Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.577
Filtrar
1.
J Card Surg ; 35(7): 1570-1582, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32652784

RESUMO

BACKGROUND: While minimally invasive techniques for aortic valve replacement (AVR) have been shown to be safe, limited data exist comparing the varying approaches. This study aimed to compare the outcomes between two minimally invasive approaches for AVR: mini-sternotomy (MS) and right anterior thoracotomy (RAT). MATERIALS AND METHODS: A systematic search of MEDLINE, EMBASE, and OVID was conducted for the period 1990-2019. Nine observational studies (n = 2926 patients) met the inclusion criteria. RESULTS: There was no difference in operative mortality between MS and RAT (odds ratio [OR]: 0.87, 95% confidence interval [CI]: 0.41-1.85; P = .709). Meta-analyses favored MS over RAT in reoperation for bleeding (OR: 0.42, 95% CI: 0.28-0.63; P < .001), aortic cross-clamp time (standardized mean difference [SMD]: -0.12, 95% CI: -0.20 to 0.029; P = .009), and the rate of conversion to sternotomy (OR: 0.32, 95% CI: 0.11-0.93; P = .036). The rate of permanent pacemaker insertion approached borderline significance in favor of MS (OR: 0.54, 95% CI: 0.26-1.12; P = .097). In-hospital outcomes of stroke, atrial fibrillation, and surgical site infection were similar between the two groups. The length of hospital stay was shorter for RAT (SMD: 0.12, 95% CI: 0.027-0.22; P = .012) and the length of postoperative ventilation was borderline significant in favor of RAT (SMD: 0.16, 95% CI: -0.027 to 0.34; P = .095). CONCLUSIONS: This study highlights important differences in short-term outcomes between MS and RAT as approaches for AVR. This has important implications for patient selection, especially in the elderly, where such approaches are becoming more common-place.


Assuntos
Valva Aórtica/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Esternotomia/métodos , Toracotomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/epidemiologia , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Resultado do Tratamento
2.
J Card Surg ; 35(10): 2853-2856, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32683721

RESUMO

BACKGROUND: Outflow graft (OG) obstruction is a dangerous complication that may occur for various reasons after left ventricular assist device (LVAD) implantation. CASE SUMMARY: We describe the case of a 51-year-old patient on LVAD support who developed significant OG kinking and external OG obstruction due to a fibrin mass causing severe stenosis. Both the OG kinking and external obstruction were eliminated via a left lateral thoracotomy.


Assuntos
Fibrina , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/cirurgia , Coração Auxiliar/efeitos adversos , Implantação de Prótese/efeitos adversos , Toracotomia/métodos , Trombose/etiologia , Oclusão de Enxerto Vascular/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
3.
Orv Hetil ; 161(29): 1215-1220, 2020 07.
Artigo em Húngaro | MEDLINE | ID: mdl-32628621

RESUMO

INTRODUCTION: In our retrospective study, we examined changes in the histological results and types of metastatectomies of pulmonary metastases during the last 12 years, in two 5-year periods. AIM AND METHOD: There were 55 patients in the first group (2006-2010), 54.5% of the patients were male (n = 30), 45.5% were female (n = 25), the mean age was 57.9 years (24-80). The second group (2014-2018) consisted of 115 patients, with 60% male (n = 69) and 40% female (n = 46), the mean age was 62.2 years (26-82). RESULTS: During the first period, the primary tumor was found in the rectum 19.3% (n = 11), colon 17.5% (n = 10), or kidney 14% (n = 8), while during the second period, the primary tumor was in the colon in 23.1% (n = 31), in the rectum in 15.7% (n = 21), or in the kidney in 9% (n = 12). The following types of surgeries were performed: atypical resection: 38.6% (n = 22) and 46.3% (n = 62); lobectomy in 31.6% (n = 18) and 26.9% (n = 36); pulmonectomy in 10.5% (n = 6) and 1.5% (n = 2); segmentectomy in 7% (n = 4) and 9.7% (n = 13); and bilobectomy in 1.8% (n = 1) and 0.7% (n = 1) in the first and second group, respectively. The ratio of video-assisted thoracic surgery (VATS) was 5.3% (n = 3) during the first period, and this ratio increased to 64.9% (n = 87) during the second period. The mean disease-free survival between the surgery of the primary tumor and the removal of the pulmonary metastasis was 45.2 months (0-144) during the first period and 33.8 months (0-180) during the second period. The median survival was 39 months in the first period, and it increased to 59 months in the second group. The mean 5-year survival was 41% in both groups. CONCLUSION: During the last 12 years, there was a more than two-fold increase in the number of patients requiring surgery due to pulmonary metastases, and the ratio of VATS metastasectomy increased significantly as well (5.3% vs. 64.9%). No significant difference was found in the ratio of the types of the primary tumors. The median survival was slightly better in the second group. Orv Hetil; 161(29): 1215-1220.


Assuntos
Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Metastasectomia/métodos , Pneumonectomia/métodos , Cirurgia Torácica Vídeoassistida/métodos , Toracotomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/patologia , Neoplasias Colorretais/patologia , Feminino , Humanos , Neoplasias Renais/patologia , Masculino , Metastasectomia/efeitos adversos , Pessoa de Meia-Idade , Pneumonectomia/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
4.
J Card Surg ; 35(8): 2103-2105, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32652642

RESUMO

A 59-year-old man with acute mitral regurgitation due to papillary muscle rupture after myocardial infarction was admitted to our hospital. He underwent emergent mitral valve replacement with a mechanical valve by median sternotomy. Although postoperative echocardiography showed no sign of a ventricular aneurysm, echocardiography performed 5 weeks after the surgery showed enlarging left ventricular pseudoaneurysm of the inferior to the posterior cardiac wall. He underwent dacron patch closure of the orifice by fifth intercostal left thoracotomy. The postoperative course was uneventful and he was discharged on postoperative day 10. The patient was successfully treated for two life-threatening complications occurring subsequently after myocardial infarction.


Assuntos
Falso Aneurisma/cirurgia , Aneurisma Cardíaco/cirurgia , Ruptura Cardíaca Pós-Infarto/cirurgia , Implante de Prótese de Valva Cardíaca , Ventrículos do Coração/cirurgia , Valva Mitral/cirurgia , Infarto do Miocárdio/complicações , Músculos Papilares , Complicações Pós-Operatórias , Toracotomia/métodos , Falso Aneurisma/etiologia , Aneurisma Cardíaco/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
5.
J Card Surg ; 35(8): 2070-2072, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32652682

RESUMO

OBJECTIVE: Highlight our management of a Pasteurella Multiocida-infected descending thoracic aorta mycotic pseudoaneurysm. METHODS: Report a case of a canine bite resulting in a P. Multiocida descending thoracic aorta mycotic pseudoaneurysm. RESULTS: We present a 61-year-old gentleman who was initially seen in an emergency department after a canine bite. He was admitted and treated with a course of IV antibiotics for P. Multiocida bacteremia and discharged. Three weeks after discharge, he continued to feel generalized malaise and work-up was significant for a descending thoracic aorta mycotic pseudoaneurysm. The patient underwent a low left posterior lateral thoracotomy and femoral-femoral cardiopulmonary bypass for complete pseudoaneurysm resection and aortic replacement with a 24-mm Gelweave graft. Given purulence and gross infection, we planned for a staged approach, with a secondary washout and omental flap for biologic coverage of the graft. The patient did well clinically and was discharged at 14 days to rehabilitation with 6-week intravenous course of antibiotics. CONCLUSIONS: The patient's clinical course with subsequent follow-up suggest that complete resection of the mycotic pseudoaneurysm, followed by omental flap coverage is a viable strategy to manage mycotic aortic infections with virulent organisms.


Assuntos
Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Aneurisma Infectado/etiologia , Aneurisma Infectado/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/etiologia , Aneurisma da Aorta Torácica/cirurgia , Bacteriemia/etiologia , Mordeduras e Picadas/complicações , Infecções por Pasteurella/etiologia , Infecções por Pasteurella/cirurgia , Pasteurella multocida , Animais , Implante de Prótese Vascular/métodos , Ponte Cardiopulmonar , Cães , Humanos , Masculino , Pessoa de Meia-Idade , Retalhos Cirúrgicos , Toracotomia/métodos
6.
J Card Surg ; 35(8): 2067-2069, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32652695

RESUMO

A 43-year-old gentleman was transferred for management of acute on chronic cardiogenic shock (left ventricular ejection fraction < 10%). Upon arrival, we inserted a left axillary intra-aortic balloon pump for hemodynamic support. He underwent an emergent left and right-heart catheterization which showed patent stents and coronaries, in the setting of severely elevated pulmonary artery and pulmonary capillary wedge pressure. On hospital day 35, we escalated support to Centrimag in conjunction with a 31 French Protek Duo Rapid Deployment cannula. A centrimag cannula apical sewing cuff was sewn in continuous fashion along the left ventricular apex. Via modified seldinger technique, we tunneled the Protek Duo Rapid Deployment cannula through the silastic sewing cuff and the ventricular apex, traversing the aortic valve. On hospital day 50, he underwent left anterior thoracotomy and mini-sternotomy for implantation of durable Heartware left ventricular assist device. He was discharged home off inotropes and had resumed his normal activities. He is currently listed as status four for heart transplantation.


Assuntos
Cateterismo Cardíaco/métodos , Coração Auxiliar , Implantação de Prótese/métodos , Choque Cardiogênico/terapia , Doença Aguda , Adulto , Doença Crônica , Transplante de Coração , Hemodinâmica , Humanos , Balão Intra-Aórtico , Masculino , Pressão Propulsora Pulmonar , Choque Cardiogênico/fisiopatologia , Esternotomia/métodos , Toracotomia/métodos , Listas de Espera
7.
J Card Surg ; 35(8): 2053-2055, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32652732

RESUMO

Colonoscopy is generally considered a safe procedure, with a low rate of complications. Although rare, the migration of the colonoscope may represent life-threatening events, requiring emergency treatment. We, herein, describe the case of an elective colonoscopy complicated by an irretrievable colonoscope that migrated, through a previous traumatic diaphragmatic hernia, in the chest cavity. This hernia was likely a chronic complication of a previous abdominal trauma. Several attempts to retrieve the scope were unsuccessful. After further investigations and collegial discussion, a left thoracotomy was performed, with the aim to retrieve the colonoscope and to reduce the hernia.


Assuntos
Colonoscópios/efeitos adversos , Colonoscopia/efeitos adversos , Corpos Estranhos/cirurgia , Migração de Corpo Estranho/cirurgia , Cavidade Torácica , Toracotomia/métodos , Traumatismos Abdominais/complicações , Idoso , Hérnia Diafragmática/etiologia , Humanos , Masculino
8.
Artigo em Inglês | MEDLINE | ID: mdl-32520448

RESUMO

The clamshell incision (also known as a transverse or crossbow transsternal incision) was the common approach to the heart in the early days of cardiac surgery and was occasionally also used to access mediastinal tumors or both lungs. However, with the introduction of the median sternotomy, the clamshell incision was virtually forgotten, except for cardiothoracic trauma and double lung transplant. However, in rare situations, such as in large space-occupying lesions in the mediastinum, surgeons will resort to the clamshell approach to achieve exposure and complete resection.  In this video tutorial, we demonstrate the operative steps for using the clamshell approach in one of those rare clinical scenarios. The resected mass was a giant mediastinal teratoma measuring 21 x 27 x 6 cm.


Assuntos
Neoplasias do Mediastino/cirurgia , Teratoma/cirurgia , Toracotomia/métodos , Feminino , Humanos , Adulto Jovem
9.
J Card Surg ; 35(7): 1729-1731, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32485064

RESUMO

BACKGROUND: Right anterior minithoracotomy (RAMT) is an alternative to full or partial sternotomy for accessing the aortic valve. The adoption of this approach for aortic valve replacement has been limited by its perceived technical complexity. Resection of a mobile aortic valve tumor is a simple procedure that is conventionally done through a sternotomy. AIM: The following case describes the resection of an aortic valve papillary fibroelastoma through an RAMT. MATERIALS & METHODS: This is a report on a single patient's case. RESULTS: The fibroelastoma was safely excised through a RAMT approach. DISCUSSION: An aortic valve fibroelastoma offers an ideal starting point for surgeons to begin using a RAMT approach. CONCLUSION: The excision of aortic valve masses is a procedure that is well suited to minimally invasive strategies, and we suggest sternum-sparing RAMT is the optimal approach.


Assuntos
Valva Aórtica/cirurgia , Fibroma/cirurgia , Neoplasias Cardíacas/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Toracotomia/métodos , Idoso , Feminino , Humanos , Resultado do Tratamento
10.
Rev Col Bras Cir ; 47: e20202435, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32491032

RESUMO

OBJECTIVE: Since its first report, video-assisted thoracic surgery (VATS) lung lobectomy was carried out with the use of conventional surgical instruments, used in laparoscopy and open thoracotomy. These instruments are expensive, not standardized and there are a variety of models and manufacturers. The aim of this study was to determine the impact of the use of these instruments on the experimental pulmonary lobectomy. METHODS: We used a modified surgical simulator that uses a porcine heart-lung block filled with tomato sauce, and tested specific (Group 1) and regular (Group 2) instruments. Each group includes 15 experiments. RESULTS: The median total time, excluding the time spent to correct the lesions, was 45.08 and 45.81 minutes, respectively in Group 1 and Group 2. There was no statistical difference between the total times (p=0.58). The only statistically different was seen for partial times regarding the elapsed time to cut and suture of lung fissures (p=0.03 and 0.04, respectively). There were more direct lesions and indirect leaks in Group 2, but without statistical significance (p=1.000 and p=0.203, respectively). The mean time spent for the diagnosis and correction of these events was 1.77 minutes with a standard deviation of 1.18 for Group 1 and 2.72 ± 1.11 minutes for Group 2 (p=0.044). CONCLUSION: The use of minimally invasive instruments is not associated with time improvement spent with experimental video-assisted lung lobectomy and does not lead to a faster or safer surgery. The use of VATS instruments makes correction of adverse events faster when they occur.


Assuntos
Pneumonectomia/instrumentação , Instrumentos Cirúrgicos , Cirurgia Torácica Vídeoassistida/instrumentação , Toracotomia/instrumentação , Humanos , Pneumonectomia/métodos , Treinamento por Simulação/métodos , Cirurgia Torácica Vídeoassistida/métodos , Toracotomia/métodos
11.
Am J Otolaryngol ; 41(5): 102585, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32521300

RESUMO

INTRODUCTION: Determine the feasibility of a two-incision surgical approach to hypoglossal nerve stimulator implantation based on anatomic considerations. METHODS: Upper airway stimulation (UAS) using the Inspire system uses three implanted devices-the implantable pulse generator (IPG), stimulation lead and sensing chest wall lead. The traditional surgical approach requires three skin incisions located on the submandibular neck, anterosuperior chest wall and inferolateral chest wall. Our surgical team sought to determine the anatomic considerations of combining the two chest wall incisions into one. In order to minimize morbidity and reduce operative time, the chest wall sensing lead was placed posterolateral to the IPG site via the same incision. RESULTS: Using an adult cadaver for anatomical analysis, access to the third and fourth intercostal spaces was made more difficult by the pectoralis major humeral head and upper arm. The intercostal space was narrower, the musculature along the anterior axillary line and anterior chest wall was devoid of the innermost intercostal muscle group found more laterally. Furthermore, there were much thinner external and internal intercostal muscle components as they transitioned to a membranous layer anteriorly in comparison to the inferolateral chest wall. CONCLUSION: Lack of the innermost intercostal muscle and thinning of the external and internal intercostal muscles lateral to the IPG site leaves little barrier between the thoracic musculature and parietal pleural increasing the risk of complications such as pleurisy and pneumothorax. Given the anatomical findings, a two-incision surgical approach for UAS therapy is at higher risk for complications.


Assuntos
Terapia por Estimulação Elétrica/instrumentação , Terapia por Estimulação Elétrica/métodos , Eletrodos Implantados , Nervo Hipoglosso , Implantação de Prótese/métodos , Toracotomia/métodos , Cadáver , Estudos de Viabilidade , Humanos , Parede Torácica/anatomia & histologia , Parede Torácica/cirurgia
12.
J Card Surg ; 35(7): 1539-1547, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32579786

RESUMO

BACKGROUND: Despite improved survival and morbidity after durable left ventricular assist device (dLVAD), outcomes for cardiogenic shock patients are suboptimal. Temporary mechanical circulatory support (tMCS) can permit optimization before dLVAD. Excellent outcomes have been observed using minimally-invasive dLVAD implantation. However, some feel tMCS contraindicates this approach. To evaluate whether left thoracotomy/hemisternotomy (LTHS) dLVAD placement is safe in this setting, we compared patients who did and did not require tMCS. METHODS: Outcomes for patients receiving dLVADs via LTHS were compared among those bridged with extracorporeal membrane oxygenation (ECMO), intra-aortic balloon pump (IABP), or no tMCS. We evaluated demographics, comorbidities, laboratory and hemodynamic data, and intraoperative and postoperative outcomes. RESULTS: Eighty-three patients underwent LTHS dLVAD placement. Fifty did not require tMCS, while 22 (26%) required IABP, and 11 (13%) ECMO. Non-tMCS patients were primarily Intermacs 3 (56%), while IABP recipients were mainly Intermacs 2 (45%). All patients with ECMO were Intermacs 1. Patients with tMCS had worse end-organ function. Operative outcomes were similar except more concomitant procedures and red-cell transfusions in patients with ECMO. Intensive care unit and hospital length of stay and inotrope duration were also similar. There were no differences in bleeding, stroke, and infection rates. Three- and 12-month survival were: no tMCS: 94%, 86%; IABP: 100%, 88%; and ECMO: 81%, 81% (P = .45). CONCLUSIONS: Patients with cardiogenic shock can safely undergo LTHS dLVAD implantation after stabilization with ECMO or IABP. Outcomes and complications in these patients were comparable to a less severely ill cohort without tMCS.


Assuntos
Oxigenação por Membrana Extracorpórea , Ventrículos do Coração/cirurgia , Coração Auxiliar , Balão Intra-Aórtico , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Implantação de Prótese/métodos , Choque Cardiogênico/terapia , Esternotomia/métodos , Toracotomia/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Segurança , Choque Cardiogênico/mortalidade , Taxa de Sobrevida , Resultado do Tratamento
13.
Ann Thorac Surg ; 110(4): e339-e341, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32413359

RESUMO

Right anterior minithoracotomy is gaining larger acceptance for isolated aortic valve replacement. In some patients, however, surgical exposure during the intervention may be challenging even for experienced surgeons or centers. In our opinion, proper preoperative selection of the patients by computed tomography scan seems mandatory. We routinely perform right anterior minithoracotomy, and over time, we have found that the angle between the right border of the sternum and the left side of the aorta, at the level of the pulmonary artery, helps with patient selection.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Seleção de Pacientes , Toracotomia/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
14.
Pediatr Surg Int ; 36(7): 755-761, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32451635

RESUMO

Standard surgical repair of esophageal atresia/tracheoesophageal fistula (EA/TEF) is via a right posterolateral thoracotomy. A recognized complication is the later development of scoliosis. The prevalence and pathogenesis of secondary scoliosis are poorly understood. We, therefore, conducted a systematic review on this topic. All English language articles reporting incidence, outcomes and/or interventions for scoliosis in children after EA repair via thoracotomy were identified. Fourteen relevant articles published between 1969 and 2019 reporting 1338 children were included in the analysis. The aggregate prevalence of scoliosis among 937 children without congenital vertebral anomalies was 13%, but this figure varied widely between studies. Severity of scoliosis was documented in 181 children; eight children had a Cobb angle > 40° and 10 had undergone spinal surgery. The spinal curvature in affected individuals was dominantly or exclusively convex to the left. In conclusion, the reported prevalence of scoliosis varies widely but on average affects about one in eight children after open repair of EA/TEF. Most cases are mild and do not require intervention. It is currently uncertain whether secondary scoliosis is preventable by using meticulous thoracotomy techniques or thoracoscopic repair.Level of evidence IV.


Assuntos
Atresia Esofágica/cirurgia , Escoliose/etiologia , Toracotomia/efeitos adversos , Toracotomia/métodos , Criança , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos
15.
Niger J Clin Pract ; 23(5): 626-630, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32367868

RESUMO

Background: Lipomas are rarely seen tumors of adipose tissue that are benign in character. Although mostly located to the subcutaneous region, specifically in the upper back, neck, and shoulder, they may also occur in thoracic cavity. Aim: They aim of the study was to analyse clinical features and outcome of treatment of intrathoracic pleural lipomas. Materials and Method: We retrospectively evaluated the clinicopathological records of seven patients with intrathoracic lipomas who had undergone surgery between 2005 and 2017. We made analyses in terms of age, gender, admission complaints, lesion locations and dimensions, diagnostic techniques, operative procedures, histopathological features, and prognosis. Results: Four women and three men with a mean age 62.7 (range, 48-75 years) were included. They had chest pain (n = 2), effort dyspnea (n = 1) as the admission symptom, whereas four patients were asymptomatic, whose lesions were detected on chest radiography on an incidental basis. The radiological features of the tumors were well-demarcated, homogenous lesions with fat density. Tumors of all cases were excised, which were located on the right side in two patients and left in five. We used video-assisted thoracoscopy in two patients, single-port video-assisted thoracoscopy in three patients, thoracotomy in two patients. All lesions were of parietal pleural origin and were located intrathoracically. They had a range of size between 4 and 10 cm, with an average of 6.7 cm. All cases were operated with complete resection. At a mean follow-up duration of 4.7 years no recurrence was noted. Conclusion: Intrathoracic lipomas are rare, benignly behaving tumors. As it may prove difficult to differentiate them from malignant lesions and they may grow in an invasive growth pattern, surgery should be pursued in all patients for both diagnosis and treatment.


Assuntos
Lipoma/cirurgia , Neoplasias Torácicas/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Toracoscopia/métodos , Toracotomia/métodos , Adulto , Idoso , Dor no Peito/etiologia , Dispneia/etiologia , Feminino , Humanos , Lipoma/patologia , Masculino , Pessoa de Meia-Idade , Lobo Parietal , Prognóstico , Estudos Retrospectivos , Neoplasias Torácicas/patologia , Resultado do Tratamento
16.
Artigo em Inglês | MEDLINE | ID: mdl-32436667

RESUMO

In the field of minimally invasive surgical aortic valve replacement, the right anterolateral minithoracotomy is an approach that offers very limited procedural trauma. Our method of right anterolateral minithoracotomy uses femoral percutaneous cannulation, a high-definition thoracoscope and a transthoracic cross-clamp. It allows a minimized skin incision and full preservation of the sternum, sternocostal cartilages, and ribs. The patient we present in this video tutorial is a low-risk male with severe bicuspid aortic valve stenosis. We provide detailed insight into our preoperative planning and step-by-step guidance throughout the right anterolateral minithoracotomy aortic valve replacement procedure.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/anormalidades , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Toracotomia/métodos , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/etiologia , Doenças das Valvas Cardíacas/complicações , Próteses Valvulares Cardíacas , Humanos , Masculino , Pessoa de Meia-Idade
17.
Artigo em Inglês | MEDLINE | ID: mdl-32459074

RESUMO

In recent years, parenchymal sparing techniques for tumor resection have been developed in order to reduce the amount of lung parenchyma that must be removed in cases of centrally located tumors. These techniques maintain oncological radicality while reducing postoperative complications. At the same time, video-assisted thoracoscopic surgery (VATS) has been shown to offer comparable surgical and oncological outcomes to thoracotomy, even in complex cases that require tracheal and bronchial reconstructions. In this video tutorial, we describe a case of an isolated sleeve resection of the bronchus intermedius performed through a VATS approach for a bronchial paraganglioma.


Assuntos
Brônquios , Neoplasias Pulmonares , Paraganglioma , Pneumonectomia/métodos , Cirurgia Torácica Vídeoassistida/métodos , Toracotomia/métodos , Adulto , Brônquios/diagnóstico por imagem , Brônquios/patologia , Brônquios/cirurgia , Feminino , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/fisiopatologia , Neoplasias Pulmonares/cirurgia , Paraganglioma/patologia , Paraganglioma/fisiopatologia , Paraganglioma/cirurgia , Resultado do Tratamento
18.
J Card Surg ; 35(7): 1657-1659, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32362007

RESUMO

BACKGROUND: Bronchial artery aneurysms (BAAs) are a rare vascular entity. They can have various presentations ranging from an incidental finding on radiological examination to life-threatening hemoptysis. MATERIAL AND METHODS: We report the case of a 60-year-old woman with three posterior mediastinal BAAs who presented with unilateral periscapular pain, shortness of breath, hoarseness, and dysphagia. The BAAs were removed successfully via thoracotomy, with excellent recovery and relief of the periscapular pain. DISCUSSION AND CONCLUSION: We use this case as a platform to discuss the treatment options for BAAs.


Assuntos
Aneurisma/cirurgia , Artérias Brônquicas/cirurgia , Toracotomia/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Aneurisma/complicações , Aneurisma/diagnóstico por imagem , Aneurisma/patologia , Angiografia , Artérias Brônquicas/diagnóstico por imagem , Artérias Brônquicas/patologia , Dor no Peito/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Resultado do Tratamento
20.
J Card Surg ; 35(6): 1322-1324, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32445191

RESUMO

The left atrial appendage (LAA) has been identified as a site of thrombus formation in the heart and as a source of embolism in patients with atrial fibrillation, leading to stroke. Studies suggest that LAA closure may reduce the risk for stroke and the need for anticoagulation; conversely, incomplete closure can increase the stroke risk almost 12-fold. Because open heart surgery is associated with increased risk for subsequent stroke, surgeons generally prefer to close the LAA during heart surgery, as recommended in current atrial fibrillation management guidelines. Building on trends toward minimally invasive approaches in cardiac surgery, we developed a simple, unique, and reproducible method for complete LAA closure during mitral valve surgery that has proven to be safe and efficacious: Our first three patients remained completely free from stroke and minor neurological manifestations 27 months after surgery.


Assuntos
Apêndice Atrial/cirurgia , Fibrilação Atrial/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Toracotomia/métodos , Fibrilação Atrial/complicações , Humanos , Valva Mitral/cirurgia , Prognóstico , Acidente Vascular Cerebral/etiologia , Trombose/etiologia , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA