Indian Journal of Thoracic and Cardiovascular Surgery最新文献

{"title":"Extracorporeal membrane oxygenation-assisted resection of a ruptured carotid artery pseudoaneurysm causing airway compromise: a novel surgical strategy.","authors":"Hemantkumar Yadavrao Bodhankar, Nitish Kumar, Frankleena Viveka Dilip Parage, Omshubham Asai, Jitendra Vitthal Kalbande","doi":"10.1007/s12055-025-02156-7","DOIUrl":"10.1007/s12055-025-02156-7","url":null,"abstract":"<p><p>A 55-year-old man presented with sudden-onset right-sided neck swelling, fever, and stridor. Clinical examination revealed a firm, non-mobile mass near the angle of the mandible. Ultrasonography and contrast-enhanced computed tomography of the neck confirmed a pseudoaneurysm of the right common carotid artery just proximal to the bifurcation, measuring 37 × 28 × 33 mm, surrounded by a peripherally enhancing inflammatory mass extending into the parapharyngeal space and causing airway compromise. The internal jugular vein was thrombosed. Due to anterior tracheal compression, both intubation and tracheostomy were deemed unsafe. Elective extracorporeal membrane oxygenation (ECMO) was initiated via femoral artery and vein cannulation using a cardiopulmonary bypass machine. Spinal anaesthesia was administered, and systemic heparinization was performed to achieve an activated clotting time > 480 s. ECMO enabled safe general anaesthesia and surgical control. A longitudinal cervical incision exposed the pseudoaneurysm, which was excised along with the surrounding infected mass. The anterior carotid wall was necrotic, and the intima was calcified. A reversed saphenous vein graft was used to reconstruct the artery between the common and internal carotid segments. The external carotid artery and thrombosed internal jugular vein were ligated. Postoperatively, the patient was ventilated and supported with inotropes. He was extubated on postoperative day 3 and discharged on day 10 without neurological deficits. This case highlights the novel use of ECMO in managing carotid pseudoaneurysms with airway compromise, offering a safe alternative when conventional airway access is not feasible.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"42 5","pages":"675-679"},"PeriodicalIF":0.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13066089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147672832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reno-hemiazygos venous connection identified on contrast-enhanced abdominal CT: a developmental variant.","authors":"Vedat Yaman","doi":"10.1007/s12055-025-02162-9","DOIUrl":"10.1007/s12055-025-02162-9","url":null,"abstract":"<p><p>The reno-hemiazygos venous connection is a rare developmental variant that arises from the persistence of transient embryonic communications. A 75-year-old male underwent contrast-enhanced abdominal computed tomography (CT) for evaluation of abdominal pain. Imaging revealed a normal left renal vein (LRV) draining into the inferior vena cava (IVC) and an additional posterior connection from the LRV to the hemiazygos vein. No evidence of IVC obstruction or renal abnormality was present. Recognition of a reno-hemiazygos connection is important to prevent misinterpretation as a pathologic retroperitoneal vessel or lymphadenopathy, to appreciate its potential role as a collateral pathway in cases of IVC obstruction or Budd-Chiari syndrome, and to aid in preoperative planning to minimize the risk of vascular injury or bleeding during retroperitoneal or renal surgeries..</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"42 5","pages":"672-674"},"PeriodicalIF":0.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13066073/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147672851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Absent right superior vena cava with persistent left superior vena cava.","authors":"Naveen Deep Kaur, Javid Raja, Sunder Negi","doi":"10.1007/s12055-025-02152-x","DOIUrl":"10.1007/s12055-025-02152-x","url":null,"abstract":"<p><p>Absence of right superior vena cava with a persistent left superior vena cava is rare. We report a case of an 8-month-old child who presented with a ventricular septal defect, absent right superior vena cava, and a persistent left superior vena cava. This case report describes the potential problems during cardiac surgery in this anomaly and its clinical implications.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s12055-025-02152-x.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"42 5","pages":"680-683"},"PeriodicalIF":0.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13066203/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147672812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyperglycaemia, inflammation and early cardiac remodelling in non-surgically revascularized STEMI: the role of microvascular obstruction and intramyocardial haemorrhage.","authors":"Vyacheslav Ryabov, Evgeny Vyshlov, Stanislav Dil, Yana Alexeeva, Vladimir Usov, Olga Mochula, Konstantin Zavadovsky, Kristina Nasekina, Leonid Maslov","doi":"10.1007/s12055-025-02082-8","DOIUrl":"https://doi.org/10.1007/s12055-025-02082-8","url":null,"abstract":"<p><strong>Background and aims: </strong>In ST-elevation myocardial infarction (STEMI), timely reperfusion via percutaneous coronary intervention (PCI) reduces mortality but is limited by microvascular injury (MVI), including microvascular obstruction (MVO) and intramyocardial hemorrhage (IMH), which drive adverse cardiac remodeling. This study evaluates the incidence of MVO and IMH, their combined effects, and associations with hyperglycemia, inflammation, and left ventricular (LV) dysfunction after successful non-surgical revascularization of STEMI.</p><p><strong>Methods and results: </strong>A single-center cohort of 60 STEMI patients (2019-2020) underwent contrast-enhanced cardiac magnetic resonance imaging (MRI) 48 ± 6 h post-infarction to assess MVI. Patients were classified into four groups: no MVI, isolated MVO, isolated IMH, and combined MVO + IMH. For some analyses, patients were also dichotomized into MVI-present versus MVI-absent groups to facilitate comparison of functional and biochemical outcomes. LV function was evaluated via echocardiography (days 7 and 90). Biomarkers were analyzed at admission and day 7. MVI occurred in 68.3% of patients: isolated MVO (16.7%), isolated IMH (15%), and combined MVO + IMH (36.7%). Combined MVO + IMH correlated with larger infarct size, prolonged ischemia, and higher admission glucose. C-reactive protein (CRP) levels on day 7 were elevated in isolated MVO (59.8 [9.1-75.9] mg/L) and MVO + IMH (32.8 [4-55.6] mg/L) versus no-MVI (4.6 [2.9-12.7] mg/L). LV ejection fraction (LVEF) was significantly lower in MVO + IMH groups (p < 0.05). Admission glucose inversely correlated with day 7 LVEF (r = -0.43, p < 0.0001).</p><p><strong>Conclusion: </strong>Combined MVO and IMH was associated with a more unfavorable remodeling pattern and subtle LV dysfunction, which may be exaggerated by hyperglycemia and inflammation. Elevated CRP links MVO to systemic inflammation, while IMH reflects mechanical capillary damage. These findings emphasize the need for early glycemic control, anti-inflammatory strategies, and imaging-guided risk stratification to mitigate microvascular injury and improve outcomes in STEMI.</p><p><strong>Graphical abstract: </strong>AMI-Acute Myocardial Infarction; IMH-Intramyocardial Hemorrhage: MVO-Microvascular Obstruction.Hyperglycaemia, inflammation and early cardiac remodelling in non-surgically revascularized STEMI: the role of microvascular obstruction and intramyocardial haemorrhage.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s12055-025-02082-8.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"42 5","pages":"595-607"},"PeriodicalIF":0.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13065921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147672819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Durability and survival following valve-sparing root replacement: a longitudinal study.","authors":"Siddhant Mehra, Makwana Rohan Kiritkumar, Devi Prasad Shetty, Vikneswaran Gunaseelan, Pradeep Narayan, Varun Shetty","doi":"10.1007/s12055-025-02104-5","DOIUrl":"https://doi.org/10.1007/s12055-025-02104-5","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate immediate and long-term outcomes of valve-sparing root replacement (VSRR) for patients with dilated aortic roots.</p><p><strong>Methods: </strong>This observational study included all patients undergoing VSRR between June 2009 to October 2024, systematically documenting patient demographics, pre-operative characteristics, surgical details, and valve morphology. The primary outcome was all-cause mortality, with secondary endpoints including valve-related complications and reintervention rates.</p><p><strong>Results: </strong>The cohort consisted of 91 patients, predominantly males (81.3%), with a mean age of 38.5 ± 14.2 years. Of these, 83 (91.2%) patients were diagnosed with aortic aneurysm, and 25(27.4%) had connective tissue disorder. The valve morphology analysis revealed that 76 (83.5%) patients had tricuspid aortic valves, and 73 (80.2%) presented with moderate-severe aortic regurgitation. Sixty-one (67%) straight tubular Dacron grafts and 30(33%) Valsalva grafts were used.Surgical complications were relatively low, with 5 (5.4%) patients requiring re-exploration. Serious adverse events were infrequent, and 1(1.1%) patient had a stroke, 3(3.2%) developed acute kidney injury requiring dialysis, and 1(1.1%) patient needed a tracheostomy. Additional complications included complete heart block or permanent pacemaker implantation in 2 patients (2.1%), and extracorporeal membrane oxygenation (ECMO) use in 1 patient (1.1%). The 30-day mortality was 3 (3.2%). The mean survival was 12.7 years; 95% confidence interval (CI): 11.7 to 13.7 years. The cumulative survival rates at 1, 5 and 10-years was 95%, 93%, and 86%. Freedom from moderate/ severe aortic regurgitation at 1, 3, and 5 years was 88%, 88% and 77% respectively.</p><p><strong>Conclusion: </strong>The excellent survival and low complication rates suggest VSRR as a viable surgical approach for patients with aortic root pathologies.</p><p><strong>Graphical abstract: </strong></p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s12055-025-02104-5.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"42 5","pages":"577-585"},"PeriodicalIF":0.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13066040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147672821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Establishing reference values for aortic dimensions in the general Indian population and implications for global standards.","authors":"Mohammed Idhrees, Nora Bacour, Onur Dolmaci, Jedidiah Samraj, Bashi Velayudhan, Nimrat Grewal","doi":"10.1007/s12055-025-02173-6","DOIUrl":"10.1007/s12055-025-02173-6","url":null,"abstract":"<p><strong>Background: </strong>The dimensions of the aorta play a crucial role in cardiovascular health, serving as a determinant of normalcy and a marker for pathological conditions such as aortic aneurysms and dissections. Extensive research has been conducted on the ascending aortic dimensions in the Western population, which forms the basis of the current aortic surgical guidelines. However, there remains a paucity of data specifically focused on the Indian population, which is essential for accurate diagnosis, risk stratification, and management of aortic diseases in the Indian context. This paper aims to describe the general aortic size distribution in the general Indian population.</p><p><strong>Methods: </strong>To study the aortic size in the Indian general population, we included all consecutive individuals who underwent a computed tomography (CT) scan between January 2022 and December 2022. Patients under the age of 18 years, those with cardiovascular comorbidities, and those with any aortic segment measuring > 45 mm were excluded from the analysis. The maximum aortic diameters were measured at predefined levels (aortic root, ascending aorta, aortic arch, proximal descending aorta, and the abdominal aorta).</p><p><strong>Results: </strong>Our study comprised 891 individuals with a mean age of 51.9 years, of which 41.5% were female. The mean ascending aortic diameter of all subjects was 29.3 ± 3.9 mm and was significantly smaller in women (28.7 ± 4.0 mm) as compared to men (29.8 ± 3.8 mm), even after correcting for age, body mass index (BMI), and body surface area (BSA). The proportion of subjects with an ascending aorta < 3.5 cm was 93.5%, that of subjects with 3.5-3.9 cm was 6.2%, and that of subjects with 4.0-4.4 cm was 0.3%.</p><p><strong>Conclusions: </strong>The general aortic dimension in the Indian population is deceptively small, most commonly < 3.5 cm. The ascending aorta is significantly smaller in the female population, also after correcting for age, BMI, and BSA. This study provides evidence to question current recommendations in the aortic guidelines for surgical intervention at 5-5.5 cm for the Indian population and whether a distinction should be made for the female patients.</p><p><strong>Graphical abstract: </strong></p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s12055-025-02173-6.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"42 5","pages":"586-594"},"PeriodicalIF":0.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13065947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147672760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Porcelain left atrium, from stone to function - a surgical challenge.","authors":"Murali Mohan Soma, Chaitanya Chittimuri, Abhinaba Sarkar, Srikant Sharma, Manpreet Kaur","doi":"10.1007/s12055-025-02122-3","DOIUrl":"10.1007/s12055-025-02122-3","url":null,"abstract":"<p><p>Long-standing rheumatic heart disease (RHD) remains the most common cause of mitral stenosis (MS) in developing countries, leading to chronic pressure overload, left atrial (LA) dilation, and a predisposition to thrombus formation due to blood stasis; in rare cases, the LA wall undergoes extensive calcification, a condition known as \"porcelain left atrium\" (PLA), which further complicates surgical intervention. Presenting a case of a 49-year-old, emaciated, 30-kg female, who presented with severe dyspnea of New York Heart Association (NYHA) class IV. Massively dilated LA with extensive calcification was noticed in the chest x-ray, and echocardiography revealed a 65-mm LA filled with a large thrombus, severe MS, thickened and calcified mitral leaflets, and moderate tricuspid regurgitation (TR). Intraoperatively, a large thrombus was found in the LA in various stages of organisation, with the outermost layer calcified and adherent to the LA wall. The thrombus was meticulously removed, and mitral valve replacement (MVR) was performed using a 29-mm TTK Chitra monoleaflet mechanical prosthetic valve. She was discharged on the seventh postoperative day following an uneventful course. This case emphasises the rare but significant surgical difficulties associated with extensive LA calcification. It highlights the need for prudent preoperative assessment, meticulous surgical technique, and individualised management for better patient outcomes.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"42 5","pages":"662-666"},"PeriodicalIF":0.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13066102/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147672633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Re: Surgically tunneled femoral IABP with Dacron graft: a novel technique to facilitate rehabilitation before and after cardiac surgery.","authors":"Fatih Kizilyel, Mehmet Rum","doi":"10.1007/s12055-026-02200-0","DOIUrl":"10.1007/s12055-026-02200-0","url":null,"abstract":"","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"42 5","pages":"691-692"},"PeriodicalIF":0.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13066087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147672808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abdominal aortic injury during lumbar microdiscectomy.","authors":"Gianluca Caragliano, André Tomescot, Keyvan Mostofi","doi":"10.1007/s12055-025-02148-7","DOIUrl":"10.1007/s12055-025-02148-7","url":null,"abstract":"<p><p>Vascular injuries during lumbar spine surgery are rare but potentially life-threatening, most commonly involving the iliac vessels and, less frequently, the abdominal aorta. Early recognition and prompt management are critical for patient survival. We report a case of a 48‑year‑old male who underwent L4-L5 microdiscectomy for severe lumbar disc herniation. During discectomy, the anterior disc annulus was inadvertently perforated, resulting in massive arterial bleeding and hemodynamic collapse. Emergency laparotomy revealed active bleeding from the posterolateral abdominal aorta just above the bifurcation. Hemostasis was achieved via packing and aortoiliac clamping, followed by implantation of a prosthetic aortoiliac graft with a proximal aorto‑prosthetic anastomosis. The patient was successfully resuscitated and transferred to the intensive care unit for monitoring. Iatrogenic abdominal aortic injury during lumbar discectomy, though rare, represents a surgical emergency. Rapid recognition, multidisciplinary management, and immediate surgical intervention are essential for survival. Open repair remains the gold standard in hemodynamically unstable patients, while endovascular approaches may be considered in stable cases.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"42 5","pages":"657-661"},"PeriodicalIF":0.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13065996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147672775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Thoracoabdominal aortic aneurysm in connective tissue disorder patients.","authors":"Diletta Loschi, Enrico Rinaldi, Germano Melissano","doi":"10.1007/s12055-022-01368-5","DOIUrl":"10.1007/s12055-022-01368-5","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1007/s12055-021-01324-9.].</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"1 1","pages":"574"},"PeriodicalIF":0.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12982787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45877380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}