Indian Journal of Thoracic and Cardiovascular Surgery最新文献

{"title":"Atypical cardiac melioidosis masquerading as a right atrial mass: a case report.","authors":"Varsha Malladi, Koustav Biswas, Hemachandren Munuswamy, Ajay Kumar Jha, Deepak Amalnath","doi":"10.1007/s12055-026-02187-8","DOIUrl":"10.1007/s12055-026-02187-8","url":null,"abstract":"<p><p>The incidence of melioidosis, a disease caused by <i>Burkholderia pseudomallei</i>, has been increasing in India over the past decade. Cardiac melioidosis is a rare complication of melioidosis, which typically presents as pericarditis, myocarditis, or endocarditis. We report a very rare and probably the first of its kind presentation of cardiac melioidosis as a right atrial mass. A 24-year-old man presented with fever, cough with expectoration, and right-sided multiple joint pain. <i>Burkholderia pseudomallei</i> was isolated from blood cultures, and culture-specific antibiotic treatment was started accordingly. Echocardiography and computed tomography (CT) images incidentally revealed a right atrial mass extending from the inferior vena cava (IVC) and prolapsing into the right ventricle through the tricuspid valve. The patient was planned for excision of the right atrial mass through median sternotomy. Intraoperatively, the mass was found to be an encapsulated pus-filled sac mimicking a right atrial thrombus. Upon histopathological analysis of the specimen and microbiological culture of the exudate, the final diagnosis of a rare variant of cardiac melioidosis was made. He was successfully operated on and treated with meropenem postoperatively during his hospital stay until blood cultures reported sterile. He was discharged with co-trimoxazole as maintenance therapy on regular follow-up as an outpatient. This clinical case adds cardiac melioidosis as a potential differential diagnosis for intracardiac mass, posing diagnostic challenges-requiring a high index of suspicion, culture confirmation, and appropriate imaging with combined surgical intervention and medical management for accurate diagnosis and effective management.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s12055-026-02187-8.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"42 8","pages":"988-993"},"PeriodicalIF":0.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13365078/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148446104","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":"Left atrial appendage morphology, characteristics and its relation with left atrial appendage clot and atrial fibrillation in patients with valvular heart lesions.","authors":"Saurabh Jagtap, Sushrut Potwar, Heli Oza, Abhishek Potnis, Uday Eknathrao Jadhav, Avinash Gonnade","doi":"10.1007/s12055-026-02197-6","DOIUrl":"10.1007/s12055-026-02197-6","url":null,"abstract":"<p><strong>Aim: </strong>To associate the morphology and characteristics, namely, flow velocity, external orifice diameter (EOD), and contractility of the left atrial appendage with the incidence of atrial fibrillation (AF) and left atrial appendage (LAA) clot using transesophageal echocardiogram (TEE) and intraoperative findings during valve surgery.</p><p><strong>Materials and methods: </strong>An observational study of a total of 81 patients during the course of this study with an inclusion criterion of them being in AF and/or having a LAA clot, while 54 patients in the control group being the ones in a sinus rhythm and without a LAA clot.</p><p><strong>Results: </strong>Out of the 81 study patients, 60 patients with AF had a LAA clot, while 21 patients were in AF without a LAA clot. The commonest occurrence of LAA morphology was found to be the chicken wing type (37%). Chicken wing morphology, when compared to non-chicken wing morphology, showed a significantly lower rate of LAA clot and AF (<i>p</i> = 0.0177). Within the 60 patients with LAA clot, windsock (50%) was the commonest morphology.</p><p><strong>Conclusion: </strong>In this comprehensive study, we have found a significant statistical association between the morphology and characteristics of LAA with that of LAA clot and AF. This, therefore, broadens the horizons of application of these findings to patients who are in normal sinus rhythm (NSR) without a clot. Given the marked risk associated with non-chicken wing LAA morphologies, especially the windsock, cactus, and cauliflower types, clinicians should maintain heightened vigilance in patients exhibiting these anatomical patterns, particularly when LAA flow velocity or contractility falls below 25 cm/s and the EOD exceeds 25 mm. Such a combination identifies individuals at distinctly increased risk for future LAA thrombus development and AF, warranting proactive monitoring and potential early intervention.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s12055-026-02197-6.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"42 8","pages":"946-952"},"PeriodicalIF":0.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13365079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148446216","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":"Coronary artery bypass grafting in a patient with factor XIII deficiency: case report and review of perioperative management.","authors":"Sowmya Kanthimathinathan, Phani Krishna Machiraju, Louis Felix Sridhar, Prabu Pandurangan, Satya Prasad Namala, Srujan Singanamala","doi":"10.1007/s12055-026-02193-w","DOIUrl":"10.1007/s12055-026-02193-w","url":null,"abstract":"<p><p>Factor XIII (FXIII) is the final enzyme in the coagulation cascade that cross-links the fibrin monomers, thereby enhancing the clot strength. Congenital FXIII deficiency is rare and is inherited in an autosomal recessive manner. FXIII deficiency may lead to bleeding, delayed wound healing, hence increasing the risk for any surgical intervention. Literature on patients undergoing cardiac surgery with FXIII deficiency is rare. Cardiac surgery poses a major risk in this setting, as it involves heparinization while performing the surgery. This increases the risk of bleeding. In this case report, we present a patient undergoing coronary artery bypass grafting (CABG) surgery with FXIII deficiency. In this report, we focus on the perioperative management of FXIII deficiency, intraoperative surgical management, and postoperative surgical care in a patient who underwent CABG surgery with FXIII deficiency as opposed to standard CABG procedure.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"42 8","pages":"1016-1020"},"PeriodicalIF":0.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13365094/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148446165","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":"Diagnostic value of narrow-band imaging in suspected lung cancer: a single-centre observational study.","authors":"Massimiliano Caterino, Cristiano Cesaro, Umberto Masi, Dupuis Diego, Dario Amore, Alfonso Fiorelli, Umberto Caterino","doi":"10.1007/s12055-026-02227-3","DOIUrl":"10.1007/s12055-026-02227-3","url":null,"abstract":"<p><p>Narrow-band imaging (NBI) enhances mucosal and vascular contrast during bronchoscopy and may support the detection of malignant airway lesions, although its specific diagnostic role in routine practice is still being defined. This single-centre retrospective observational study evaluated the relationship between NBI vascular patterns and histological diagnosis in 49 patients undergoing bronchoscopy for suspected lung cancer. Vascular patterns were classified as normal, dotted, abrupt-ending, or tortuous; dotted, abrupt-ending, and tortuous patterns were collectively considered pathological. Malignancy was confirmed in 34 patients (69.4%). Pathological vascular patterns were observed in 28 malignant cases and in three non-malignant cases, whereas normal patterns were present in six malignant and 12 non-malignant cases, corresponding to a sensitivity of 82.4%, specificity of 80.0%, positive predictive value of 90.3%, and negative predictive value of 66.7%. Pathological patterns were significantly associated with malignant histology (<i>p</i> < 0.001). Some numerical differences in the distribution of individual pathological patterns across histological subtypes were considered exploratory only. In conclusion, pathological NBI vascular patterns were significantly associated with malignant disease and demonstrated good diagnostic performance as an adjunct to white-light bronchoscopy. NBI should be regarded as a complementary tool for lesion assessment and biopsy guidance, while histopathological confirmation remains essential.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"42 8","pages":"977-982"},"PeriodicalIF":0.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13365059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148446148","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":"Barriers to rehabilitation in a Jehovah's Witness post-bilateral lung transplant.","authors":"Ariel Pereira, Talita Rodrigues, Raquel Afonso Caserta, Daniel Santos, Flávia Sales Leite, Vagner Pires de Campos Júnior","doi":"10.1007/s12055-026-02192-x","DOIUrl":"10.1007/s12055-026-02192-x","url":null,"abstract":"<p><p>This case report describes the physiotherapeutic management of a 63-year-old female Jehovah's Witness with familial idiopathic pulmonary fibrosis who underwent bilateral lung transplantation. The refusal of blood transfusions imposed major clinical, ethical, and physiological challenges, requiring individualized multidisciplinary planning. The surgery, performed in May 2024, involved anatomical adjustments and intraoperative blood conservation techniques, including Cell Saver use and veno-arterial extracorporeal membrane oxygenation (ECMO). Postoperatively, the patient developed primary graft dysfunction, severe anemia (minimum hemoglobin (Hb) 4.9 g/dL), respiratory infections (<i>Candida glabrata</i>, <i>Klebsiella pneumoniae</i>), septic shock, and acute kidney injury, demanding prolonged ventilatory support, early tracheostomy, and renal replacement therapy. Physiotherapy interventions were focused on respiratory and motor rehabilitation, guided by objective parameters such as maximal inspiratory pressure (-26 cmH₂O; 36.18% predicted), diaphragmatic ultrasound, and the Perme Intensive Care Unit Mobility Score (Perme ICU). Early mobilization was limited by critical Hb levels (< 7 g/dL) and was progressively advanced from passive mobilization and postural control to upright positioning, neuromuscular electrical stimulation, and cycle ergometer exercises as tolerance improved. The case highlights two main barriers to early mobilization-hemodynamic instability and cultural factors related to limited understanding of mobilization safety during anemia-and reinforces the importance of individualized, data-driven physiotherapy approaches. Despite significant medical complexity and ethical restrictions, the case demonstrates the feasibility and safety of structured rehabilitation in transfusion-restricted post-lung transplant patients, contributing to evidence-based practice in physiotherapy and critical care.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"42 8","pages":"1000-1003"},"PeriodicalIF":0.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13365284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148446107","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":"Surgical management of left ventricular masses: a case series highlighting ventricular-sparing approaches.","authors":"Pawan Parasnath Singh, Vidyut Kumar, Prashant Pawar","doi":"10.1007/s12055-026-02210-y","DOIUrl":"10.1007/s12055-026-02210-y","url":null,"abstract":"<p><p>Left ventricular (LV) masses, ranging from neoplasms to thrombi, pose diagnostic challenges and significant embolic risks. The traditional surgical approach often involves a ventriculotomy, which can contribute to compromised myocardial function. In the present case series, we aim to report three patients with LV masses of different etiologies managed surgically at a tertiary care center. In the first case, a suspected myxoma attached to the anterior papillary muscle was excised via a trans-mitral approach. Histopathology revealed a rare non-valvular papillary fibroelastoma. In the second case, the patient presented with ischemic cardiomyopathy (left ventricular ejection fraction (LVEF) 40%) and a small apical thrombus, which was managed via a trans-aortic approach, allowing extraction through the aortic valve to preserve ventricular geometry. The third case was a patient with ischemic heart disease (post-percutaneous coronary intervention (post-PCI)) and severe LV dysfunction (LVEF 30%) who presented with a massive (5 × 4 cm) anterior wall thrombus. Access was achieved via the trans-mitral route, facilitating complete extraction of the large burden without ventriculotomy. In this series, we suggest a tiered approach toward LV masses depending on the mass size, location, and patient hemodynamics. Utilizing natural valve orifices (trans-atrial and trans-aortic) to avoid ventriculotomy, particularly in patients with compromised ejection fractions, may improve surgical outcomes by preserving ventricular physiology.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"42 8","pages":"1010-1015"},"PeriodicalIF":0.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13365289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148446283","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":"Double trouble following VATS thymectomy for thymoma: an unusual complication and new-onset myasthenia gravis in the follow-up period.","authors":"Rahul Kumar Jaiswal, Aditya Kumar, Rohit Bhatia, Rajinder Parshad","doi":"10.1007/s12055-025-02145-w","DOIUrl":"10.1007/s12055-025-02145-w","url":null,"abstract":"<p><p>We present a case of a 38-year-old lady who developed chylothorax following video-assisted extended thymectomy and post-thymectomy myasthenia gravis (PTMG). The patient had non-myasthenic thymoma and underwent video-assisted thoracoscopic surgery (VATS) extended thymectomy. On the second postoperative day (POD), we noticed milky fluid from the intercostal drain. On subsequent biochemical analysis, a diagnosis of chylothorax was confirmed. She was managed successfully with conservative measures, including dietary modification. She was discharged on postoperative day 10. Three months following VATS thymectomy, she presented in myasthenic crisis, corresponding to Myasthenia Gravis Foundation of America (MGFA) Class V. With a diagnosis of PTMG, she was admitted to the intensive care unit for further management. Pharmacological management, including intravenous (IV) corticosteroids, azathioprine, and pyridostigmine along with plasma exchange (PLEX) therapy, was initiated. Respiratory support was provided via bilevel positive airway pressure (BiPAP) for non-invasive ventilation. Chylothorax is a rare complication of thymectomy; only 13 cases have been reported in English literature to date. This case highlights the importance of early recognition and non-operative management strategies in addressing this uncommon postoperative entity while also drawing attention to the potential for PTMG. This case is exceptionally rare, as it represents the first documented case in the English literature of a patient without preoperative myasthenia gravis (MG) who developed both chylothorax and post-thymectomy myasthenic crisis following VATS thymectomy. This report highlights the uniqueness and clinical significance of this presentation.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"42 8","pages":"994-999"},"PeriodicalIF":0.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13365106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148446130","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":"Primary monophasic spindle cell synovial sarcoma of the lung.","authors":"Suresh Kumar, Shiva Shiva, Pankaj Singh, Sanjeev Kumar, Rohan Singh, Riddhi Jaiswal","doi":"10.1007/s12055-026-02190-z","DOIUrl":"10.1007/s12055-026-02190-z","url":null,"abstract":"<p><p>Primary pulmonary synovial sarcoma (PPSS) is an exceptionally rare malignancy representing < 0.5% of all primary lung tumors. The monophasic (spindle cell) variant poses significant diagnostic challenges due to its histological overlap with other spindle cell neoplasms of the lung. We report a case of a 24-year-old male deep-sea diver who presented with an acute onset of right-sided pleuritic chest pain and fever. Imaging revealed a large right lower lobe mass initially suspected to be hydatid disease. Following thoracotomy and lobectomy, the diagnosis of monophasic spindle cell synovial sarcoma was confirmed on histopathology and immunohistochemistry. The patient remains disease-free 1 year post-surgery. To conclude, primary synovial sarcoma of the lung should be considered in the differential diagnosis of large peripheral lung masses in young patients. Complete surgical resection remains the mainstay of treatment. Accurate diagnosis relies on immunohistochemistry and molecular confirmation.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"42 8","pages":"983-987"},"PeriodicalIF":0.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13365070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148446188","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":"Management of Harlequin syndrome in veno-arterial extracorporeal membrane oxygenation.","authors":"Justin Robinson, Jason Ejimogu, Warren Naselsky, Allison Bathula, Michael Plazak, Alison Grazioli, Crystal Li, Bartley Griffith, Doug Tran, Bradley Taylor, Aakash Shah","doi":"10.1007/s12055-026-02185-w","DOIUrl":"10.1007/s12055-026-02185-w","url":null,"abstract":"<p><strong>Background: </strong>Veno-arterial extracorporeal membrane oxygenation (VA ECMO) provides temporary mechanical circulatory support, primarily for patients with compromised cardiac function. In individuals supported on femoral VA ECMO with concurrent pulmonary dysfunction, poorly oxygenated blood may be ejected from the left ventricle resulting in differential hypoxia to the upper body, or Harlequin syndrome.</p><p><strong>Methods: </strong>A retrospective, observational review of our institutional experience in managing patients who developed Harlequin syndrome from March 2016 to May 2021 was conducted. We evaluated interventions to correct Harlequin syndrome, pre-cannulation laboratory values, clinical outcomes, and overall survival to discharged.</p><p><strong>Results: </strong>Forty-four patients developed Harlequin syndrome during the study period. Eleven (25%) patients underwent ECMO revision, while 33 (75%) patients did not. The ECMO revision group had a Survival after Veno-Arterial ECMO (SAVE) score of -15 (interquartile range (IQR) -17, -11), while the non-revision group had a SAVE score of -6.0 (IQR -10, -1). The median time to resolution of Harlequin syndrome for the entire cohort was 4.5 h (IQR 1.4, 7.80). Hospital length of stay was similar between groups. There were eight (73%) patients in the ECMO revision group who survived to decannulation, compared to 23 (70%) patients in the non-revision group.</p><p><strong>Conclusions: </strong>Our findings underscore Harlequin syndrome as a serious complication of femoral VA ECMO. Our observed findings also suggest that physiological interventions can effectively resolve Harlequin syndrome and should be considered as a key strategy before considering ECMO revision.</p><p><strong>Graphical abstract: </strong></p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s12055-026-02185-w.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"42 8","pages":"935-942"},"PeriodicalIF":0.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13365069/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148446173","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":"Contemporary management of obstructive hypertrophic cardiomyopathy with surgical myectomy: past, present, and future.","authors":"Barry J Maron, Martin S Maron","doi":"10.1007/s12055-026-02224-6","DOIUrl":"10.1007/s12055-026-02224-6","url":null,"abstract":"","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"42 8","pages":"974-976"},"PeriodicalIF":0.6,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13365080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148446175","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}