bypass grafting (CABG) and the prognosis and to explore the predictors of myocardial non-recovery. METHODS: Eighty-one patients with a preoperative left ventricular ejection fraction (LVEF) ≤ 40% who underwent isolated CABG between 2002 and 2015 and had undergone echocardiographic follow-up (median follow-up, 3.1 years; interquartile range 1...
May 14, 2018: General Thoracic and Cardiovascular Surgery
Athanasios Antoniou, Mohamad Bashir, Amer Harky, Benjamin Adams, Rakesh Uppal
Over the past few decades, the advents in monitoring, imaging, diagnostics, and implementation of multidisciplinary team approach in Type A aortic dissection surgery resulted in improved surgical outcomes. One other factor that needed to be targeted and carefully analyzed was the volume-outcome relationship on hospital and surgeon level in the settings of Type A dissection. This surely sprung form reports which indicated that supercenters providing aortic services with concentrated expert and expertise were performing better than smaller centers...
May 12, 2018: General Thoracic and Cardiovascular Surgery
Yasoo Sugiura, Hiroyuki Fujimoto, Toshinori Hashizume, Go Ogura, Etsuo Nemoto
A woman in her 70s with an 8.6-cm tumor in the anterior mediastinum underwent tumor excision by median sternotomy, which combined resection of the fifth and sixth ribs. The pathological diagnosis was myxofibrosarcoma, and pathologically curative resection was accomplished. Local recurrence was detected at 10, 19, 23 and 28 months after the initial surgery. After repeated surgical resection, radiation therapy for the fourth unresectable recurrence resulted in failure. She died 34 months after the initial surgery...
May 10, 2018: General Thoracic and Cardiovascular Surgery
Tetsuhiko Go, Nariyasu Nakajima, Naoya Yokota, Hiroyasu Yokomise
Parosteal lipoma derived from the rib is extremely rare and is usually resected through open thoracotomy despite its benign nature. A 33-year-old man who had no symptoms was referred to our hospital for treatment of a 30-mm chest wall mass that has slightly increased in size during 2 years of follow-up. En bloc resection of the tumor with parts of the 3rd and 4th ribs was performed through a complete thoracoscopic approach using orthopedic electric micro drill. This was the first report on a case of parosteal lipoma of the rib that was resected by a complete thoracoscopic procedure...
May 9, 2018: General Thoracic and Cardiovascular Surgery
Yuka Kadomatsu, Shoichi Mori, Harushi Ueno, Mika Uchiyama, Kenji Wakai
OBJECTIVE: Clinical evidence comparing paravertebral (PVB) and continuous intercostal nerve (ICB) blocks for pain management post video-assisted thoracic surgery (VATS) is limited. This study confirms the analgesic effect of ICB using two catheters is not inferior to that of PVB under direct vision. METHODS: Fifty patients who underwent VATS lobectomy from July 2015 to March 2016 were prospectively recruited and randomly assigned to PVB and ICB groups. Postoperative pain was assessed using the visual analog scale (VAS)...
May 8, 2018: General Thoracic and Cardiovascular Surgery
Fulya Kamit Can, Soysal Turhan, Ayse Berna Anil, Kadir Burhan Karadem, Onur Aras Isik
Penetrating injuries of the carotid and vertebral arteries are rare, but life-threatening conditions. There are still challenges in the first intervention management and patient treatment. Deciding which methods to apply in the first intervention, whether to perform imaging, and the preferred appropriate treatment for the patient (open surgery or endovascular intervention) plays a main role in the patient's survival without neurological deficit. The general management of trauma in penetrating neck injuries and the knowledge of special approaches to carotid artery injury are important for pediatric trauma centers...
May 8, 2018: General Thoracic and Cardiovascular Surgery
Hasan Ersoz, Cem Nazli
OBJECTIVE: One of the techniques used in the treatment of tracheoesophageal fistula is applying the umbrella catheter, designed for closure of atrial septal defects, in this region. In the literature, we have encountered only 9 case reports in this regard. We shared a successfully closed tracheoesophageal fistula case with this technique. CASE: A tracheoesophageal fistula in a 47-year-old male patient was successfully closed with an atrial septal defect occluder device...
May 5, 2018: General Thoracic and Cardiovascular Surgery
Noriaki Kishimoto, Takeshi Ikuta, Hirofumi Fujii, Akihiro Sumiya, Eiji Kimura, Yoshihiro Shimizu
We herein report an unreported case of pyogenic granuloma that originated in the pulmonary artery. A 38-year-old man was urgently hospitalized with dyspnea and back pain. He had been on hemodialysis for 2 years due to chronic renal failure. We performed contrast-enhanced computed tomography and detected a mass occluding the left main pulmonary artery. The maximum standardized uptake value (SUVmax ) of 18 F-fluorodeoxy glucose (FDG) in the mass was 4.1. We made a tentative diagnosis of pulmonary artery tumor, and planned an operation...
May 2, 2018: General Thoracic and Cardiovascular Surgery
Takashi Nakayama, Hirofumi Uehara, Marie Osawa, Yukichi Tanahashi, Hiroshi Kondo, Masafumi Kawamura
Atraumatic tension hemothorax is extremely rare. We report a case of 62-year-old woman presented with obstructive and hypovolemic shock status by tension hemothorax due to ruptured aneurysm of congenital intercostal artery-azygous fistula. Contrast-enhanced computed tomography and aortography revealed an aberrant 12th intercostal artery flowing into the aneurysm with a fistula draining into the azygous vein and the rupture of aneurysm. Our experience indicates that the rupture of congenital arteriovenous fistulas (AVFs) of systemic circulation in the thoracic cavity might cause not only hypovolemic shock but also atraumatic tension hemothorax...
April 26, 2018: General Thoracic and Cardiovascular Surgery
Koichi Sughimoto, Kagami Miyaji, Norihiko Oka, Shinzo Torii, Tadashi Kitamura
OBJECTIVES: Although primary sutureless technique for total anomalous pulmonary venous drainage has been introduced to reduce postoperative pulmonary vein obstruction (PVO), controversy still exists about superiority of the procedure between the conventional repair and primary sutureless technique at the initial repair. In our unit, the conventional repair has been consistently used based on four important surgical policies: (1) mark incision lines between 2 chambers to gain anatomically natural alignment, (2) place precise stitches by "intima-to-intima" using monofilament suture, (3) adequate orifice size should be guaranteed in greater than expected mitral valve size, (4) do not hesitate to undertake a redo additional anastomosis by a different approach when an echocardiography shows the velocity more than 1...
April 26, 2018: General Thoracic and Cardiovascular Surgery
Vasileios Kouritas, Emmanouel Kefaloyannis, Peter Tcherveniakov
Surgical sealants have been used in thoracic surgery in an effort to reduce air leak duration, intercostal drain duration, length of stay and complications. They are instilled over a defect usually treated with other means. We herein present the technique of controlling a difficult to treat defect by directly instilling Bioglue™ alone into a crater, caused during empyema Video-assisted thoracic surgery in a 50-year-old patient with a trapped lung. This deep crater had caused a significant air leak rendering intraoperative ventilation challenging...
April 25, 2018: General Thoracic and Cardiovascular Surgery
Hikaru Ishii, Hidehito Endo, Hiroshi Tsuchiya, Yusuke Inaba, Katsunari Terakawa, Hiroshi Kubota
Left ventricular free wall rupture (LVFWR) is a catastrophic complication of myocardial infarction. In these cases, cardiopulmonary bypass (CPB) should be performed for left ventricular repair, but can impact hemodynamic stability. An 87-year-old man presented with acute shock. He was diagnosed with LVFWR after myocardial infarction. We describe a simple, effective, and reproducible technique to achieve hemostasis at the LVFWR site during emergency operation using Hydrofit® and Surgicel® surgical hemostatic agents...
April 24, 2018: General Thoracic and Cardiovascular Surgery
Kyoko Nohara, Kazuhiko Yamada, Leo Yamada, Teruki Hagiwara, Toru Igari, Chizu Yokoi, Daisuke Soma, Satoshi Yamashita, Taeko Dohi, Yuki I Kawamura
In the original publication of the article, Fig. 1 was published incorrectly.
April 24, 2018: General Thoracic and Cardiovascular Surgery
Yuichiro Ozawa, Mitsuaki Sakai, Hideo Ichimura
OBJECTIVE: The aim of this study was to compare coverage with oxidized regenerated cellulose mesh and that with polyglycolic acid sheet to decrease the incidence of postoperative recurrent pneumothorax. METHODS: From August 2010 to August 2014, a total of 112 patients with primary spontaneous pneumothorax undergoing thoracoscopic bullectomy were enrolled. We compared the clinicopathological characteristics between recurrent and non-recurrent cases and examined their association with the material used for visceral pleural coverage: polyglycolic acid sheet versus oxidized regenerated cellulose mesh...
April 24, 2018: General Thoracic and Cardiovascular Surgery
Nathan Burnside
OBJECTIVES: Cardiothoracic surgery is a small specialty, often with a limited presence on the undergraduate curriculum. In the past, there was a heavy reliance on postgraduate exposure to inform career choice. Recent changes in recruitment to the specialty in the United Kingdom may reduce exposure of the best trainees to the specialty, and reduce the quality of future surgeons. This study will evaluate the impact of junior surgical jobs on future career preferences. METHODS: We asked all 126 core surgical trainees in the Northern Ireland Deanery their surgical specialty preferences over 2 years...
April 21, 2018: General Thoracic and Cardiovascular Surgery
Takuya Matsui, Kotaro Mizuno, Takeshi Yamada
Situs inversus totalis (SIT) is a rare anomaly. A limited number of reports document surgery for lung cancer in patients with SIT. We report the case of a 68-year-old man with SIT who underwent video-assisted thoracoscopic bisegmentectomies for synchronous double primary lung cancers. Preoperative evaluation of the pulmonary vessels and bronchus by three-dimensional computed tomography (CT) was unavailable owing to the patient's renal function disorder. However, the procedure was safely completed by adequate anatomic identification and careful operative manipulation based on plain CT study...
April 18, 2018: General Thoracic and Cardiovascular Surgery
Naoki Masaki, Kiichiro Kumagai, Konosuke Sasaki, Satoshi Matsuo, Naotaka Motoyoshi, Osamu Adachi, Masatoshi Akiyama, Shunsuke Kawamoto, Koichi Tabayashi, Yoshikatsu Saiki
OBJECTIVES: Medical therapy for patients with uncomplicated acute type B aortic dissection (ABAD) is essentially accepted for its excellent early outcome; however, long-term outcomes have not been satisfactory due to aorta-related complications. This trial was performed to investigate the efficacy of a statin as an additive that may enhance the effectiveness of conventional medical treatment in patients with ABAD. METHODS: This was a multi-center, prospective, and randomized comparative investigation of patients with uncomplicated ABAD...
April 6, 2018: General Thoracic and Cardiovascular Surgery
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