430 Works

Aorto-Left Ventricular Tunnel Neonatal Repair

Ana Pita Fernandez, Juan-Miguel Gil-Jaurena, Ramón Pérez-Caballero, Carlos Pardo Pardo, Corazon-Mabel Calle-Valda, Hugo Rodríguez-Abella, Edmundo Fajardo-Rodríguez & Diego Monzon-Diaz
Introduction.

Levy et al [1] first described the aorto-left ventricular tunnel in 1963. This rare congenital malformation is an abnormal channel that connects the ascending aorta with the left ventricle bypassing the aortic valve. In view of its rarity, surgical series are small. Most of the patients develop symptoms of heart failure during the first year of life but there are cases of asymptomatic adults [2-3]. Onset of heart failure depends on the cross-sectional...

Total Arterial Myocardial Revascularization Using OPCAB Technique With 3 In-Situ Arterial Grafts

Giuseppe Tavilla, Daniel L. Beckles, Amber Malhotra, Brady Gunn & Ramachandra C. Reddy
In this video we present our technique of total arterial myocardial revascularization using bilateral internal thoracic arteries and the right gastroepiploic artery as in-situ grafts for three-vessel disease. The left internal thoracic artery (LITA) is used as a sequential graft to the diagonal branch (Diag) and the left anterior descending artery (LAD). The right internal thoracic artery (RITA) is routed through the transvers sinus to revascularize the obtuse marginal branch (OM). Finally, the right gastroepiploic...

Innovations on the Norwood Procedure: Sustained Total All-Region (STAR) Perfusion

Neel K. Prabhu, James M. Meza, Nicholas D. Andersen & Joseph W. Turek
Recovery following the neonatal Norwood procedure is often complicated by bleeding, acute kidney injury, systemic inflammatory response, and low cardiac function [1]. The traditional conduct of this operation under deep hypothermic circulatory arrest likely exacerbates these problems. Total body perfusion during Norwood reconstruction may improve post-operative recovery by cooling to only mild hypothermia and eliminating ischemic time in all vascular beds. Here, we present a novel technique for sustained total all-region (STAR) perfusion of the...

Robotic Left Upper Lobe Sleeve Lobectomy

Fernando Ascanio Gosling, Pilar Montoya Urbano, Laura Romero Vielva, Joel Rosado & Alberto Jauregui
We present the case of a 20-year-old man with 3 days of fever and headache, as well as a dry cough and dysgeusia. A chest CT scan was performed and a lesion in the left upper lobe was observed. The previous medical history included toxic megacolon and a viral pericarditis. The PET scan showed a hypermetabolic endobronchial lesion in the left upper lobe bronchus, resulting in atelectasis of the entire lobe. A bronchoscopy was performed...

Subxiphoid VATS Thymectomy After Cardiac Surgery

Aseel Rishiq, Raghida Sinnokrot, Firas AbuAkar & Bisanne Shaqqura
Although the traditional (median sternotomy) approach has been set as the standard for thymectomy due to its better visualization and control of the anatomical structures, video-assisted thoracoscopic surgery (VATS) thymectomy can offer a less invasive technique with fewer perioperative complications and better cosmetic outcomes. This article contains a video demonstrating excision of anterior mediastinal mass via subxiphoid VATS technique on a pregnant female with a history of previous cardiac surgery via midline sternotomy. In this...

One Stage Thoracoscopic Segmentectomy and Transphrenic Adrenalectomy for Non-Small Cell Lung Cancer With Unique Metastasis

Patrick Bagan, JC Das Neves Pereira, B Dakhil & R Zaimi
Objective;Metastasis from non-small cell lung cancer (NSCLC) is traditionally considered as a contraindication to surgery. Favourable long-term survival following staged lung resection and resection of synchronous isolated adrenal metastasis has been reported in N0 patients. Considering the retroperitoneal location of the adrenal gland, the transdiaphragmatic approach offers an attractive alternative to standard approaches to adrenal tumors. We describe a technique of simultaneously completing a lung resection and adrenalectomy safely through the thoracic approach.Case video Summary:We...

Papillary Muscle Cross-Control Technique to Overcome Excessive Leaflet Tethering in Complex Tricuspid Valve Repair.

Ahmad Ali Amirghofran & Elahe Nirooei
Long standing tricuspid valve regurgitation(TR), either with functional or organic origin, might lead to severe right ventricular dilatation and/or dysfunction. The chordal shortening caused by papillary muscle displacement secondary to marked RV dilation results in severe leaflet tethering and progressive lack of coaptation which makes the tricuspid valve repair surgery much more complicated. The annular and RV wall dilatation occurs mostly in the antero-posterior commissure parts and the septal area is less involved. The tricuspid...

Normothermic Ex vivo Lung Perfusion: Toronto Protocol

Hemant Gokhale, Manyin Chen, Rafaela Ribeiro, Aizhou Wang, Marcelo Cypel, Jonathan Yeung & Shaf Keshavjee
The advent of normothermic ex vivo lung perfusion (EVLP) has allowed for significant increases in lung transplant volume, allowing for the recovery of lungs deemed unsuitable for transplantation. At our center, lung transplant activity has more than doubled within the last decade since the introduction of EVLP into our program. Here, we outline some of the important aspects of the Toronto EVLP protocol within a narrative video. References Cypel, M., Yeung, J. C., Hirayama, S.,...

Usefulness of Leakage Test in Mitral Valve Repair

Tiziano M Torre, Francesca Toto, Enrico Ferraris, Thomas Theologou, Giuseppina Surace, , Gabriele Casso & Stefanos Demertzis
Mitral valve repair is the preferred surgical treatment for mitral regurgitation.
Nowadays minimally invasive technique through right minithoracotomy is routinely performed for treating this pathology for complex repair too.
Cardiac surgeons must increasingly pursue high-quality mitral valve repair, which ensures excellent long-term outcomes.
Intraoperative assessment of a competency of the repaired mitral valve before closure of the atrium is an important step in accomplishing successful mitral valve repair.
Saline test is the most...

Totally Endoscopic Port-Access Artial Myxoma Resection Without Robotic Assistance

Nguyen Cong Huu
The video presents the technique of surgical excision of the right atrial myxoma using a totally endoscopic port-access without robotic assistance.
A 51-years-old female was admitted to the hospital because of chest pain just one day before. She had a normal medical history. Transthoracic echocardiography revealed a giant neoplasm in the right atrium, a mass measuring 48x36 mm had a stalk attached to the interatrial septum. The computed tomography for metastatic workup was negative....

Extensive Repair of an Injured Bicuspid Pulmonary Valve Following Balloon Dilatation By Using Autologous Pericardium And Repair of a Flail Tricuspid Valve

Fırat Altın, Murat Kardas & Numan Ali Aydemir
13 years-old, 70 kg male patient was admitted to Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital pediatric cardiac surgery clinic with fatigue and dyspnea on exertion. He had a history of balloon dilatation of the pulmonary valve when he was 3 years old. Preoperative echocardiography revealed a flail tricuspid anterior leaflet with severe regurgitation, moderate to severe pulmonary valve regurgitation, and a dilated right ventricle. QT interval was 110 msec. The right...

Robotic Assisted Right Lower Lobectomy Following Immunotherapy and Post-Oesophagectomy

Alexander Smith & Andrea Biller
Immune checkpoint inhibitors (ICIs) targeting the T-Cell programmed death receptor-1 (PD-1), showed improved survival in patients with locally advanced and metastatic non-small cell lung cancer (NSCLC). However, the role of salvage thoracic surgery in the management of residual disease following immunotherapy or in patients with synchronous cancers has yet to be defined. There are very few reported cases of pulmonary resection in this patient cohort (1), with reported surgical challenges related to post-immunotherapy hilar fibrosis...

Left Thoracoscopic Approach for Convergent AF Ablation: How to do Everything From the Same Side.

Alexander Moiroux-Sahraoui & Konstantinos Zannis
Atrial fibrillation (AF) is associated with increased risk of stroke, heart failure and all-cause mortality [1]. When it comes to treating persistent AF, the Cox-Maze procedure is the gold standard. However, it presents significant morbidity and mortality rates. The classical endocardial ablation approach appears to be safer but has limited efficacy to treat long lasting persistent AF [2]. Thoracoscopic hybrid epicardial-endocardial ablation technique proved to be effective and safe to treat long lasting persistent AF...

Successful Management of Postoperative Chylothorax in a Neonate after Coarctation Repair

Sameh M. Said & Gamal Marey
This is a 3.8 kg, 6-day old neonate whose initial presentation was a cardiogenic shock secondary to ductal closure. Upon admission, prostaglandins was initiated and the neonate was stabilized. Echocardiography and Computed tomography scan showed critical coarctation with severe arch hypoplasia and a paramembranous ventricular septal defect. One-stage repair via median sternotomy was performed where an extended end-to-end repair of the aortic coarctation was performed with pulmonary homograft patch augmentation of the anastomosis anteriorly, in...

Robotic assisted Right Upper Sleeve Lobectomy

Dylan Tan Jun Hao, Jennifer Whiteley, Alan Kirk & Rocco Bilancia
This video describes a step-by-step demonstration of a robotic assisted sleeve lobectomy for the treatment of a typical carcinoid tumour in the right upper lobe. The tumour was visible in the right upper lobe bronchus during endobronchial examination. We used a four-port approach plus utility port for this procedure. Robotic assistance was provided using the Da Vinci X robotic system. Arms 1 and 3 were used as instrument ports, Arm 2 was used as a...

How to Perform a Hybrid Endocardial / Epicardial Mapping and Ablation for IST/POTS

Mark La Meir
Inappropriate sinus tachycardia (IST) is defined as a sinus HR >100 bpm at rest (with a mean 24-hour HR > 90 bpm not due to primary causes) and is associated with distressing symptoms of palpitations, fatigue and exercise intolerance. Postural tachycardia syndrome (POTS) is a systemic disease, with postural tachycardia being one of several underlying criteria. It is usually characterized by frequent symptoms that occur with standing, such as light-headedness, palpitations, tremor, generalized weakness, blurred...

Fissure-Last VATS Left Lower Lobe Lobectomy

Tristan D. Yan & Joel Dunning
Welcome to the tenth of twelve videos that compose the series "Thoracic Surgical Oncology - Technical Approaches" by Professor Tristan D. Yan.
The Royal Prince Alfred Hospital provides the largest thoracic oncology service in New South Wales, Australia.
This series of video tutorials demonstrate how to perform VATS lobectomy in a safe and simple way, using the Edinburgh Posterior Approach. This approach is favoured, because it provides excellent visualisation of the tips of the...

Respecting The Mitral With Home-Made Loops

, Grzegorz Laskawski & Joseph Zacharias
In this video, we have used a home-made chord loops for mitral valve repair. We believe that this system is flexible for the mitral surgeons as the number of loops can be controlled. Usually, we use the Chordex system made by On-X, but due the shortage of supplies we faced due the pandemic, we started to make this system intraoperatively.

We usually use size 16mm chords for posterior mitral leaflet and 20-24mm chords...

Non Atriotomy Epicardial Ablation for AF

Eric Okum
This video demonstrates a novel non-atriotomy technique for performing the maze procedure in patients undergoing non mitral valve open heart surgery. It is estimated that only 15-25% of patients with atrial fibrillation undergoing either coronary artery bypass or aortic valve procedures receive a maze procedure(1). However, concomitant maze procedure is recommended by the Society of Thoracic Surgeons guidelines as a Class I indication for those undergoing CABG, AVR , or combination of both(2).
This...

Robotic Right Upper Lobe Anterior (S3) Segmentectomy: Case Discussion and Technical Aspects

Jahnavi Kakuturu, Ankit Dhamija, Ghulam Abbas & Alper Toker
The advent of low dose CT scans for lung cancer screening has resulted in increased detection of small lung nodules concerning for malignancy. Based on the location, some of these nodules may not be amenable to diagnostic transthoracic biopsy or wedge resection. In this scenario, a segmentectomy may be performed for diagnostic purposes.

In-depth knowledge of the venous and arterial anatomy is crucial when performing segmental operations. Specifically, for right upper lobe anterior...

No Visible Scars Implantation of a Continuous Flow Ventricular Assist Device

Manuel Wilbring, Utz Kappert, Sebastian Arzt, Ephraim Winzer, Julia Fischer & Aron Popov
Ventricular assist device surgery using a lateral access has been shown to be a safe and a partially beneficial alternative to the standard approach by sternotomy (1). Hereby, left anterolateral minithoracotomy is obligatory for accessing the apex, but for facilitating the outflow-graft anastomosis mainly two options are described: (I) partial upper sternotomy and (II) right anterior minithoracotomy using the second intercostal space (2). Both are well established techniques, but still have the need for either...

Neonatal Repair of Left Pulmonary Artery Sling and Long Segment Tracheal Stenosis With a Slide Tracheoplasty

Vinod Sebastian
We present the case of a 2.8 kg baby born with Axial Mesodermal Disruption syndrome that encompasses features of Oculo-Auriculo-Vertebral spectrum disorder and VACTERL. OAV spectrum disorder is also known as Goldenhar. The patient was diagnosed with a left pulmonary artery sling, long segment tracheal stenosis, atrial septal defect and bilateral superior vena cavae. The patient underwent a colostomy immediately after birth due to an imperforate anus. Patient was also diagnosed with cleft palate, microtia,...

Modified Norwood/Sano Stage I Palliation for Hypoplastic Left Heart Syndrome without Circulatory Arrest

Gamal Marey & Sameh M. Said
We present to you a stage-I palliation of hypoplastic left heart syndrome (HLHS) via a modified Norwood/Sano procedure in a 3.9 kg, 6-day old neonate with aortic and mitral valves atresia. The neonate had unrestricted atrial septum and was placed on prostaglandin infusion after birth to maintain ductal patency.
Our preference is to modify the Sano conduit prior to sternotomy by suturing the end of a 5-mm ringed Gore-Tex graft to a 7-mm aortic/pulmonary...

Robotic Assisted Right Lower Lobectomy Following Immunotherapy and Post-Oesophagectomy

Alexander Smith & Andrea Biller
Immune checkpoint inhibitors (ICIs) targeting the T-Cell programmed death receptor-1 (PD-1), showed improved survival in patients with locally advanced and metastatic non-small cell lung cancer (NSCLC). However, the role of salvage thoracic surgery in the management of residual disease following immunotherapy or in patients with synchronous cancers has yet to be defined. There are very few reported cases of pulmonary resection in this patient cohort (1), with reported surgical challenges related to post-immunotherapy hilar fibrosis...

Robotic Assisted Diaphragm Resection and Pleurectomy

Alexander Smith & Andrea Bille
We present a case of a 40 year old lady who presented with cyclical abdominal pain, and was subsequently diagnosed with endometriosis. Computed tomography scan of the chest revealed a 25mm nodule in the right hemidiaphragm, and she was therefore consented for robot-assisted diaphragmatic resection and repair, and pleurectomy to prevent possible catamenial pneumothorax. We initially approached the diaphram using 3 robotic ports and 1 assistant port in a pelvic position (1). Once the endometrial...

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