169 Works

VATS Lobectomy for Fourteen-Month-Old Infant

Lu Wang, Fabrizio De Rita & Vincenzo Pagliarulo
The patient was a fourteen-month-old infant who was born at term with an antenatal diagnosis of congenital pulmonary airway malformation. The infant was otherwise healthy and never had any episode of chest infection. Her CT chest showed mixed micro and macro cystic lesions, occupying 50 percent of the right lower lobe, without evidence of synchronous sequestration. After general anesthesia and positioning, a 5mm camera port and 10mm utility port were inserted into the seventh intercostal...

Transconal Unroofing of Anomalous Left Main Coronary Artery from Right Sinus With Transseptal Course

Nicholas Oh, Tara Karamlou & Hani Najm
Anomalous aortic origin of the left coronary artery (AAOLCA) from the right coronary sinus is a rare condition. However, this disease process is clinically important as it carries an increased risk of sudden cardiac death in otherwise healthy young persons, when compared to anomalous right coronary arteries. Anatomically, after its origin from the right coronary sinus, the anomalous left main coronary artery takes one of four courses: 1. Front of PA; 2. Behind the Aorta;...

Transconal Unroofing of Anomalous Left Main Coronary Artery from Right Sinus With Transseptal Course

Nicholas Oh, Tara Karamlou & Hani Najm
Anomalous aortic origin of the left coronary artery (AAOLCA) from the right coronary sinus is a rare condition. However, this disease process is clinically important as it carries an increased risk of sudden cardiac death in otherwise healthy young persons, when compared to anomalous right coronary arteries. Anatomically, after its origin from the right coronary sinus, the anomalous left main coronary artery takes one of four courses: 1. Front of PA; 2. Behind the Aorta;...

Posterior Annulus Reinforcement with Autologous Pericardium During Mitral Valve Replacement for Endocarditis and Severe MAC

John Duggan, Alex Peters, John Kucera, Paul S. Massimiano & Junewai Reoma
This video demonstrates the use of autologous pericardium to reinforce and reconstruct the posterior annulus during a mitral valve replacement for endocarditis and severe mitral annular calcification (MAC). Background The patient was initially admitted for pneumonia and sepsis. After persistently positive blood cultures despite appropriate antibiotics, he underwent an echocardiogram on hospital day four, which identified mitral valve endocarditis and mitral valve regurgitation. The remainder of the patient’s medical and surgical history was largely noncontributory....

Posterior Annulus Reinforcement with Autologous Pericardium During Mitral Valve Replacement for Endocarditis and Severe MAC

John Duggan, Alex Peters, John Kucera, Paul S. Massimiano & Junewai Reoma
This video demonstrates the use of autologous pericardium to reinforce and reconstruct the posterior annulus during a mitral valve replacement for endocarditis and severe mitral annular calcification (MAC). Background The patient was initially admitted for pneumonia and sepsis. After persistently positive blood cultures despite appropriate antibiotics, he underwent an echocardiogram on hospital day four, which identified mitral valve endocarditis and mitral valve regurgitation. The remainder of the patient’s medical and surgical history was largely noncontributory....

Uniportal VATS Segmentectomy with Indocyanine Green Imaging

Rita Costa, Anita Paiva, Carlos Pinto, André Carvalho, Pedro Fernandes & Paulo Pinho
This video demonstrates a case of uniportal VATS segmentectomy with indocyanine green imaging. The patient was a sixty-five-year-old woman, nonsmoker, with a 12mm ground glass opacity in the apical segment of the right upper lobe. A lepidic adenocarcinoma of the lung was diagnosed by transbronchial biopsy. She had a patient performance status of 1, but her lung function test demonstrated an FEV1 of 102%.
Steps of the Surgery Some adhesions were dissected before the dissection of...

Esophageal Stenting: Expert Techniques

Lauren A. Johnson, Katy A. Marino & Jason L. Muesse
Esophageal stents are useful for palliation of dysphagia in patients who are not candidates for other therapy modalities either because of their comorbidities or because of tumor characteristics that classify the lesion as unresectable. Stenting is also indicated in patients with recurrent disease after completion of primary treatment. Stents are also used in the treatment of malignant tracheoesophageal fistulas as well as for nutritional support during neoadjuvant therapy. Benign indications for use include patients with...

Open Right Lower Sleeve Lobectomy Technique

Saiesh Reddy Voppuru, Devayani Niyogi, Virendra Kumar Tiwari & George Karimundackal
This video demonstrates the technique of an open right lower sleeve lobectomy. The patient is a thirty-four-year-old male diagnosed with a typical carcinoid involving the right lower lobe bronchus. For this surgery, a right posterolateral thoracotomy approach was used. Lung isolation was achieved with a left-sided double lumen endotracheal tube (DLT). The surgical steps depicted in this video commence with the dissection of the pulmonary artery and proceed to the division of the major vessels...

Robotic Ivor Lewis Esophagectomy After Gastric Band Placement

Erin M. Schumer & Dennis A. Wigle
This article and accompanying video present a case of a robotic assisted Ivor-Lewis esophagectomy after gastric band placement. The patient was a sixty-seven-year-old man who had previously undergone placement of laparoscopic gastric band for weight loss approximately twenty years prior to this procedure. Under a routine surveillance esophagogastroduodenoscopy, he was found to have a long segment Barrett’s esophagus. A biopsy of the gastroesophageal junction demonstrated intestinal metaplasia with high grade dysplasia, along with high suspicion...

Unroofing of Anomalous Right Coronary Artery

Qasim Al Abri, Lamees Ibrahim El Nihum, M. Mujeeb Zubair, Aaron J. Spooner & Mahesh Ramchandani
A sixty-year-old woman with angina. A coronary angiography showed an anomalous origin of the right coronary artery from the left coronary cusp. This was confirmed on s gated coronary CT, which showed it arising from the left sinus of Valsalva with a slitlike orifice and a significant intramural course. She was scheduled for repair by unroofing of the anomaly. Median sternotomy was performed and routine cannulation done for cardiopulmonary bypass. Dissection began between the great...

Homograft Replacement Twenty-Four Years After Persistent Truncus Arteriosus Repair

Yongfeng Shao, Jiaxi Gu & Junjie Du
This video demonstrates a redo aortic root procedure and homograft replacement for a thirty-year-old woman who was diagnosed with PTA at birth. She also had surgical repairment and reconstruction of the right ventricular outflow track with a homograft when she was six. The computed tomography angiography (CTA) showed an aortic root aneurysm beneath her sternum and homograft calcification with severe stenosis. Also, the transesophageal echocardiogram (TEE) showed severe aortic insufficiency. A 5mm-diameter, 30-degree-angled endoscope was...

Robotic Sublobar Resection of Intralobar Bronchopulmonary Sequestration

Jonathan Nitz, Stacey Su, Charles Bakhos, Cherie Erkmen & Roman Petrov
A sixty-three-year-old male patient was newly diagnosed with intralobar bronchopulmonary sequestration. It was found in the right lower lobe after a diagnosis of COVID-19 prompted a CT scan of the chest. He had reported recurrent pneumonia since he was a child growing up in eastern Europe. He had a seven-pack-a-year smoking history and last smoked thirty-one years ago. After receiving therapy for his latent tuberculosis and a thorough preoperative workup, he was cleared for surgery....

Repair of Partial Anomalous Pulmonary Venous Return (Scimitar Vein) via Interposed Polytetrafluoroethylene (PTFE)

William Mitchell, Lawrence Greiten, Christian Eisenring, Markus Renno & Brian Reemtsen
This patient is a 62 yo Female with a history of chronic cough and exercise intolerance who presented to an outside hospital for elective Calcium scoring via Cardiac CT. This demonstrated previously undiagnosed anomalous pulmonary venous return (scimitar vein) to her right atrium. She was referred to our adult congenital heart disease program for further workup. Cardiac MRI revealed moderate right ventricular dilation, and a Qp:Qs of 1.92. 3D MRI reconstruction is shown demonstrating the...

Reconstruction of Complex Proximal Aortic Dissections with Aortic Insufficiency Using Aortic Ring Annuloplasty

Anthony Perez-Tamayo, Joshua N. Baker, Marc W. Gerdisch, Takashi Murashita, Arun Singhal, Timothy W James, Richard S. Downey & J. Scott Rankin
Ascending aortic dissections often involve the aortic root and create aortic valve insufficiency. Prosthetic valve replacement in this setting yields inferior long-term results. Reparative management by commissural resuspension has been associated with an incidence of valve and sinus deterioration over time. The background of aortic ring annuloplasty is presented, as well as rationale for application to aortic root dissection. A video of a representative case with Loeyz-Dietz syndrome and extensive aortic root dissection is presented....

Anatomic Repair of Congenitally Corrected Transposition: 1.5V Repair with Hemi-Mustard and Rastelli Procedures

James Tweddell & Alan ODonnell
We present an operative technique video of the anatomic repair of congenitally corrected transposition (ccTGA) with ventricular septal defect (VSD), pulmonary atresia (PS), and mild right ventricular hypoplasia in a 2-year-old palliated with a 3.5mm rmBTS (and coronary artery fistula ligation) in the neonatal period, followed by a rmBTS takedown and bidirectional Glenn shunt at 4m/o. Morphologic left-ventricle-to-aorta (mLV-to-Ao) baffling: The VSD was inspected through a vertical ventriculotomy along the morphologic RVOT. The mLV-to-Ao baffle...

Repair of Aortopulmonary Window in a Newborn

Sameh M. Said & Gamal Marey
A 2-week-old, 3.5 kg neonate presented with tachypnea and a murmur was heard. Echocardiogram showed a type I aortopulmonary window and patent foramen ovale. Computed tomography scan confirmed the diagnosis and a mild distal aortic arch hypoplasia was present. No coronary arterial anomalies were identified. Through a standard median sternotomy, and with indirect innominate artery and right atrial cannulation, cardiopulmonary bypass was initiated at normothermia. Both branch pulmonary arteries were temporary controlled with vessel loops....

Mediastinal Tumors: Etiology and Surgical Management in Iraq

Iraqi Board for Medical Specialization - Thoracic and Cardiovascular Surgery Subspecialty
This is a retrospective study that was performed in the Department of Thoracic and Cardiovascular Surgery, Subspecialty Hospital - Medical City (Baghdad) from 1 January 2017 to 31 December 2020. The aim of this study is to show the points of agreement and the points of disagreement with other studies over the world that dealwith mediastinal masses from the aspects of incidance, clinical diagnostic procedures, surgical management, and outcomes.The total number of patients studied was...

Right Main Bronchus Transection After Blunt Thoracic Trauma

Ivan CH Siu, Innes YP Wan & Randolph HL Wong
Tracheobronchial injury is a rare occurrence in people with blunt thoracic trauma, and it is associated with significant mortality (1). The majority of patients with tracheobronchial injuries die before reaching the hospital because of the associated mechanism of high-energy impact injuries. However, for those who survive, signs and symptoms can be nonspecific, and a high index of suspicion should be adopted (2). The Patient A fifty-three-year-old female with known scoliosis suffered a blunt thoracic trauma...

Right Main Bronchus Transection After Blunt Thoracic Trauma

Ivan CH Siu, Innes YP Wan & Randolph HL Wong
Tracheobronchial injury is a rare occurrence in people with blunt thoracic trauma, and it is associated with significant mortality (1). The majority of patients with tracheobronchial injuries die before reaching the hospital because of the associated mechanism of high-energy impact injuries. However, for those who survive, signs and symptoms can be nonspecific, and a high index of suspicion should be adopted (2). The Patient A fifty-three-year-old female with known scoliosis suffered a blunt thoracic trauma...

Robotically Assisted Mitral Valve Repair After Failed Percutaneous Repair

Pruna-Guillen R, Sandoval E & Pereda D
Mitral valve repair after failed percutaneous edge-to-edge repair (Mitraclip® device) can be complex and technically challenging. In this video, we show that it may be safely performed using a totally endoscopic robotically assisted approach (1, 2). Patient Details The patient was a fifty-two-year-old male with a medical history of active smoking, alcoholism, hypertension, dyslipidaemia, COPD, and chronic ischemic cardiopathy since 2015 with multiple stents on the LAD and circumflex arteries. In October 2020, the patient...

VATS Posterior Mediastinal Mass Excision: A Video Vignette

Sriniket Raghavan, Swapnil Patel, Prudviraj S, Amar Prem & Durgatosh Pandey
The patient was a twenty-eight-year-old man with an upper abdominal discomfort and dyspepsia with no comorbidities and no significant family history. Upon examination, his performance status was good. On initial assessment, a USG abdomen showed a well-defined retrohepatic mass. A CT scan showed a heterogenous pleural based mass in the right hemithorax abutting the inferior vena cava, pericardium, and right lower lobe of the lung with no obvious infiltration of the lung parenchyma or diaphragm....

Surgical Management of Atrial Fibrillation in Patients Undergoing Myectomy for Obstructive Hypertrophic Cardiomyopathy

Hartzell V. Schaff, Sri Harasha Patlolla & Joseph A. Dearani
This video provides an overview of the prevalence and clinical impact of atrial fibrillation in patients with obstructive hypertrophic cardiomyopathy (HCM) presenting for septal myectomy and describes an approach to surgical management of these patients and the corresponding operative techniques. The video emphasizes the importance of choosing the appropriate surgical technique based on atrial fibrillation's symptomatic burden and characteristics. Essential steps and details of surgical techniques for pulmonary vein isolation and the Cox-maze III procedure...

Imaging in Obstructive Hypertrophic Cardiomyopathy

Milind Desai
This video discusses the role of multimodality imaging (echocardiography and cardiac magnetic resonance or CMR) in identifying various phenotypes of hypertrophic cardiomyopathy (HCM) patients who demonstrate dynamic LV outflow tract obstruction. It highlights the importance of precise wall thickness measurements to adequately plan surgical myectomy. This might require a combination of echo and CMR. It further demonstrates the importance of evaluating the direction of the jet of mitral regurgitation in identifying the precise etiology. Additionally,...

Repair of Bridging Bronchus and Severe Tracheal Stenosis Associated with Left Pulmonary Artery Sling and Ventricular Septal Defect

Chawki Elzein
Bridging the bronchus and tracheal stenosis can be associated with congenital heart defects like atrial septal defects, ventricular septal defects, tetralogy of Fallot, and aortic coarctation. This video features a case of bridging the bronchus and severe tracheal stenosis associated with left pulmonary artery sling, ventricular septal defect, and aortic coarctation. This case was successfully repaired in a low-birth-weight neonate.
References
Henry BM, Cheruiyot I, Wong LM, Keet K, et al. The bridging...

Resection of Left Ventricular Rhabdomyoma in a Neonate

Sameh M. Said & Gamal Marey
This video features a one-day-old, 3kg neonate with a prenatal diagnosis of a cardiac mass. The postnatal transthoracic echocardiogram shows a large left ventricular mass occupying the majority of the left ventricular cavity and extending into the left ventricular outflow tract (LVOT). Other small masses also appear to be in the interventricular septum and on its right side. This suggests cardiac rhabdomyoma. A cardiac magnetic resonance imaging (MRI) confirms the findings. A brain MRI then...

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