Resection and double pericardial patch repair of a congenital aneurysm of the mitral-aortic intervalvular fibrosa.

Mitral-aortic intervalvular fibrosa aneurysms and pseudoaneurysms are rare entities but can lead to different, unpredictable and sometime dramatic complications. We report the case of a young woman presenting a congenital form of this aneurysm. Given the clinical and symptomatological progression, surgical treatment is mandatory. After a transverse aortotomy, we resected the aneurysm. Performing a pulmonary arteriotomy allows adequate control of the left main coronary artery, adjacent to the lesion. We repaired the remaining cavity, not far from the left coronary aortic cusp, with a double patch of bovine pericardium.

Video-assisted thoracic surgery for left upper lobectomy for complex lesions: how to extend the indication with optimal safety?

The feasibility of extending the VATS approach to locally advanced NSCLC has been described with good clinical outcome. These complex resections are still technically challenging and patient safety must remain the highest priority. In this article, we describe our routine VATS approach for left upper lobectomy in proximal, locally advanced lesions. Both surgical and anaesthesiology teams are trained during simulation sessions to respond rapidly in case of urgent thoracotomy. Encircling arterial and venous vessels allow control of inadvertent bleeding during difficult dissection. Also, whenever needed the double vessel control technique is a time saver waiting for conversion to thoracotomy.