2,274 Works

Cor Triatriatum Sinister With an Intact Interatrial Septum and a Decompressing Vein in a Toddler

Ziyad M. Binsalamah, Luis E. De Leon, Lauren C. Kane & Jeffrey S. Heinle
ObjectivesCor triatriatum sinister is a very rare cardiac anomaly that may lead to pulmonary hypertension, right ventricular dilation, and eventually right heart failure.MethodsThe authors report a procedure performed for a toddler who was misdiagnosed with asthma as an infant. She had progressive respiratory symptoms and was found to have cor triatriatum sinister with a restrictive communication, decompressing vertical vein, severe tricuspid regurgitation, and severe right ventricular dysfunction.ResultsThe surgical repair, shown in the video, was uneventful...

Multiport Video-Assisted Thoracoscopy for Left Anterior Segment GGO

Jian Hu, , Azmat Rustam, Shilpa Gandhi, Katarzyna Zanowska & Wahid Gohrain
The patient was a 63-year-old male chronic smoker with a positive family history of lung cancer. Computed tomography (CT) scan thorax was suggestive of 1.4 x 1.2cm mixed GGO in the S3 segment of the left upper lobe. The rest of the investigations were normal.
The authors started with a standard 3-port VATS approach dissecting the hilum first to skeletonize the left superior pulmonary vein. V3a was identified, dissected, and divided after suture ligation at...

VATS Right Middle Lobe Lobectomy in the Setting of Oligometastatic Lung Cancer

Shanda Blackmon
BackgroundA 31-year-old woman who was a former ice hockey player, was in the military, and is a lifetime never-smoker presented with a medical history of asthma, migraine headaches, endometriosis, and recurrent sinus infections. She had a maternal grandfather with lung cancer and a paternal grandmother with colon cancer. During an initial evaluation for a breast abnormality, magnetic resonance imaging (MRI) of the breast was performed and revealed an incidental lung nodule. She then had a...

Mitral Valve Repair in Barlow's Disease Using PTFE Neochords and Annuloplasty: The Bending Plasty

Jorge Rodriguez-Roda
This video demonstrates the repair of a mitral valve with Barlow's disease without resecting the tissue of the prolapsing leaflet. The patient was a 44-year-old man who was totally asymptomatic in sinus rhythm with no treatment, and the echocardiographic findings consisted in a preserved left ventricle ejection fraction with a 40 mm left ventricle end-systolic diameter and grade 4+ mitral regurgitation, due to a prolapse of the posterior leaflet.Echocardiography showed features typical of Barlow´s disease:...

Minimally Invasive Cardiac Surgery Through Periareolar Approach

Mateo Marin Cuartas, Lizeth Dayana Saldaña, Alberto Alejandro Quintero, Juan Santiago Jaramillo & Juan Camilo Rendon
IntroductionSince the early 1990s, minimally invasive cardiac surgery (MICS) has evolved worldwide. It started with mitral valve procedures and then gradually expanded towards other valve procedures, coronary artery bypass grafting and various types of simple congenital heart operations. There has been a growing interest for MICS given the association of this technique with decreased pain, shorter hospital stay, accelerated recuperation and cost effectiveness (1, 2). Recently, better aesthetic results have also been sought without compromising...

Robotically-Assisted Myxoma Resection: Tips and Tricks

, Per Wierup, Daniel Burns & Marc Gillinov
This video demonstrates the technique for robotically assisted myxoma resection. Also, it highlights the tips and tricks that have made this approach the authors’ method of choice for nearly all patients. The patient was a 72-year-old woman who had a routine chest CT, which showed an incidental LA mass, as demonstrated in this image. She had neither heart failure nor constitutional symptoms. She also denied a history of embolic events.
The preoperative transesophageal echocardiography showed a...

CTSNet Step-by-Step Series: Central Cannulation

, Omar A. Jarral, Shruti Jayakumar, Jason Varzaly, Leanne Harling & James Edwards
This video demonstrates a central cannulation in a step-by-step fashion, using diagrams and surgical video to illustrate key technical elements.Step 1Aortic cannulation is always done prior to atrial cannulation. At this step in the video, you can see partial thickness purse string sutures being placed into the aorta, which are then snared. Next, an incision is made into the aorta through the middle of the purse string suture, and a cannula is placed into the...

Surgical Repair for Coarctation of the Aorta

& Pradeep Narayan
Coarctation of the aorta is a congenital narrowing of the upper descending aorta adjacent to the site of attachment of ductus arteriosus. In neonates and young infants, surgical repair is the treatment of choice. The most common contemporary technique used is resection and end-to-end anastomosis, and if anatomically warranted, an extended end-to-end anastomosis. This video illustrates the steps of coarctation repair by extended end-to-end anastomosis through a left posterolateral thoracotomy. Important steps are: thoracotomy, opening...

Transcatheter Versus Conventional Mitral Valve Surgery: Which Questions Should Future Clinical Trials Seek to Answer?

Francis Charles Wells
Francis Charles Wells of the Papworth Hospital in Cambridge, UK, compares transcatheter and conventional surgical mitral valve interventions. He focuses on the questions that need to be answered regarding surgical outcomes in order to properly compare the two approaches.This presentation was originally given during the SCTS Ionescu University program at the 2017 Annual Meeting of the Society for Cardiothoracic Surgery in Great Britain and Ireland. This content is published with the permission of SCTS. Please...

Simultaneous Mitral Valve Repair and Pectus Excavatum Correction

Oleksandr Babliak & Volodymyr Demianenko
The authors present a case of mitral valve (MV) repair combined with pectus excavatum repair in a highly symptomatic 28-year-old woman. Her preoperative transesophageal (TEE) echo showed severe mitral insufficiency, and her preoperative computed tomography (CT) scan showed a Haller index of 16.3 and heart displacement to the left.
The authors’ plan was to take out all the costal cartilages starting from the second rib. Transverse sternotomy at the second intercostal space was performed. The upper...

Mitral Repair by Minimally Invasive Approach

Daniel Navia, Manuel Roque Cervetti, Julian Benavides, Nestor Manuel Clusa, Alvaro Muñoz, Juan Mariano Vrancic, Fernando Piccinini & Mariano Camporrotondo
Mitral valve repair is shown to have better survival, better preservation of ventricular function, and decreased thromboembolic complications compared to mitral valve replacement for mitral regurgitation (1-2). The Cardiovascular Institute of Buenos Aires in Argentina is a center with extensive experience in mitral repair, with a 98% success rate in posterior valve.The authors present a mitral valve repair performed for a 69-year-old woman. Her cardiovascular history includes smoking, dyslipidemia, and asymptomatic severe mitral insufficiency due...

Concomitant Minimally Invasive Surgical Approach: Minimally Invasive Direct Coronary Artery Bypass and Minimally Invasive Endoscopic Ressection of Cardiac Tumor

João Pedro Monteiro, Sara Simões Costa, Daniel Martins, Ricardo Ferraz, Rodolfo Pereira, Nelson Santos Paulo & Luis Vouga
Case Presentation
A 46-year-old man with a history of stroke and permanent atrial fibrillation was referred to the authors’ institution with the diagnosis of an LV mass. During preoperative study, catheterization revealed an 80% stenosis of the mid portion of the left anterior descending artery (LAD), and echocardiography showed a PFO. As the authors’ institution has experience with both minimally invasive mitral valve repair (MIMVR) and minimally invasive direct coronary artery bypass (MIDCAB), they opted for...

Omentoplasty For the Treatment of Early Graft Infection After Valve-Sparing Aortic Root Replacement

Koray Ak, Fatih Ozturk, , , Yasin Guctekin & Sinan Arsan
Even though infection of thoracic aortic grafts is rarely seen, management of these cases still remains a real challenge in current clinical practice. The treatment of complete removal of the infected graft and radical debridement has been accepted as the gold standard. Reoperation has been shown to be a high mortality situation (1). In situ graft-sparing surgical therapy with aggressive debridement has been proposed as a promising alternative to conventional treatment in patients with thoracic...

Left Lower Lobe Bronchiectasis After Rare Abnormal Migration of Ventriculoperitoneal Shunt in a Hydrocephalic Child

Mohamed El Adel & Mohamed Alaa Nady
The ventriculoperitoneal (VP) shunt is a commonly used treatment for hydrocephalus. Shunt malfunctions such as obstruction and disconnection are common; however, migration of the distal catheter out of the abdomen is less frequent. Recurrent chest infection in a hydrocephalic child should be taken in serious consideration. The authors report a very rare case of distal migration of a VP shunt catheter into the left lower lobe of the lung. This is the first case in...

Robotic-Assisted Treatment of Aberrant Retroesophageal Right Subclavian Artery

, Lee Hafen, Anthony Tran & William Shutze
Aberrant right subclavian artery (ARSA) is a rare anomaly but is the most common congenital abnormality of the aortic arch with an incidence of 0.3-3.0% (1, 2). The vessel embryologically is the 4th branch of the aortic arch, most commonly passes behind the esophagus and crosses the midline between the esophagus and the vertebral column to reach the right arm (3). Approximately 60% may be aneurysmal at their origin (4). An aberrant right subclavian artery...

COVID 19 and Life Threatening Cardiac and Cerebellar Thromboembolic Events in Cardiac Operations

, Leonidas Hadjinikolaou, , Saad A. Khan, Anil Darbar & Giovanni Mariscalco
There are several reported cases that have showed that COVID 19 is a highly thrombogenic disease. The release of cytokines during cardiopulmonary bypass plus COVID 19 related thrombogenic factors can trigger life-threatening thromboembolic events as we have experienced with these two young patients(video). Myocarditis was rare in COVID-19 in an autopsy population of 277 subjects; however, COVID-19-related cardiovascular histopathologic findings, such as macro or microvascular thrombi were reported in nearly half of the cases 11....

When Things Go Wrong in Thoracic Surgery: A Middle Lobectomy With Bleeding That Required Cardiopulmonary Bypass to Address

Joel Dunning, Jonathan Ferguson, &
This is a video showing a procedure performed by open thoracotomy with a head camera that records audio. The patient had a large middle lobe tumor and had an ICD, an impaired left ventricular function, and previous coronary artery bypass grafting. Unfortunately, the operating surgeon got into a bleeding scenario that required the whole team to work together to get out of this problem.
This is a 34 minute video where the viewer can hear exactly...

Surgical Correction of a Giant Left Atrial Myxoma Producing Critical Mitral Stenosis

Bulat A. Ziganshin, Osama Anis, Mohammad A. Zafar, Kai Swenson, Adebowale J. Adeniran, Maryann Babcock & John A. Elefteriades
Slide 1
With this video illustrating the operative technique we present a case of surgical correction of a giant left atrial myxoma that produced critical mitral stenosis in our patient.

Slide 2
Primary tumors of the heart are extremely rare with their incidence as low as zero point 19%. Three quarters of all cardiac tumors are benign in origin. Myxomas are benign neoplasms, they are the most common type of intracardiac tumors. 75% of...

Repair of Saccular Aortic Arch Aneurysm in a Patient With Behcet Disease and Multiple Aortic Aneurysms

Abdulwahid Almulla, Hatem Sarhan, Laith Tbishat & Mohamed Elkahlout
A 30-year-old male patient was diagnosed with Behcet disease in January 2020 when he was admitted with abdominal aorta vasculitis. This resulted in a leaking large abdominal aneurysm that was repaired by the vascular team using a tube graft. The work up on that admission showed pulmonary embolism in the left lower lobe branches and RV thrombus as well. There was a saccular aortic arch aneurysm distal to left common carotid artery and the left...

Nonintubated Tracheal Resection

Jiang Lei, , Wu Liang, & Luciano Bulgarelli Maqueda
The authors present the care provided to a 40-year-old man, a smoker, with a nonrelevant past history, experiencing chronic irritative cough and bloody sputum since one month before consultation. During the medical examination, stridor was noticed. Flexible bronchoscopy was performed and found an exophytic lesion in the upper trachea. Biopsy demonstrated an adenoid cystic carcinoma.The treatment plan was discussed in a multidisciplinary meeting, and the patient was referred for surgical resection of the lesion. The...

VATS Bilobectomy of RU+RML on a 27 Year-Old Patient Post Chemo/Radiation

Dimitrios Kyparissopoulos
Minimal invasive approaches are the golden standard for the treatment of thoracic malignancies. Nowadays, we can offer a vast number of different procedures with either VATS or RATS approach, that would be out of question a few years ago. In this video, we demonstrate a VATS Bilobectomy through an only 4 cm incision on a 27 yo patient who underwent chemo/radiation therapy prior to his surgery. He was discharged just 36 hours post surgery.

Transaortic Extended Left Ventricular Septal Myectomy in an Adult With Hypertrophic Obstructive Cardiomyopathy

Gamal Marey & Sameh M. Said
This is a 52-year-old man with hypertrophic obstructive cardiomyopathy (HOCM). He has been on maximal medical therapy with combination of Beta blockers and calcium channel blockers with progression of his symptoms especially during exertion. Preoperative evaluation included transthoracic echocardiography and cardiac MRI for risk stratification. Studies showed severe septal hypertrophy especially at the basal levels. At rest, the the peak gradient across the left ventricular outflow tract was 59 mm Hg which increased to 115...

Early Migration of a Self-Expanding Transcatheter Aortic Valve Prosthesis Causing Coronary Occlusion: A Practical Technique for Surgical Explantation

Jordan P. Bloom, Michael Kwon & George Tolis
ObjectivesTranscatheter aortic valve replacement (TAVR) has become the standard of care for high-risk patients and is growing in popularity for lower risk patients. The authors report a case of early migration of a self-expanding transcatheter aortic valve prosthesis causing coronary obstruction and myocardial infarction.MethodsA 76-year-old woman with renal failure underwent an uncomplicated TAVR. Thirty-two days later she presented with acute angina, ruled-in for myocardial infarction, and was found to have iatrogenic coronary obstruction from the...

Life-Threatening Left Subclavian Arterial Rupture Following Blunt Thoracic Trauma: A Case Report

Introduction Traumatic subclavian arterial rupture represents an uncommon complication of blunt chest trauma. Arterial rupture usually causes massive hemorrhages, and it must be quickly and properly confirmed by physical examination. Although it is uncommon, it is a challenging surgical problem and many surgeons have limited experience with its management [3, 4]. In recent years, complex subclavian injuries have been increasingly managed through endovascular intervention that is applied for patients who are hemodynamically stable at presentation...

Shared Mental Model in VATS Lobectomy

René Horsleben Petersen
Since the introduction of video-assisted thoracoscopic lobectomy more than 25 years ago, the focus for thoracic surgeons has been to enhance the surgeon’s technical skills. This has been implemented with success across the world, and a minimal invasive approach to lung cancer is standard of care in many units today. However, major intraoperative complications occur occasionally. To improve patient outcome and safety, it is important that the entire team perform at a high level.

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