430 Works

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...

The Historical Perspective of the Cox Maze III

Patrick McCarthy
Dr. James L. Cox is rightly credited for his pioneering methodical work developing a treatment for atrial fibrillation (AF): identifying the magnitude of the clinical problem, studying the mechanisms of AF in his laboratory, developing an operative solution in the animal model, then successfully introducing the operation into clinical practice in 1987. The operation became widely recognized as the “Cox-Maze Procedure”. The operation creates a “maze” of pathways in the atria starting at the SA...

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...

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.

VATS Resection of Multiple Pulmonary Metastasis Using the LEONARDO® Dual Wave 200W Laser System

Oliver Harrison & Lukacs Veres
Laser-assisted resection of pulmonary metastasis has been established for over a decade(1). A significant advantage over conventional wedge resection is the preservation of lung tissue, allowing resection of multiple and/or bilateral metastasis without compromising pulmonary function, whilst achieving similar survival and recurrence rates(2). The technique has since been adapted to the VATS setting. In this trainee-led procedure, the Leonardo® 200w dual wave laser system was used, the first use of this device for VATS metastatectomy...

Unroofing of Left Main Coronary Artery with Trans-septal Course

Gamal Marey & Sameh M. Said
Trans-septal/Intraconal Left Main Coronary Artery (LMCA) is a rare form of coronary arterial anomalies. It has been linked to increase risk of myocardial ischemia and sudden death. In this anomaly, the proximal portion of LMCA is surrounded by the myocardium of the interventricular septum. Usually there is a single anterior coronary artery that gives origin to both right and left coronaries. Repair of such anomaly has been challenging.
We present a 12-year-old boy who presented...

Reconstruction of Complete Sternal Cleft with Congenital Heart Disease

Debasis Das, Adhish Basu, Nilanjan Dutta, Shyamal Maiti & Pradeep Narayan
Cleft Sternum (CS) contributes to only 0.15% of all chest wall malformations. It is either complete or incomplete type. Complete CS is very rare and involves non-union of the sternal plates from the manubrium to the xiphoid. There are many methods of surgical correction. Sabiston described multiple bilateral sliding chondrotomies to approximate the defect. In our case, sternal closure was achieved by bilateral sliding chondrotomies (Sabiston’s technique) of four ribs followed by local advancement of...

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...

How to Teach: Orthotopic Heart Transplantation

Dominic Emerson, Amy Roach MD, Fardad Esmailian, Dominick Megna, Danny Ramzy, Joanna Chikwe & Alfredo Trento
BackgroundIn the last 54 years, advances in organ preservation, surgical technique, and immunosuppression have resulted in improved outcomes following heart transplantation. (1,2) These advances and the increased frequency of heart transplants have led to this procedure being part of the training curriculum for trainees. (3) Teaching this procedure presents unique challenges, but also opportunities to incorporate the teaching of re-do sternotomies and rescue options when problems arise.
PreparationIn our institution, the residents and fellows are involved...

Versius Robotic Pulmonary Laser Metastasectomy

Joel Dunning & Sven Seifert
This is an interesting video where Sven Seifert and their team in Chemitz in Germany combined the CMR Versius system with their laser technology to perform the first CMR laser metastasectomy. There are two patients documented here. One had many nodules that may well have been renal metastases and the other had a single nodule in segment 3 of the left upper lobe.

Versius Robotic Pulmonary Laser Metastasectomy

Joel Dunning & Sven Seifert
This is an interesting video where Sven Seifert and their team in Chemitz in Germany combined the CMR Versius system with their laser technology to perform the first CMR laser metastasectomy. There are two patients documented here. One had many nodules that may well have been renal metastases and the other had a single nodule in segment 3 of the left upper lobe.

Medical Article or Video Totally Endoscopic Port-Access Using a Three-Dimensional Endoscopic System for Resection of the Left Atrial Myxoma and Mitral Valve

Nguyen Cong Huu, Nguyen Trung Hieu, Nguyen The Binh, Ngo Thanh Hung, Hoang Van Trung & Le The Hung
The video presents the technique of “Totally endoscopic port-access using a three-dimensional endoscopic system for resection of the left atrial myxoma and mitral valve repair without robotic assistance”. A 57 years old male was admitted to the hospital because of fatigue 3weeks before. At the admission, he presented NYHA II symptom. Clinical examination: Arrhythmia, systolic murmur grade 3/6. - Blood tests: increasing in CRP and Procalcitonin - ECG: atrial fibrillation - Transthoracic echocardiography revealed a...

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...

Double Valve Replacement and Tricuspid Annuloplasty in a Patient With Dextrocardia Due To Rheumatic Heart Disease.

Kuntal Surana, Noaman Shaikh & Jayant Khandekar
Dextrocardia is a rare congenital cardiac anomaly with the heart in the right side of the chest which can often be associated with other complex congenital heart diseases. A 30 year old male presented to our department with dyspnea on exertion NYHA grade IV. The 2D-ECHO showed dextrocardia, rheumatic heart disease with severe mitral stenosis, severe aortic stenosis and severe tricuspid regurgitation. The patient was stabilized and was posted for double valve replacement surgery with...

Alternative Strategies for Challenges in Veno-Arterial ECMO Cannulation

Helen Mari Merritt-Genore
Extracorporeal membrane oxygenation (ECMO) for cardiac failure is on the rise worldwide. Some challenges, such as limb ischemia and thrombotic or hemorrhagic events, are well-recognized. Newer data suggests that ventricle distension and upper body hypoxemia during veno-arterial (VA) support may be harmful to patient recovery also. In this video series, we present two clinical scenarios highlighting alternative strategies for optimal VA support.

Challenge #1: Poor drainage of the right heart with distension of...

Intraoperative Management of Pulmonary Artery Bleeding with Hemostatic Agents

Desiree Steimer, Emily Polhemus, Abby White & Scott Swanson
Small defects in the pulmonary artery can be managed with compression and usually do not require aggressive intervention (1-3). Major injury to the pulmonary artery, however, can lead to large volume blood loss and rapid hemodynamic collapse if not addressed appropriately (1-3). In this case, we encountered significant pulmonary artery bleeding during VATS lingula sparing left upper lobectomy in a patient treated with neoadjuvant EGFR and MEK targeted therapy for lung adenocarcinoma. To initially obtain...

Tricuspid Valve Reconstruction for Endocarditis in a Premature Newborn

Christopher E. Greenleaf, Jorge D. Salazar, Blaz Podgorsek & Julija Dobrila
Endocarditis in premature infants without congenital heart disease is exceedingly rare.

We describe a case of a premature infant who required surgical intervention for tricuspid endocarditis. The patient was a former 30-week gestation who was transferred to our facility at 18 days of age.

Echocardiogram at this time revealed a new mass on the tricuspid valve measuring 6 mm in diameter, without evidence of stenosis or regurgitation. Blood culture was positive for...

Externally-Supported Ross Procedure and Konno Aortoventriculoplasty With Sinus of Valsalva Graft

Alan O'Donnell & James Tweddell
The advantage of the Ross procedure over bioprosthetic or mechanical valve options are the superior hemodynamics, resistance to infection, durability, and lack of thrombogenicity. External support of the thin-walled pulmonary autograft aims to mitigate the rate of dilatation due to exposure to arterial pressures. The Sinus of Valsalva graft is used in particular to more closely mimic the shape of and minimize distortion of the autograft. The video demonstrates Dr James Tweddell’s unique method of...

Robotic-Assisted Bronchoscopy to Evaluate a Solitary Peripheral Lung Nodule

James Lee West, Heather Edenfield & Douglas Minnich
A 69-year-old man with chronic obstructive pulmonary disease and a 20-pack-year smoking history was found to have a 20 mm x 8 mm lung nodule concerning for malignancy in the periphery of the right lower lobe. A robotic-assisted bronchoscopy was performed to obtain a tissue diagnosis.The robotic bronchoscope consists of an inner bronchoscope (4.2 mm diameter) and an outer sheath (6 mm diameter), both with 4-way steering control, and is driven with a handheld controller....

Management of Constrictive Pericarditis Due to Calcified Thickened Pericardium of up to 18 mm Thick With Impaired Ventricles

, Matthew Beadle, , Victor Zlocha & Christopher A Efthymiou
Patient Selection
Constrictive pericarditis results from a stiff pericardium that prevents adequate diastolic filling and can cause diastolic heart failure. The normal thickness of the pericardial is found in up to 18% of constrictive pericarditis cases (1). Myocardial and pericardial cells are both involved in the pathogenesis of pericarditis and constriction as indicated by the patterns of inflammation and fibrosis in the pericardium (2). In a systematic review of recurrent pericarditis, from 1966 to 2006, there...

Management of Difficult Anterior Pulmonary Artery Branch During Robotic-Assisted Left Upper Lobectomy

Andrei I. Gritsiuta, Abbas El-Sayed Abbas, Charles T. Bakhos & Roman V. Petrov
In this video, a technique of complex robotic-assisted left upper lobectomy with difficult anterior pulmonary artery branch is demonstrated to advance the knowledge among practicing surgeons on technical nuances of complex pulmonary surgery. A 61-year-old man with newly diagnosed left upper lobe squamous cell carcinoma T1cN0M0 clinical stage IA was presented for surgical treatment. Intraoperatively, only division of the left upper lobe bronchus allowed for safely identifying challenging anatomical features of the anterior branch of...

Case Report: Repair of Type A Aortic Dissection After TAVR With an Uncovered Thoracic Endograft Without General Anesthesia

Austen Hufton, Bruce Rutkin, Elana Koss, Benjamin Hong, Rubin Gjedka & Frank Manetta
Background
The success of transcatheter aortic valve replacement in high-risk patient populations led to subsequent clinical trials that demonstrated noninferiority or superiority to SAVR in low and intermediate-risk populations. An uncommon but devastating complication of TAVR is acute type A aortic dissection, with a reported incidence of approximately 1.9% (1). Open repair remains the gold standard of care for patients with this pathology. However, patients may not always be amenable for open aortic repair, either due...

VATS Left Lower Lobe Lobectomy

Tristan D. Yan & Joel Dunning
Welcome to the fifth of twelve videos that compose the series "Thoracic Surgical Oncology - Technical Approaches," by Professor Tristan D. Yan. To learn more about the series and see the complete list of videos, click here.This series of video tutorials demonstrate how to perform a VATS lobectomy in a safe and simple way, using the Edinburgh posterior approach, pioneered by Mr William Walker. This approach provides excellent visualization of the tips of the instruments,...

Case Report: Repair of Type A Aortic Dissection After TAVR With an Uncovered Thoracic Endograft Without General Anesthesia

Austen Hufton, Bruce Rutkin, Elana Koss, Benjamin Hong, Rubin Gjedka & Frank Manetta
Background
The success of transcatheter aortic valve replacement in high-risk patient populations led to subsequent clinical trials that demonstrated noninferiority or superiority to SAVR in low and intermediate-risk populations. An uncommon but devastating complication of TAVR is acute type A aortic dissection, with a reported incidence of approximately 1.9% (1). Open repair remains the gold standard of care for patients with this pathology. However, patients may not always be amenable for open aortic repair, either due...

Totally Endoscopic Transaortic Septal Myectomy for Hypertrophic Cardiomyopathy

Antonios Pitsis, Nikolaos Tsotsolis, Nikolaos Nikoloudakis, , Vassilios Economopoulos & Georgios Efthimiadis
This video demonstrates a totally endoscopic transaortic extended septal myectomy for obstructive hypertrophic cardiomyopathy in an 81-year-old woman who was heavily symptomatic with class 3 shortness of breath. The LVOT peak gradient was measured 132 mm Hg on TOE. The authors used a totally endoscopic approach through a 3 cm, 2nd intercostal space (ICS), right parasternal working incision, a 10 mm port for the 3D 30-degree endoscope in the same ICS, and two stab wounds,...

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