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Multimedia Manual of Cardiothoracic Surgery: MMCTS

Marek Jasinski
We present a modified bicuspid aortic valve reimplantation operation using a unique technique of second line, continuous suturing during implantation of the aortic valve scallop to the prosthesis that mimics stentless, minicylinder implantation.  The feasibility of bicuspid aortic valve repair with associated aortic root management has been demonstrated. However, this repair seems to be less durable than tricuspid aortic valve repair, and this may be partly because of the connective tissue disorders that are an inherent feature of bicuspid aortic valve disease...
February 12, 2018: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Andras Durko, Daniel Thuijs, Edris Mahtab, Jos Bekkers
This short tutorial video summarizes the surgical technique for conventional open harvesting of the great saphenous vein as a conduit for coronary artery bypass grafting.
February 9, 2018: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Anita Nguyen, Colleen Pietras, Hartzell Schaff
Apical aneurysms are outpouchings of the left ventricular apex that are relatively common in patients with apical hypertrophic cardiomyopathy or hypertrophic cardiomyopathy with midventricular obstruction. Apical aneurysms have been associated with ventricular tachycardia and sudden cardiac death, but surgical resection may reduce the risks of these complications. In this tutorial, we describe resection of a left ventricular apical aneurysm in a patient with hypertrophic cardiomyopathy and midventricular obstruction...
February 8, 2018: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Nikolaos Bonaros, Cenk Özpeker, Markus Kofler, Julia Dumfarth, Johannes Holfeld, Thomas Schachner, Ludwig Müller, Michael Grimm
Bioprosthetic aortic valves have been used with increasing frequency over the past two decades, often in relatively young patients who may eventually require aortic valve re-operations due to degeneration of the bioprosthesis. Growing experience with minimally invasive aortic valve replacement has prompted surgeons to use minimally invasive approaches also with redo operations for replacement of the aortic valve.  This tutorial describes the operative steps for a minimally invasive redo replacement of the aortic valve through an upper ministernotomy...
January 30, 2018: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Mohsen Ahmed, Karl Reyes, Michael Brock, Mark Bleiweis
Double outlet right ventricle with subpulmonic ventricular septal defect is a very rare form of congenital heart disease. Surgical correction involves closure of the ventricular septal defect with baffling of blood flow from the left ventricle to the pulmonic valve and arterial switch of the usually side-by-side great arteries. In this tutorial, we present our surgical technique for single-stage repair of this complex anomaly.
January 25, 2018: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Juan Carlos Trujillo-Reyes, Elisabeth Martínez-Téllez, Ramón Rami-Porta, Carme Obiols, Sergi Call, Josep Belda-Sanchis
Surgical staging of lung and pleural cancers is crucial for planning treatment and assessing prognosis. In some cases, we need to explore both the mediastinum and the pleural cavity to confirm or rule out tumor dissemination. The combination of video-assisted mediastinoscopic lymphadenectomy (VAMLA) and thoracoscopy through a single transcervical incision allows the surgeon to widen the range of the exploration and improve the staging for lung and pleural cancers.  VAMLA consists of complete removal of the mediastinal fat and lymph nodes of the subcarinal space, the right paratracheal and pretracheal areas, and the left paratracheal space...
January 18, 2018: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Davor Stamenovic, Antje Messerschmidt
Anatomical segment resections are often technically more demanding than lobectomies. Anterior segment of the left upper lobe (S3) is usually removed within the standard resection of the upper three segments.    Our patient in this case was a 56-year-old with a known oropharyngeal carcinoma, otherwise amenable to curative treatment, who was admitted to our clinic with  a 1-cm nodule in the anterior segment of the left upper lobe.  Distant metastases were excluded, and a decision was made to proceed with a uniportal video-assisted thoracoscopic segmentectomy and lymphadenectomy...
January 11, 2018: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Davor Stamenovic, Antje Messerschmidt
Uniportal video-assisted thoracoscopic (UVATS) resections seem to offer real benefits over conventional surgery in terms of postoperative pain and better cosmetic results.  The procedure described in this tutorial, an anterior segment resection of the right upper lobe, is rarely performed, and fissureless resection of this segment by means of UVATS has, at time of writing, never been described in the literature.  Our patient was a 79-year-old female, admitted to our clinic for treatment of a solitary metachronous metastatic tumor of a colon carcinoma, located in the anterior segment of the right upper lobe...
January 11, 2018: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Stoyan Kondov, Matthias Siepe, Friedhelm Beyersdorf, Patrick von Samson-Himmelstjern, Martin Czerny
Aortobronchial fistula after thoracic endovascular aortic repair is usually a late complication. It is associated with high mortality and its surgical management is technically challenging. This tutorial illustrates the steps involved in removing an infected stent graft and replacing it with a bovine pericardial tube graft.
December 20, 2017: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Karl Reyes, Mohsen Ahmed, Alan Brock, Mark Bleiweis
Truncus arteriosus is an extremely rare and complex form of congenital heart disease. Surgical strategies vary depending on anatomic subtype.  In this tutorial, we present our surgical technique for single stage repair of a truncus arteriosus with interrupted aortic arch (Van Praagh type A4).
December 12, 2017: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Daniel Fudulu, Rakesh Krishnadas, Gianluca Casali
We describe a novel video-assisted thoracic surgery (VATS) anterior approach to lymph node station 7 after VATS left lower lobectomy.
December 12, 2017: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Andras Durko, Edris Mahtab, Jamie Romeo, Ad Bogers
This surgical tutorial demonstrates the technique of skeletonized internal mammary artery harvesting for coronary artery bypass grafting, using diathermy and cold dissection [1]. The procedure is performed on the left internal mammary artery, but is also applicable for harvesting the right internal mammary artery.
December 12, 2017: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Hitoshi Igai, Mitsuhiro Kamiyoshihara, Natsuko Kawatani, Kimihiro Shimizu
It is challenging to redo an anatomical pulmonary resection on the ipsilateral side because of the adhesions or dense fissures caused by the initial anatomic pulmonary resection. Few reports describe surgical techniques for addressing these challenges, especially using a minimally invasive thoracoscopic approach instead of standard thoracotomy. Here, we demonstrate a thoracoscopic right upper lobectomy after an initial anatomic pulmonary resection of the right lower lobe and explain the nuances of performing it...
November 14, 2017: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Shegu Gilbert, Devender Singh, M K Sivakumar
The modified carbodissection technique is a new technique for harvesting the internal mammary artery during coronary artery bypass graft surgery. It is performed using an improvised instrument that consists of an electrocautery device and a carbon dioxide blower/mister. It combines electrocautery dissection and continuous controlled gas blow dissection along with saline irrigation mist. Gas dissection causes vasodilation and maintains the artery in a dilated state during dissection. Saline flow reduces the amount of heat generated at the cautery site and prevents drying and desiccation of the tissues...
October 29, 2017: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Benedetto Del Forno, Alessandro Castiglioni, Alessandra Sala, Alberto Geretto, Andrea Giacomini, Paolo Denti, Michele De Bonis, Ottavio Alfieri
Mitral valve prosthetic ring annuloplasty represents a key milestone in the history of mitral valve repair, delivering restoration of annular shape and size. Increased leaflet coaptation, together with significant reduction in stress on sutures, has ensured predictability and immediate stability for valve repair, both of which were lacking with previous techniques. Long-term durability of repair seems to be positively affected by placement of an annuloplasty ring, and by following the well-established, standardized approach described in our tutorial, this procedure can be performed with a very low surgical risk...
October 6, 2017: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Nikolay Travin, Yury Shevchenko
We present historical, epidemiological, and statistical data on heart echinococcosis (also known as hydatid disease) and concomitant lesions of different organs, as well as a demonstration of its surgical management. The diagnosis of heart echinococcosis is based on review and identification of the cyst and we evaluate the various common diagnostic methods. Surgical treatment of patients with heart echinococcosis may require cardiopulmonary bypass or may be an off-pump procedure depending on the location of the cysts...
September 26, 2017: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Adriaan Schneider, R J M Klautz, Mark Hazekamp
Pulmonary autograft replacement of a diseased aortic valve (the Ross procedure) is effective in children, where growth is essential, and in young patients for whom a biological solution is preferred. Long-term outcomes are generally good. However eventual autograft dilatation may necessitate reoperation. In order to diminish the risk of autograft dilatation, several 'wrapping' techniques have been developed. Here, we present our technique of choice: the reimplantation of the pulmonary autograft in a vascular tube graft, scalloping the sinuses of Valsalva...
September 25, 2017: Multimedia Manual of Cardiothoracic Surgery: MMCTS
René Prêtre, Tornike Sologashvili, Raymond Pfister, Anna Nowacka
The success of the arterial switch operation mostly depends on the proper relocation of the coronary arteries. This involves more than the simple suturing of the coronary cuff to the neo-aortic root, it also involves the preparation of the landing zone and the correct mobilisation of the primary coronary branches. In this tutorial, we present our technique for correction of a dextro-transposition of the great arteries with a normal, type A, coronary artery pattern.
September 11, 2017: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Micaela De Palo, Manuela Conte, Antonio Cricco, Domenico Benvenuto, Giampiero Esposito
Aortic diseases, especially when the entire aorta is involved, are often challenging to treat since they frequently require invasive interventions. Minimally invasive hybrid treatment of such pathologies is proving to be a valid option for complex cases (for example, dilation involving the entire aorta) and is improving postoperative outcomes. It consists of a minimally invasive opening stage, where ascending aorta and aortic arch replacement and epiaortic vessel rerouting is performed using a multibranched graft equipped with a radiopaque marker...
September 1, 2017: Multimedia Manual of Cardiothoracic Surgery: MMCTS
Corrado Cavozza, Antonio Campanella, Andrea Audo
The internal thoracic artery skeletonization method typically involves careful dissection with electrocautery. However, skeletonization using harmonic technology is safer than the conventional method. Ultrasonic shears may be faster than traditional methods, and may optimize the quality of skeletonized grafts during harvesting, preserving their functional and structural conduit integrity, and facilitating harvesting of the bilateral internal thoracic artery. This tutorial shows in detail the skeletonization harvest technique, using Ethicon's harmonic shears (Ethicon Endo-Surgery©, CVD, Cincinnati, OH, USA) Our results, using this technique, showed no harvesting damage and excellent graft quality as evaluated intraoperatively...
August 10, 2017: Multimedia Manual of Cardiothoracic Surgery: MMCTS
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