Open Journal of Thoracic Surgery

Journal Information
ISSN / EISSN : 2164-3059 / 2164-3067
Current Publisher: Scientific Research Publishing, Inc. (10.4236)
Former Publisher:
Total articles ≅ 139
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SHERPA/ROMEO
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Kayo Sugiyama, Hirotaka Watanuki, Yasuhiro Futamura, Masaho Okada, Hiroki Numanami, Masayuki Yamaji, Satoshi Makino, Katsuhiko Matsuyama
Open Journal of Thoracic Surgery, Volume 11, pp 25-30; doi:10.4236/ojts.2021.111004

Abstract:
Background: Residual aneurysms after graft replacement are rare, but they can be detrimental if they are saccular and large. The etiology of residual aneurysms remains unknown, and their management is controversial. One treatment option is late open surgical conversion; however, postoperative respiratory complications resulting from the dissection of pleural adhesions, which is frequently necessary with this approach, are often unavoidable. Case presentation: Herein, we report a case of open surgical repair of a residual distal aortic arch aneurysm that occurred after total arch replacement and thoracic endovascular aortic repair. Contrast-enhanced magnetic resonance imaging was not possible in this case due to the patient’s severe renal dysfunction; however, contrast-enhanced computed tomography using minimal contrast did not detect remarkable leakage through the graft or stent graft into the aneurysm. Late open surgical conversion using video-assisted thoracic surgery was performed by thoracic surgeons, and the adhesion between the aortic wall and the lung was safely and effectively dissected. Because there was no significant pulsation or evidence of feeding arteries in the aortic wall, the aortic wall was opened carefully. No bleeding or backflow from any branch arteries into the aneurysm was noted, so the aortic wall was ligated with continuous sutures. The patient recovered without experiencing any major complications. Conclusions: This case report demonstrates that video-assisted thoracic surgery is safe and effective for late open conversion in cases of residual aneurysm; furthermore, this case suggests that video-assisted thoracic surgery may be particularly beneficial for the dissection of adhesions between the aortic wall and lung in these cases.
Mamadou Diakité, Abdoulaye Kanté, Bréhima Coulibaly, Mamadou Almamy Keita, Mariam Daou, Demba Yattera, Samba Sidibe, Souleymane Coulibaly, Boureima Dembele, Alou Sangaré, et al.
Open Journal of Thoracic Surgery, Volume 11, pp 11-17; doi:10.4236/ojts.2021.111002

Abstract:
Tuberculosis is a public health problem in Mali. Pulmonary localization is the most frequent and extra-pulmonary involvement, in particular serous, is possible. In this study, we analyze our results of surgical pericardial drainage in tuberculous pericarditis. Methodology: We carried out a retrospective study at the CHU Point G over a period of five years from January 2012 to December 2017. The histological examination carried out on all the surgical specimens made it possible to retain the diagnosis of tuberculous pericarditis. Results: We identified and operated on 49 cases of tuberculous pericarditis, i.e. 70% of the pericardial drainage performed during the same period. The average age was 31.5 years (28 men and 21 women). The most common clinical signs were dyspnea (61.2%), chest pain (26.6%) and fever (12.2%). Pericardial drainage with pericardial biopsy was performed by xiphoid route in all of our patients. The mortality and morbidity rates were 4.1% and 8.2%, respectively. Conclusion: Pericardial tuberculosis attacks are frequent in Mali. The etiological diagnosis is based on the histology of the pericardial biopsy which can only be obtained surgically.
Emilie Schultz Hougaard, Marie Schäfer, Lars Peter Riber
Open Journal of Thoracic Surgery, Volume 11, pp 36-45; doi:10.4236/ojts.2021.111006

Abstract:
Objective: This study compared and evaluated three suture methods in order to find the method with the best durability for mitral valve replacement. The methods evaluated are horizontal mattress suture with subanular pledgets, horizontal mattress suture with supraanular pledgets and continuous running suture. Methods: Thirty hearts were explanted from newly terminated pigs. The hearts were randomized in the three groups. After an atriotomy, the mitral valve was cut out, and a patch was sutured into its place. An air pump model was connected to a balloon which was placed in the left ventricle through aorta and continuously filled with air to a maximum of 300 mmHg. The peak pressure at rupture was noted. If no rupture occurred before reaching 300 mmHg, the suture was found competent. Results: Two out of ten hearts in the continuous running suture-group had myocardial rupture within a pressure of 300 mmHg. In the remaining eight hearts there were no ruptures within 300 mmHg. In the two groups sutured with horizontal mattress with pledgets placed either subanular or supraanular, no rupture of myocardium occurred. When comparing continuous running suture with the horizontal mattress with subanular pledgets or the horizontal mattress with supraanular pledgets, the 1-sided Fishers’ exact was 0.237. At 5% significance level, there was no difference between the three suture methods. Conclusion: There was no statistically significant difference between the durability of the three suture methods, though rupture was only evident in the continuous running suture line. Since it is the surgeon’s choice to select the optimal suture technique, our study should be a reminder for the surgeon to reflect on the suturing factors that have an influence on successful mitral valve replacement.
Kayo Sugiyama, Hirotaka Watanuki, Masaho Okada, Yasuhiro Futamura, Masayuki Saito, Satoshi Makino, Katsuhiko Matsuyama
Open Journal of Thoracic Surgery, Volume 11, pp 31-35; doi:10.4236/ojts.2021.111005

Abstract:
Background: Redo aortic valve replacement for prosthetic valve endocarditis is a challenge for surgeons. Echocardiography is occasionally not an effective modality for the detection of infectious signs in prosthetic valve endocarditis. Case presentation: Herein, we report the case of a patient whose prosthetic valve endocarditis was detected by multidetector computed tomography and who successfully underwent redo aortic valve replacement. Preoperative echocardiography revealed no remarkable findings related to endocarditis such as perivalvular leakage or vegetation; however, multidetector computed tomography revealed a thickened right coronary cusp. Intraoperatively, the right coronary cusp was confirmed to be covered with thick infected tissue. The pathological findings revealed broad destruction due to infection of the right coronary cusp. Conclusion: Multidetector computed tomography was useful in detecting infectious signs in prosthetic valves.
Abdoulaye Kanté, Bréhima Coulibaly, Mamadou Diakité, Samba Sidibé, Drissa Traoré, Bréhima Bengaly, Mariam Daou, Demba Yattera, Nouhoum Ongoïba
Open Journal of Thoracic Surgery, Volume 11, pp 1-10; doi:10.4236/ojts.2021.111001

Abstract:
The aortic aneurysm is the 13th leading cause of death in Western countries. The incidence of thoracic aortic aneurysms is estimated at 4.5 cases per 100,000. The diagnosis is often made on a chest x-ray or other imaging tests, such as an echocardiogram done for other heart diseases. Echocardiography is the first test to assess the diameter of the ascending aorta and its progression over time. Most patients are first assessed and followed up with spiral thoracic computed tomography with injection of contrast medium, supplemented by 3-dimensional reconstruction of the aneurysm in order to improve the accuracy of measurements, identification of its proximal part and distal. When dilation of the ascending aorta reaches the critical diameter of 50 mm, there is a risk of aortic dissection or rupture. Supravalvular aneurysms are treated by replacing the ectatic portion with a Dacron® tube in the supracoronary position. Aortic root aneurysms, including coronary ostia, require tube replacement, reimplantation of coronary ostia, as well as surgery on the aortic valve. In this article, we report a case of aneurysm of the aortic root and the ascending aorta treated by aortic valve replacement and the ascending aorta associated with the Cabrol hemi-mustache technique and we review the literature.
Bréhima Coulibaly, Abdoulaye Kanté, Mamadou Diakité, Samba Sidibé, Drissa Traoré, Bréhima Bengaly, Mariam Daou, Demba Yattera, Nouhoum Ongoïba
Open Journal of Thoracic Surgery, Volume 11, pp 18-24; doi:10.4236/ojts.2021.111003

Abstract:
Introduction: Cardiac myxomas represent the most frequent forms of primary tumors of the heart. The most frequent location is the interatrial septum. We report the clinical case of a myxoma of the left atrium and discuss its epidemiological and therapeutic aspects through a review of the literature. Observation: This was a 41-year-old female patient who presented with sudden rotational dizziness associated with vomiting. MRI revealed multiple punctiform bilateral supra and subtentorial strokes of different ages, recent and semi-recent, suggesting an embologenic etiology. Transesophageal echocardiography found a large pedunculated, homogeneous, avascular tumor hanging from the interatrial septum. The patient is operated on urgently under cardiopulmonary bypass for resection of a large tumor located in the left atrium. The pathological examination concluded with the diagnosis of myxoma of the left atrium. The postoperative follow-up was straightforward and the patient was discharged from the hospital via home hospitalization. Conclusion: The diagnosis of cardiac myxomas is suspected in the presence of symptoms associated with echocardiographic images of intracardiac masses and confirmed by histological study. Embolic accidents are one of the formidable complications of myxomas. Surgical management is urgent, especially in the presence of predictive morphological features of embolism on echocardiography.
Otabek Eshonkhodjaev, Shuhrat Khudaybergenov, Ravshan Ibadov, Rustem Hayaliev, Anvar Yormuhammedov
Open Journal of Thoracic Surgery, Volume 10, pp 41-55; doi:10.4236/ojts.2020.102005

Abstract:
The article presents a new technique developed by RSCS named after acad. V. Vakhidov for performing percutaneous dilatational tracheostomy by using the improved Howard-Kelly forceps, which ensures stable traction of the guidewire and reduces the risk of trauma to surrounding tissues. In order to assess the feasibility and necessity of carrying out a modified method of tracheostomy, a comparative analysis of the frequency and structure of complications after various options for tracheostomy was carried out, taking into account the presence or absence of risk factors for an adverse outcome.
Buchhorn Reiner
Open Journal of Thoracic Surgery, Volume 10, pp 81-88; doi:10.4236/ojts.2020.104008

Abstract:
Our first intention to treat infants’ heart failure with beta blockers was to improve the clinical condition as shown in our prospective randomized trial. We only use non-selective beta blockers in these infants, carvedilol in those with left ventricular dysfunction and propranolol in those with congenital heart disease without ventricular dysfunction. Despite a significant improvement of Ross’s heart failure score, we could not convince most colleagues within the last 25 years if the concept of neurohumoral activation in heart failure is not well-established pediatric cardiology. Recently, Honghai Liu et al. published that cardiomyocyte cytokinesis failure was increased in congenital heart disease. Inactivation of the beta adreno receptors genes and administration of the beta-blocker propranolol increased cardiomyocyte division in neonatal mice, which increased the number of cardiomyocytes (endowment) and conferred benefit after myocardial infarction in adults. We currently realize that propranolol in infants with congenital heart disease not only decrease highly elevated NT-Pro-BNP values but also decrease cardiac troponin T values that may indicate myocardial injury due to neurohumoral activation. We reproduce this observation, primarily seen in infants with congenital heart disease, in an infant with Duchenne muscular dystrophy. These observations were in good accordance with current data from H. Liu et al., who showed that treatment with non-selective beta blockers early after birth might rescue cytokinesis defects and prevent heart dysfunction in adulthood in a mouse model.
Cecilie Enevoldsen, Britt Borregaard, , Lars Schoedt Riber
Open Journal of Thoracic Surgery, Volume 10, pp 19-31; doi:10.4236/ojts.2020.101003

Abstract:
Objectives: Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery and might be avoided with amiodarone prophylaxis. We investigated the long-term effect of prophylactic amiodarone, in patients undergoing isolated, elective coronary artery bypass grafting (CABG), as well as the long-term prognosis of patients with POAF. Methods: We retrospectively analysed patients included in the randomized, control trial RASCABG allocated to either placebo or amiodarone as POAF prophylaxis. Several outcomes were evaluated using national databases. Patients were stratified and compared by prophylactic groups and rhythm. Cox proportional hazard analysis was used for multivariable analysis. Kaplan-Meier survival curves were constructed to assess the probability of survival and cumulative incidence curves. Results: Prophylactic amiodarone was not related to long-term side effects in comparison to placebo. Patients who developed POAF, were more likely to develop late AF, and had a worse overall survival. There was no difference in the overall survival between prophylactic groups. In the competing risk analysis, amiodarone and POAF was not associated with an increased risk of readmission, but POAF was associated with an increased risk of late AF HR 2.28 [95% CI 1.15; 4.55]. In the multivariable analysis, amiodarone was not associated with late AF, readmission or long-term mortality. Further, no association was found between POAF and late AF, readmission or long-term mortality. Conclusion: Amiodarone is a safe drug for the prevention of POAF in the RASCABG-setting. POAF is related to long-term worse prognosis regarding late AF and mortality.
Elias Amorim, Nilo Antunes Sousa Filho, Petrucio Abrantes Sarmento, Joseval Silva Lacerda, Wildel Campos Ferreira, Paulo Roberto Mocelin, Antonio Vieira Dias Filho, Victor Hugo Dorigo Castilho, Joel Fernando Sodré Bayma Silva, Rejane Albuquerque, et al.
Open Journal of Thoracic Surgery, Volume 10, pp 1-5; doi:10.4236/ojts.2020.101001

Abstract:
Introduction: Pentalogy of Cantrell is a rare disorder described by Cantrell in 1958 and characterized by heart anomalies, involving defects of the diaphragm, abdominal wall, supraumbilical region and pericardium. Methods: We report a case of the disease that presented with agenesis of the sternum and partial absence of costal cartilage, treated by a multi-disciplinary team. Results: The patient underwent median sternotomy. An enlarged heart, compromising the pulmonary trunk and the right ventricle, and a left superior vena cava were identified. The right atrium was opened and an interventricular communication of around 10 mm in diameter was seen through the tricuspid valve. Following the repair of the heart defects, chondroplasty and placement of biological mesh (Bioway of Gore) were performed. Conclusion: A Successful surgical treatment for Cantrell Syndrome includes correction of the cardiac malformation, a good repair of thoracoabdominal wall.
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