Awake uniportal video-assisted thoracoscopic surgery for the management of pericardial effusion.

Introduction: Pericardial drainage can be performed either with pericardiocentesis or pericardial "window" in cases with hemodynamic compromise for therapeutic and diagnostic purposes. Awake single-port video-assisted thoracoscopic surgery (VATS) is an alternative to pericardial window (PW) that has been described only in case reports in the literature. We aimed to analyse a series of patients with chronic, recurrent and/or large pericardial effusions who underwent single-port VATS-PW opening without intubation. Patients and Methods: The PW was opened using awake single-port VATS in 20 of 23 patients referred to our clinic with recurrent, chronic and/or large pericardial effusion between December 2021 and July 2022. Demographic data, imaging modalities, treatment processes and pathological samples were analysed retrospectively. Results: The median age of 20 patients was 68 years (52-81). The mean body mass index was 29.1 ± 6.0 kg/m2 and mean pericardial fluid measurements with pre-operative transthoracic echocardiography (TTE) was 2,8 ± 0,9 cm. The mean operation time was 44 ± 13.0 min and mean peri-operative drainage was 700 ± 307 cc. On the 1st post-operative day, control TTE revealed ≤0.5 cm effusion in 18 (90%) patients and ≥0.5 cm in 2 (10%) patients. The median day of discharge or referral to the clinic where they are followed up was 1 (1-2). Conclusions: Awake single-port VATS could be used safely in all patient groups with pericardial effusion or tamponade as a diagnostic and therapeutic option. This technique has advantages, especially in patients with high surgical risk.

Technical aspects of reconstruction for inadequate left atrial cuff in lung transplantation.

OBJECTIVE: Lung transplantation is the only life-saving treatment for lung diseases that do not respond to medical treatment. Heart-lung harvesting requires a careful procedure to protect an adequate donor left atrial cuff around the junction of the superior and inferior pulmonary veins. This study aims to describe inadequate left atrial cuff during harvest and techniques of reconstruction at the threshold of literature. METHODS: Left atrial cuff complications were retrospectively analyzed in consecutive lung transplant procedures between December 2016 and December 2021. Donor and patient demographics, reconstruction material and method of application and postoperative follow-up were examined. RESULTS: In the study period, 84 consecutive lung transplant procedures were performed. Reconstruction of the inadequate left atrial cuff was 3.7% (6/162) for atrial anastomoses. However, the inadequate left atrial cuff was 9.1% (5/55) in heart-lung harvesting. Donor aorta graft was used in 4 patients and Dacron mesh was used on the bilateral atrial cuff in one patient. Hospital mortality occurred in one patient. One patient died 6 months later due to antibody-mediated rejection. The follow-ups of the other three patients are continuing without any problems. CONCLUSIONS: Inadequate left atrial cuff complications occurring in heart-lung harvest seem to be more common than in the literature. Techniques of reconstruction for the inadequate left atrial cuff is vital for the patient who has reached irreversible progress in surgery for the recipient, as well as increasing the number of organs.

First case of bilateral diaphragm eventration successfully repaired through an abdominal approach following lung transplantation.

A 61-year-old male patient with bilateral lung transplantation was admitted to the outpatient clinic with increasing respiratory distress for a month. Bilateral diaphragm eventration was observed in his examinations. Bilateral diaphragm plication was successfully performed abdominally in the patient who had a complaint despite supportive treatment. The respiratory capacity of the patient returned to normal. The abdominal approach may be a good alternative option in cases where intrathoracic surgery cannot be performed due to adhesions in patients with eventration after lung transplantation. KEY WORDS: Acquired eventration, Diaphragm, Lung transplantation.

Effectiveness of echocardiographic evaluation of lung transplant candidates: Could it be an alternative to right heart catheterization?

Background: In this study, we aimed to evaluate the value of transthoracic echocardiography in the estimation of pulmonary artery pressure and to identify the presence of pulmonary hypertension in lung transplant candidates with end-stage lung disease. Methods: Between January 2012 and September 2020, a total of 244 patients (166 males, 78 females; mean age: 48.6±13.8 years; range, 18 to 77 years) who were diagnosed with end-stage lung disease due to various underlying conditions and underwent right heart catheterization and transthoracic echocardiography within 72 h were retrospectively analyzed. Hemodynamic parameters of the patients were compared. Correlation analysis was performed among the values estimated by transthoracic echocardiography and measured by right heart catheterization for pulmonary artery pressure measurements. Results: The median pulmonary artery systolic pressure with right heart catheterization was 43 mmHg and 40 mmHg using transthoracic echocardiography. A positive correlation was seen between the pulmonary artery systolic pressure estimated by transthoracic echocardiography and right heart catheterization (r=0.718; p<0.001). The sensitivity, specificity, and positive and negative predictive values of pulmonary artery systolic pressure measurement were 76.30%, 64.22%, 72.54%, and 68.63%, respectively. Conclusion: This study revealed a strong positive correlation between the pulmonary artery systolic pressure evaluated with transthoracic echocardiography and measured with right heart catheterization. Pulmonary hypertension detection by these two methods showed acceptable sensitivity and specificity. Transthoracic echocardiography may be a useful and practical method to monitor pulmonary artery pressure trends both initially and in the subsequent follow-up of cardiac hemodynamics in lung transplant candidates.

Lung transplantation for non-cystic fibrosis bronchiectasis in Turkey: An initial institutional experience.

BACKGROUND/OBJECTIVE: Lung transplantation is a well-established treatment in patients who have bronchiectasis with diffuse involvement, and with a progressive decline in respiratory function despite maximal medical therapy. We have aimed to present pre-transplantation factors and our results of lung transplantation for non-cystic fibrosis bronchiectasis. METHODS: Patients who underwent lung transplantation for non-cystic fibrosis bronchiectasis between the dates of December 2016 and July 2019 were included. The patients' clinical parameters, pulmonary function tests, microbiological results, cardiac parameters, intraoperative data, and lung transplant outcomes were assessed retrospectively. RESULTS: Bilateral lung transplantation for bronchiectasis were performed in eleven patients. The mean age was 36.5 years (range 22-57 years). There were 4 (36.4%) female patients and 7 (63.6%) male patients. All patients had a high score as per the bronchiectasis severity index (BSI). The FACED score was moderate in six patients and severe in five patients. Preoperative colonization with Pseudomonas aeruginosa was observed in five patients. Hospital mortality was 18.2% (2/11). The 1-year mortality was 27.2% (3/11). Eight patients were alive. The mean follow-up period of patients with survival was 28.2 months (range 13-42 months). One patient was diagnosed with chronic lung allograft dysfunction (CLAD). The 3-year survival rates were 73%. CONCLUSION: Lung transplantation for bronchiectasis with end-stage lung disease can improve the quality of life and increase survival in selected patients. Further studies are needed to identify the optimal time for lung transplantation referral due to the availability of limited data.

Lung Transplantation for Cystic Fibrosis in Turkey: First Report.

OBJECTIVES: Lung transplant is the most important treatment approach that improves the life expectancy and quality of life for patients with cystic fibrosis with end-stage lung disease. In this study, we retros-pectively analyzed patients with cystic fibrosis who were referred to our lung transplant program in Turkey. MATERIALS AND METHODS: We evaluated 14 patients with cystic fibrosis who were referred to our lung transplant clinic between December 2016 and December 2019. The characteristics of the patients at the time of referral to our lung transplant clinic, survival, and lung transplant results were recorded. RESULTS: Four patients died on the wait list, 3 patients were not eligible for lung transplant, and lung transplant was performed in 7 patients. The mean age of all patients was 22.8 years (range, 11-41 years), and the mean age for patients who underwent lung transplant was 27.5 years (range, 21-41 years). The mean time of suitable donor offer or survival life was 140 days in the patients who were referred for lung transplant. The 1-year mortality rate was 28.6% (2 of 7 patients) after lung transplant. One patient died of chronic lung allograft dysfunction at the 25th month after lung transplant. Four patients were alive without any problems. CONCLUSIONS: Lung transplant is the final treatment method for patients with cystic fibrosis with terminal period lung disease. To provide the best benefit, patients should be evaluated for transplant early. Cystic fibrosis care clinics and lung transplant clinics should work in coordination in order to increase the number of lung transplants and improve outcomes.

A salvage maneuver for the caudal part of the pectoralis major muscle in the reconstruction of superior thoracic wall defects: The pectoralis kite flap.

The pectoralis major muscle flap is the most commonly used option for chest wall reconstruction. However, its utilization should be avoided in chest wall tumors infiltrating the muscle. This article presents the utilization of the caudal part of the pectoralis major muscle as a pedicled flap in cases requiring the resection of the cranial part of the muscle due to tumor infiltration. Fourteen patients with a mean age of 60.3 years were operated for malignant thoracic wall tumors between 2011 and 2014. All tumors were located on the upper thoracic area with a mean defect size of 16.6 × 12 cm. During tumor resection, the thoracoacromial vessels and pectoral branch were preserved and dissected until reaching the pectoralis muscle. After the resection of the cranial part of the muscle, the caudal part is prepared as a pedicled island flap and used for the coverage of the resultant defect. The mean postoperative follow-up period was 10.9 months. All flaps survived without any partial or total flap loss. A case of local recurrence, two cases of hematoma requiring drainage, and two cases of local wound-healing problems were the encountered complications. The pectoral kite flap is a versatile and reliable option for the coverage of small to medium upper chest wall defects with minimal morbidity, and it gives the reconstructive surgeon the opportunity to use the non-infiltrated caudal part of the pectoralis muscle instead of an unnecessary resection of the whole muscle.

Are there any psychological factors in male patients with primary spontaneous pneumothorax?

BACKGROUND: Primary spontaneous pneumothorax (PSP) is usually seen in young male smokers. Pathophysiology of PSP remains unclear, and studies concerning emotional status are scarce. The aim of this study is to investigate psychological factors associated with primary spontaneous pneumothorax. METHODS: The Beck Depression Inventory, Beck Anxiety Inventory, State-Trait Anger Expression Inventory, and State-Trait Anxiety Inventory were administered. RESULTS: A total of 40 patients and 40 healthy controls were included in this study. The mean age in the patient group was 24.60 years, while that in the control group was 26.45 years. The difference was not significant. The weight and body mass index of the patient group were significantly lower compared to those of the control group. The mean Beck Anxiety Inventory scores in the patient and control groups were 10.37 ± 11.34 and 8.25 ± 10.60, respectively. Anxiety levels did not differ between the groups (p = 0.389). The mean Beck Depression Inventory scores of the patient and control groups were 8.20 ± 8.37 and 6.80 ± 7.57, respectively, but the difference was not significant (p = 0.435). When the anger structures of the groups were compared, no difference was found in any sub-scale. Trait anxiety scores were higher in the patient group compared to those in the control group, but the difference was not significant (p = 0.369). CONCLUSIONS: This study's findings indicated that anger, anxiety, and depression levels did not differ between the primary spontaneous pneumothorax and healthy groups.