Indian Journal of Thoracic and Cardiovascular Surgery最新文献

{"title":"Reoperation for acquired discrete subaortic membrane and multivalvular dysfunction after mitral valve replacement.","authors":"Nail Kahraman, Nöfel Ahmet Binicier","doi":"10.1007/s12055-025-01995-8","DOIUrl":"https://doi.org/10.1007/s12055-025-01995-8","url":null,"abstract":"<p><p>A 57-year-old female patient presented to our outpatient clinic with complaints of anginal chest pain. She had a history of mitral commissurotomy and later mechanical mitral valve replacement via a robotic surgical approach due to rheumatic heart disease. On physical examination, a pansystolic murmur at the apex and an arrhythmic mechanical heart sound were noted. Transesophageal echocardiography (TEE) revealed severe tricuspid valve insufficiency, pulmonary hypertension, moderate to severe aortic stenosis, acquired discrete subaortic membrane (DSM), a paravalvular leak with mild insufficiency in the mechanical prosthetic mitral valve, and non-obstructive pannus on the left ventricular side. The patient underwent reoperation, including DSM resection, aortic and tricuspid valve replacement, and paravalvular leak repair. Postoperative recovery was uneventful. Acquired DSM following mitral valve replacement (MVR) is a rare but increasingly recognized entity. The underlying mechanism may involve postoperative hemodynamic alterations, excessive leaflet preservation, or residual fibrosis. Extended myectomy techniques may offer a more durable solution in selected cases, reducing the risk of recurrence and reoperation.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s12055-025-01995-8.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 10","pages":"1483-1487"},"PeriodicalIF":0.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12450177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124596","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":"Free pericardial fat pad for covering bronchial stump after thoracoscopic lobectomy: a sutureless method.","authors":"Dario Amore, Dino Casazza, Umberto Caterino, Pasquale Imitazione, Alessandro Saglia, Cristiano Cesaro, Marco Rispoli, Marcellino Cicalese, Lucio Cagini","doi":"10.1007/s12055-025-01998-5","DOIUrl":"https://doi.org/10.1007/s12055-025-01998-5","url":null,"abstract":"<p><p>Bronchopleural fistula is one of the most serious complications after pulmonary lobectomy. Although its prevention remains controversial, various autologous tissues have been used to cover the bronchial stump after major lung resection. In our institution, between June 2022 and July 2023, subjects with three or more patient-related risk factors for postoperative bronchopleural fistula underwent bronchial stump coverage using a free pericardial fat pad after thoracoscopic right upper or left upper lobectomy, with a sutureless method. In these patients, the free pericardial fat pad was interposed between the azygos vein arch or the interlobar artery and the bronchial suture. No postoperative bronchopleural fistula occurred in these patients at a median follow-up of 14 months (7-20 months) and persistence of a residual free pericardial fat pad around the bronchial stump was detected a few months after thoracoscopic lobectomy. Our results suggest that the use of free pericardial fat pad to cover the bronchial stump with a sutureless technique may be an alternative method of bronchial stump buttressing in subjects with patient-related risk factors for postoperative bronchopleural fistula undergoing thoracoscopic right upper or left upper lobectomy.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 10","pages":"1439-1442"},"PeriodicalIF":0.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12450192/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124530","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":"Common celiomesenteric-renal trunk: a visceral arterial anatomical variant.","authors":"Damandeep Singh, Aprateem Mukherjee, Sanjeev Kumar","doi":"10.1007/s12055-025-01983-y","DOIUrl":"https://doi.org/10.1007/s12055-025-01983-y","url":null,"abstract":"<p><p>We report a case of a 30-year-old female with bilateral lower extremity weakness where computed tomography angiography (CTA) demonstrated a rare variant of abdominal aortic visceral branching pattern with a common trunk arising from the aorta subsequently dividing into celiac axis, superior mesenteric artery, and bilateral renal arteries. Additionally, significant stenosis was seen involving abdominal aorta distal to this common trunk suggesting midaortic syndrome. A hypertrophied arc of Riolan was also noted. This is an exceedingly rare anatomical variant discovered on CTA reflecting pivotal role of imaging in identifying such variant anatomy which can attribute to patients' symptoms and guide further management.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s12055-025-01983-y.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 10","pages":"1507-1509"},"PeriodicalIF":0.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12450125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124471","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":"Development and validation of a nomogram-based model for predicting postoperative pulmonary complications after coronary artery bypass grafting with cardiopulmonary bypass.","authors":"Ying Ji, Jingjing Liu, Tao Shan, Ruoyu Jia, Hong-Guang Bao, Hong-Yu Wang, Jing Hu, Yan Shen, Qian Zhao, Yongjun Li","doi":"10.1007/s12055-025-02011-9","DOIUrl":"https://doi.org/10.1007/s12055-025-02011-9","url":null,"abstract":"<p><strong>Objective: </strong>Patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) are at high risk of developing postoperative pulmonary complications (PPCs). This study aimed to develop and validate a clinical prediction model for these complications after CABG.</p><p><strong>Methods: </strong>In total, 849 patients were randomly divided into training (<i>n</i>=594) and validation (<i>n</i>=255) sets in a 7:3 ratio. We used least absolute shrinkage and selection operator (LASSO) regression to identify predictive variables, incorporated them into a multivariable logistic regression model, and developed a nomogram. Model performance was assessed through discrimination (receiver operating characteristic (ROC) curve analysis, area under the curve (AUC)), calibration (calibration curves, maximum calibration error (Emax), average calibration error (Eavg)), and clinical utility assessment (decision curve analysis).</p><p><strong>Results: </strong>Five predictive indicators were selected: age, smoking history, diabetes mellitus, emergent surgery, and anesthesia duration. The model demonstrated excellent predictive performance, with an AUC of 0.902 (0.859-0.945) for the training set and 0.864 (0.811-0.917) for the validation set. Calibration curve results showed non-significant <i>P</i>-values from the unreliability test (<i>P</i> = 0.861 for training set, <i>P</i> = 0.741 for validation set), indicating excellent calibration. Emax and Eavg values were 0.042 and 0.013 for the training set, and 0.046 and 0.009 for the validation set, respectively, showing a strong agreement between the predicted values and actual observations.</p><p><strong>Conclusion: </strong>An original nomogram accurately predicted PPCs after CABG with CPB, which enables clinicians to rapidly assess PPC risk for individual patients without complex calculations, providing objective, quantitative evidence for preoperative risk evaluation, informed consent discussions, and perioperative management.</p><p><strong>Graphical abstract: </strong></p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s12055-025-02011-9.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 10","pages":"1396-1407"},"PeriodicalIF":0.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12450204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124537","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":"Where are the coaches for technical skill training for our cardiovascular and thoracic students?","authors":"Adarsh Subrahmanyam Koppula","doi":"10.1007/s12055-025-02001-x","DOIUrl":"https://doi.org/10.1007/s12055-025-02001-x","url":null,"abstract":"","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 10","pages":"1516-1518"},"PeriodicalIF":0.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12450155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124566","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":"Intermittent, partial occlusion of inferior vena cava for hemodynamic stabilization during OPCAB procedures with left ventricular dysfunction.","authors":"Arsiwala Saify, Sangtani Deepak, Mathur Alok","doi":"10.1007/s12055-025-01986-9","DOIUrl":"https://doi.org/10.1007/s12055-025-01986-9","url":null,"abstract":"<p><p>Off-pump coronary artery bypass (OPCAB) grafting has gained popularity as a technique for coronary bypass. Technical challenges exist for patients with left ventricular (LV) dysfunction while grafting the lateral wall vessels. This group of patients commonly present with varying mitral regurgitation which worsens with positioning of the heart for graft construction. High doses of inotropes, fluid challenges, or intra-aortic balloon pump (IABP) are needed to maintain hemodynamic stability during the procedure. We present a novel technique of intermittent, partial occlusion of inferior vena cava (IVC) to achieve hemodynamic stability during graft construction without high dose of inotropes or IABP.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 10","pages":"1521-1524"},"PeriodicalIF":0.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12450186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124561","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":"Anomalous systemic arterial supply to the left lower lung lobe combined with arterial-pulmonary venous fistula: a case first diagnosed by echocardiography.","authors":"Xiaohan Jiang, Junmei Guan, Shuhua Duan, Hao Wan","doi":"10.1007/s12055-025-01996-7","DOIUrl":"https://doi.org/10.1007/s12055-025-01996-7","url":null,"abstract":"<p><p>A 5-year-old boy with a precordial murmur was initially diagnosed with anomalous systemic arterial (ASA) supply to the left lung lower lobe combined with arterial-pulmonary venous fistula (APVF) by transthoracic echocardiography (TTE), then evaluated by computed tomography angiography (CTA) and digital subtraction angiography (DSA). He received interventional therapy and recovered well. Although ASA supply to the lung lobes combined with APVF is usually diagnosed by CTA, it may also be first diagnosed by TTE in a patient who has a significant heart murmur. Careful TTE examination can improve the diagnostic rate of this cardiovascular abnormality.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 10","pages":"1493-1497"},"PeriodicalIF":0.6,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12450170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145124435","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":"Combined single-stage approach for repair of extensive aortic pathologies - our initial experience.","authors":"Unmesh Chakraborty, Abhinaba Sarkar, Shubham Gupta, Tanulina Sarkar, Gopal Sarkar, Anuj Kumar Das, Somnath Das, Atanu Saha","doi":"10.1007/s12055-025-01974-z","DOIUrl":"10.1007/s12055-025-01974-z","url":null,"abstract":"<p><p>Management of aortic pathologies affecting the arch and proximal descending thoracic aorta, with complex anatomical features, remains a formidable clinical challenge. We report our surgical experience using a single-stage combined approach for such repairs using a simultaneous anterolateral thoracotomy and midline sternotomy and its benefits. This is a retrospective, single-centre experience of 17 patients from January 2021 to September 2023. The entire thoracic aorta is well visualised and excellent access to the arch vessels and even distal limits of the disease is achieved. In this series, there were no incidents of stroke, renal failure, or spinal cord ischaemia. There was no mortality. One patient needed a reintervention, and another developed chylothorax which needed surgical drainage. Three patients had recurrent laryngeal nerve paresis that resolved over time. One patient had a transient posterior cerebral artery infarct that responded to conservative management. Mean cardiopulmonary bypass time was 247 min, with a mean of 183 min aortic cross-clamp time. Adequate neurological protection was usually achieved by low flow circulation. All patients are doing well, without any symptoms, on follow-up. While the prospect of utilizing two long incisions may initially raise concerns about increased morbidity, the substantial advantages of this approach in terms of enhanced visualization and access, ensuring proper distal body perfusion, and facilitating precise surgical techniques far outweigh the associated complications. Long-term data of a large cohort of such patients is needed to arrive at a definite conclusion.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 9","pages":"1218-1222"},"PeriodicalIF":0.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12373623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144951906","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":"From skin to lung: a rare case of PDZRN3/RAF1 fusion in recurrent dermatofibrosarcoma protuberans with lung metastasis.","authors":"Raja Chhabra, Sajjan Rajpurohit, Kshitij Bajpai, Jasbir Singh, Md Ali Osama","doi":"10.1007/s12055-025-01990-z","DOIUrl":"10.1007/s12055-025-01990-z","url":null,"abstract":"<p><p>Dermatofibrosarcoma protuberans (DFSP), a soft tissue neoplasm of intermediate grade not commonly encountered in oncology clinics, has been traditionally known for its locally aggressive nature and recurrence after surgical excision. This spindle cell neoplasm of fibro-histiocytic origin has one of its rare aggressive variants, pronounced by a high risk of local relapse and metastasis, recognized as fibrosarcomatous transformation of dermatofibrosarcoma protuberans (FS-DFSP). Here, we present a novel case of DFSP of the scalp which, after repeated local recurrences, transformed into an aggressive variant (FS-DFSP) with metastasis to the lungs. After comprehensive molecular profiling of the tumor, an infrequent PDZ Domain-Containing RING Finger 3-Rapidly Accelerated Fibrosarcoma 1 (PDZRN3/RAF1) gene fusion was identified, suggesting a plausible targetable chemotherapeutic option in the era of precision medicine. This case report also highlights the diagnostic conundrum faced by medical oncologists and radiologists, who, at first glance, thought of an invasive lung primary malignancy encasing the bronchus, but the histopathological findings turned out to be a flabbergasting surprise.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 9","pages":"1235-1239"},"PeriodicalIF":0.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12373625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144951956","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":"Post-TAVI atrioventricular block: navigating the triple jeopardy of tricuspid regurgitation, pacemaker-induced heart failure, and left innominate vein obstruction.","authors":"Hussien Salih Hussien Hado, Hafiz Altijani, Mohammed Hasan Alaboud, Abdullah Ahmed Hussain Sharaf, Mubarak Abdulhadi Aldossari","doi":"10.1007/s12055-025-01982-z","DOIUrl":"10.1007/s12055-025-01982-z","url":null,"abstract":"<p><p>Transcatheter aortic valve implantation (TAVI) has become a widely accepted therapeutic intervention for severe aortic stenosis, but it is frequently complicated by the development of atrioventricular block (AVB) that requires pacemaker implantation. This case report aims to present a 66-year-old male who developed a high-grade AVB after TAVI, requiring implantation of a dual-chamber pacemaker. Post pacing implantation, the patient presented with symptoms of heart failure (HF) and two-dimensional echocardiogram revealed severe tricuspid regurgitation (TR) and reduced left ventricular systolic function. Despite attempts to upgrade the pacemaker to a biventricular system, complications arose due to venous obstruction of the left brachiocephalic vein, which was overcome by tunneling the left ventricular lead from the right side. The patient achieved complete resolution of HF symptoms and marked improvement in both TR and left ventricular function after upgrading. This case illustrates the \"triple jeopardy\" of post-TAVI complications: pacemaker-induced HF, worsening of TR, and venous obstruction. It underlines the importance of thorough assessment of the patient and innovative management strategies for optimum results. The successful lead-tunneling techniques could become a solution for similar cases of venous obstruction when pacemakers are being replaced. Whereas TAVI saves life, management of complications such as AVB and TR with utmost care would prevent morbidity and enhance long-term outcome. This case emphasizes on the need for continuous monitoring post-TAVI and guided intervention that addresses both pacemaker-induced and venous complications.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 9","pages":"1223-1229"},"PeriodicalIF":0.6,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12373592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952217","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}