499 Works

A Day of Thoracic Surgery With Professor Tristan D. Yan

Tristan D. Yan
Welcome to this series of CTSNet videos titled Thoracic Surgical Oncology - Technical Approaches, by Professor Tristan D. Yan. The Royal Prince Alfred Hospital and Chris O'Brien Lifehouse provide the largest thoracic oncology service in New South Wales, Australia. To introduce this video series, Professor Yan will take you through a day of thoracic surgery in his operating theaters. Professor Yan is a consultant cardiovascular and thoracic surgeon based in Sydney. His appointments include the...

The Surgical Modification of the Hybrid Procedure With a PTFE Ringed Graft for HLHS and Repair of Obstructive TAPVR on Beating Heart

& Ahmet Sasmazel
A 2 kg girl was transferred from another hospital to the ICU of Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital with a preliminary diagnosis of a hypoplastic left ventricle (AA/MA) and supracardiac TAPVR. The echocardiography showed mitral atresia, aortic atresia, 1 mm diameter ascending aorta, and mild stenosis in a vertical vein and pulmonary venous confluence. The patient was intubated and general condition was poor. A bilateral pulmonary banding was performed and...

Management of Contained Rupture of Wrapped Ascending Aorta: Redo Sternotomy, Replacement of Aortic Valve, and Ascending Aorta

, Christopher Efthymiou, Saad Khan & Giovanni Mariscalco
Patient Selection
The standard method of treatment for an ascending aorta aneurysm is replacement with the Dacron tube graft. However, some surgeons use alternative techniques in selected cases for dilated ascending aorta, such as wrap without aortoplasty (1, 2), wrapping of the ascending aorta with a fine transparent and stretchable Dacron mesh (3), manually pre-prepared prosthesis which respects the shape of the aorta (4), and reduction aortoplasty with wrapping (5, 6). The Dacron sleeve is...

Acupuncture and Complementary Therapy in Thoracic Surgery

Joel Dunning & Robin Sunley
This is a short video interview with Robin Sunley, a complementary therapist that started with Joel Dunning’s team in October of 2019. He routinely provides acupuncture, auriculotherapy, and mindfulness to thoracic surgical patients as part of their routine clinical care.

Exploit the Internet and Be a Shining Star

Edward M. Bender, Mara Antonoff, Jessica G. Y. Luc &
Filmed at the 2020 STS Annual Meeting in New Orleans, Louisiana, Edward M. Bender of Stanford University in California, USA, moderates a discussion on how the internet plays a role in establishing and growing cardiothoracic careers. He is joined by T. Sloane Guy of Thomas Jefferson University in Philadelphia, Pennsylvania, USA, Jessica G. Y. Luc of the University of British Columbia in Canada, and Mara Antonoff of MD Anderson Cancer Center in Houston, Texas, USA....

Exploit the Internet and Be a Shining Star

Edward M. Bender, Mara Antonoff, Jessica G. Y. Luc &
Filmed at the 2020 STS Annual Meeting in New Orleans, Louisiana, Edward M. Bender of Stanford University in California, USA, moderates a discussion on how the internet plays a role in establishing and growing cardiothoracic careers. He is joined by T. Sloane Guy of Thomas Jefferson University in Philadelphia, Pennsylvania, USA, Jessica G. Y. Luc of the University of British Columbia in Canada, and Mara Antonoff of MD Anderson Cancer Center in Houston, Texas, USA....

From Conventional Circuit to MiECC

Ignazio Condello, Giuseppe Santarpino, Marco Moscarelli, Giuseppe Nass & Giuseppe Speziale
The major advantage of MiECC systems’ intrinsic characteristics is that they abet the best applying cardiovascular physiology to intraoperative perfusion, while they ultimately unify all three operative disciplinary techniques into a common strategy. This joined holistic effect of MiECC may be considered as a therapy in cardiovascular diseases. Many believe that using MiECC systems leads to an increase in the costs of cardiac surgery. This video explains in a simplified way how to transform a...

A Review of Surgical Ligation of Patent Ductus Arteriosus in a Neonate

Maxwell F. Kilcoyne, Chi Chi Do-Nguyen & Randy M. Stevens
IntroductionAs transcatheter technology improves, the need for surgical ligation of a patent ductus arteriosus (PDA) decreases. Until recently, no device was approved for infants <5 kg. The Amplatzer Duct Occluder II Additional Size (ADO II AS, Abbott Vascular, Santa Clara, California, USA) was approved by the US Food and Drug Administration for infants >700 grams and at least three days old (1). However, patients <700 grams and those with anatomy unamenable to this transcatheter technology...

Konno-Rastan Aortoventriculoplasty for Aortic Valve Replacement in an Adult With Previous Mediastinal Irradiation

Sameh Said & Gamal Marey
This is a 50-year-old man who presented with exertional dyspnea and fatigue secondary to severe aortic valve stenosis. His past medical/surgical history was significant for previous left lung resection via left thoracotomy followed by a sternotomy for a left pleuropulmonary blastoma that was complicated with a paralyzed left hemidiaphragm. He received adjuvant chemotherapy and mediastinal irradiation as a child. Other significant medical issues include hypertension, hyperlipidemia, obstructive sleep apnea, and obesity with a BMI of...

Total Correction of Tetralogy of Fallot in an Infant

, , Shyamal Maiti, & Pradeep Narayan
Tetralogy of Fallot (TOF) is one of the most common cyanotic congenital heart diseases. The aim of this video is to demonstrate the technical aspects of total correction of TOF in a 5-month-old, 5 kg infant. Median sternotomy was performed. The surgery required standard cardiopulmonary bypass with aortobicaval venous cannulation. The authors’ choice of cardioplegia is del Nido cardioplegia.
The main steps are:
Resection and relief of right ventricular outflow tract (RVOT) obstructionVSD closureReconstruction of RVOT...

AV Valve Repair in a 3 kg Infant With Tricuspid Atresia

Vinod Sebastian & Charlie Steele
The authors present a case of AV valve repair in a 3 kg infant with tricuspid atresia.
The patient was diagnosed prenatally with tricuspid atresia. The patient was born full term with a birth weight of 2.8 kg. Diagnosis was confirmed as tricuspid atresia with transposition of the great arteries. Atrial septal defect and bulboventricular foramen were unrestrictive and the BVF was larger in dimension than the aortic valve. The patient underwent PA banding as...

Non-Intubated Subxiphoid Multiport VATS Thymectomy

Jian Hu, , Azmat Rustam, Shilpa Gandhi, Katarzyna Zanowska & Wahid Gohrain
This is a video of a non-intubated subxiphoid multiport VATS thymectomy. The patient was a 40-year-old man who was an asymptomatic chronic smoker. On incidental evaluation, HRCT thorax was suggestive of anterior mediastinal lesions, which on further MRI thorax was confirmed to be cystic and 1.8 x 0.8c m. Awake ventilation anesthesia without muscle relaxant was given under LMA. Tubeless principles were adopted. The patient was placed in a supine position, keeping legs wide apart...

Robotic Right Lower Lobe Anteromedial Basilar (S7 + S8) Segmentectomy: A Case Report and Discussion

Ankit Dhamija, , Alper Toker & Ghulam Abbas
Pulmonary segmentectomy can be an adequate oncological lung resection for early stage lung cancer and deeper metastatic lesions. In select patients, the outcomes are comparable to lobectomy. Historically, this operation has been associated with higher air leak and prolonged length of stay (1). Both video-assisted (VATS) and robotic assisted segmentectomy have similar outcomes (2). The authors believe the robotic approach allows for a more precise dissection secondary to its 3D visibility, dexterity, and wrist mobility....

Single Stage Retrograde Replacement of Thoracic Aorta With Aortic Valve Replacement

Mohammed Ibrahim, , Mohammed Idhrees, &
A 63-year-old old man was diagnosed with an aortic aneurysm by routine chest X-ray. His 2D echo showed moderate aortic regurgitation with normal LV function. A CT aortogram revealed an aortic aneurysm involving the ascending aorta, arch, and descending thoracic aorta. Coronary angiogram showed a tight ostioproximal lesion in the ramus intermedius. He was taken up for surgery.A median sternotomy was done. A 7 mm dacron graft was attached to the right axillary artery and...

COVID-19 and Cardiac Surgery: An Overview From a Lower Middle Income Country

, Shahid A Sami &
This study is an overview of the impact of COVID-19 on the provision of cardiac surgery in a Lower Middle Income Country, Pakistan, the fifth most populous country in the world with 24% of Pakistan's population living below the national poverty line (3) before the COVID-19 outbreak.

From Thoracic Surgery Triage to Service Reactivation: How to Protect Yourself

Hussein Elkhayat
There is currently not enough evidence to decide upon the best practice for thoracic surgery during the pandemic since the situation continues to be highly dynamic on a day-to-day basis. The author presents this short video recorded from a Medtronic thoracic surgery appearing in a webinar during this pandemic to emphasize the points that need to be addressed for service reactivation and how can surgeons can protect themselves during this time.ReferencesThoracic Surgery Outcomes Research Network,...

Totally Endoscopic Aortic Valve Replacement and Transaortic Mitral Valve Repair

Antonios Pitsis, Nikolaos Tsotsolis, Nikolaos Nikoloudakis, Isaak Keremidis, & Konstantinos Dean Boudoulas
The authors present the case of a 77-year-old woman in NYHA class 3, due to severe AS and severe secondary MR. The operation was performed with the authors’ totally endoscopic technique, which has been previously published on CTSNet (1-4). A 3D 30-degrees Karl Storz endoscope was used. Under stereoscopic vision, the mitral valve was approached through the aortotomy after the excision of the calcific aortic valve. A self-expanding metal net (Fehling) was deployed in the...

Giants of Cardiothoracic Surgery: An Interview With James L. Cox

Joel Dunning, James L. Cox & Emel Dubar
In this Giants of Cardiothoracic Surgery interview, Joel Dunning speaks with James L. Cox, creator of the Cox maze procedure for the treatment of atrial fibrillation. Dr. Cox recounts the creation of the Cox maze operation and the evolution to modern atrial fibrillation surgery, as well as the future of this treatment. He also calls for a new categorization system for atrial fibrillation, calling the current system “not fit for purpose.”

Biventricular Repair in Hypoplastic Left Heart Syndrome

James Tweddell & Alan ODonnell
The patient was a 23-month-old, 11.7 kg girl with an antenatal diagnosis of hypoplastic left heart syndrome (mitral stenosis/aortic stenosis).

Transthoracic echocardiogram demonstrated a hypoplastic, non-apex forming left ventricle with moderate dysfunction and evidence of extensive endocardial fibroelastosis (EFE). Initial left ventricular volume was measured at 17 ml/m^2. The mitral valve was hypoplastic and stenotic. Further, the mitral valve demonstrated poor leaflet excursion with a small effective orifice (0.66cm: Z-score -2.59). Echobright papillary muscles also...

Thoracoscopic Repair of a Vascular Ring Formed by a Right Aortic Arch and a Left Ligamentum Arteriosum

Ana Pita Fernandez, Juan Carlos De Agustin-Asensio, Hugo Rodríguez-Abella, Maria Antonia Garcia Casillas, Ramon Perez-Caballero Martinez, Carlos Pardo Pardo, Diego Diaz Monzon &
Introduction
Vascular ring is a congenital anomaly of the aortic arch that compresses the esophagus and/or trachea. It can be asymptomatic for life and not require any intervention. On the contrary, there are some vascular rings that are associated with respiratory (frequent infections, stridor, cough, distress) and esophageal (difficulty feeding, gastroesophageal reflux, dysphagia) symptoms. The most common vascular rings are double aortic arch and right aortic arch with left ligamentum arteriosum.
Case Report
The patient was a 4-year-old,...

Modified Biatrial Approach for Obstructed TAPVC

Krishna Manohar
In this video, the technique of a modified biatrial approach for a 7-month-old, 3.6 kg boy who presented with an obstructed TAPVC to the coronary sinus is shown. Median sternotomy was done, and the aorta and RA appendage were cannulated. During cooling, the ligamentum was divided and the LPA was looped so that the left upper pulmonary vein was freed first. The innominate vein and IVC were cannulated. The advantages of cannulating the innominate vein...

Totally 3D Endoscopic Minimally Invasive Resection of Papillary Fibroelastoma

Yuichiro Fukumoto, Soh Hosoba, Sho Takagi & Yoshihiro Goto
Surgical resection is the first line of therapy for cardiac tumors. Some studies suggest that a totally endoscopic surgery technique results in better cosmetic outcomes (1, 2) and a 3D endoscopic view provides better visualization of structures deep in the chest cavity (2) compared with conventional sternotomy. Herein, the authors report a totally 3D endoscopic minimally invasive removal to papillary fibroelastoma on the posterior mitral leaflet in a young patient.
A 42-year-old otherwise healthy woman...

Modified Button-Bentall Operation: The Miniskirt Technique

Andrea Venturini, Alan Gallingani & Domenico Mangino
The aim of this video is to highlight the surgical details of a modified button-Bentall operation specifically designed to incorporate any type of prosthetic valve in composite conduit aortic root replacement. The authors’ technical modification allows composite conduit creation and proximal suture line construction as a single-step maneuver. Moreover, the proximal suture line is reinforced with a running monofilament suture incorporating aortic wall remnants and graft edge, therefore improving proximal hemostasis. In the strategy presented,...

Robotic-Assisted Tracheobronchoplasty

Igor Brichkov, & Jason Shaw
This is the case of an elderly woman with significant tracheobronchomalacia (TBM) who presented with exertional dyspnea and cough. The patient underwent awake fiberoptic bronchoscopy, which confirmed posterior malaria with >90% narrowing of the trachea and right mainstream bronchus. The patient was treated conservatively with bronchodilators for six months without symptomatic improvement. She was referred for tracheobronchoplasty via a minimally invasive approach.
A four-arm robotic-assisted approach was selected. The trachea was dissected to the level of...

Biventricular Repair in Hypoplastic Left Heart Syndrome

James Tweddell & Alan ODonnell
The patient was a 23-month-old, 11.7 kg girl with an antenatal diagnosis of hypoplastic left heart syndrome (mitral stenosis/aortic stenosis).

Transthoracic echocardiogram demonstrated a hypoplastic, non-apex forming left ventricle with moderate dysfunction and evidence of extensive endocardial fibroelastosis (EFE). Initial left ventricular volume was measured at 17 ml/m^2. The mitral valve was hypoplastic and stenotic. Further, the mitral valve demonstrated poor leaflet excursion with a small effective orifice (0.66cm: Z-score -2.59). Echobright papillary muscles also...

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