Indian Journal of Thoracic and Cardiovascular Surgery最新文献

{"title":"The great masquerade: TB endomyocarditis as left ventricular mass.","authors":"Ikshudhanva Tharranath, Channabasavaraj Shivalingayya Hiremath, Sudheer Arava, Veeksha Venugopal Gowda","doi":"10.1007/s12055-024-01875-7","DOIUrl":"10.1007/s12055-024-01875-7","url":null,"abstract":"<p><p>Cardiac masses are rare and often diagnosed via imaging due to difficulties in obtaining tissue samples. This case highlights an unusual presentation of tuberculosis (TB) endomyocarditis as a left ventricular mass. A 25-year-old male presented with intermittent fever, chills, atypical chest pain, and weight loss over 6 months, with no other cardiac symptoms or TB exposure. Imaging revealed a left ventricular mass (5 × 4 × 2 cm) with a high standardised uptake value (SUV) of 28 and mediastinal lymph nodes with an SUV of 8, raising suspicions of sarcoma or lymphoma. After multidisciplinary evaluation, the patient underwent three cycles of ifosfamide and epirubicin, but the mass did not decrease in size. A biopsy showed necrotising abscesses and epithelioid cell granulomas, but no atypical cells, ruling out malignancy. A positive tuberculin test prompted initiation of intensive anti-tubercular treatment (HRZE). Two months later, follow-up magnetic resonance imaging (MRI) indicated a reduction in mass size by over 90%. This case illustrates a rare instance of primary intracardiac tubercular endomyocarditis and emphasizes the need to consider TB in atypical cardiac masses. The patient continues anti-tubercular therapy and is under follow-up.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 7","pages":"911-914"},"PeriodicalIF":0.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170463/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325557","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":"Redefining weaning in a VA ECMO: a case report on pump-controlled retrograde trial off.","authors":"Raghavendra Deshpande, Rajavardhan Rangappa, Saikat Kanjilal, Narayana Swamy Moola, Suriyanathan Madhan Kumar","doi":"10.1007/s12055-025-01895-x","DOIUrl":"10.1007/s12055-025-01895-x","url":null,"abstract":"<p><p>Extracorporeal membrane oxygenation (ECMO) is widely recognized as a life-saving measure. The use of veno-arterial extracorporeal membrane oxygenation (VA ECMO) is on the rise, serving as an effective mechanical circulatory support (MCS) device that aids in the restoration of systemic perfusion in patients suffering from cardiogenic shock. Weaning methods for VA ECMO exhibit considerable variability, with pump-controlled retrograde trial off (PCRTO) being one of the methods employed. PCRTO is a practical weaning method due to its physiological approach. In this case report, we discuss the application of PCRTO, in conjunction with a pulmonary artery catheter, for weaning a 41-year-old male patient from VA ECMO. The patient presented with acute coronary syndrome with cardiogenic shock. PCRTO played a pivotal role in the successful explantation of the ECMO cannulae, particularly given the patient's uncertain cardiorespiratory recovery. The PCRTO method, being both feasible and reversible, serves as a significant predictor for successful weaning from VA ECMO through a preload stress test. This case underscores the potential of PCRTO as a valuable tool in the weaning process from VA ECMO.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s12055-025-01895-x.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 7","pages":"937-941"},"PeriodicalIF":0.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170960/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325551","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":"Rare cause of hemoptysis: bronchial Dieulafoy's disease-what not to do.","authors":"Srikant K Malegaonkar","doi":"10.1007/s12055-025-01902-1","DOIUrl":"10.1007/s12055-025-01902-1","url":null,"abstract":"<p><p>Hemoptysis is an alarming symptom caused by diverse etiologies. Dieulafoy's disease is an uncommon vascular anomaly commonly described as a cause of gastrointestinal bleed. It is characterized by abnormal dysplastic submucosal artery with mucosal branches that can lead to recurrent bleeding. Herein, we present a rare case of bronchial dieulafoy's disease (BDD) presenting as recurrent hemoptysis, also highlighting important aspects of its management.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 7","pages":"951-954"},"PeriodicalIF":0.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170975/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325550","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":"Extubation in the operating room after elective on-pump CABG surgery: impact on patient outcome and clinical practice during the COVID-19 pandemic.","authors":"Anna Fischbach, Julia Alexandra Simons, Steffen Bernhard Wiegand, Celiné Lang, Rüdger Kopp, Gernot Marx, Sebastian Johannes Bauer, Patrick Winnersbach, Payam Akhyari, Gereon Schälte","doi":"10.1007/s12055-025-01908-9","DOIUrl":"10.1007/s12055-025-01908-9","url":null,"abstract":"<p><strong>Purpose: </strong>Coronary artery bypass graft (CABG) surgery is the standard treatment for advanced coronary artery disease. Despite evidence supporting enhanced recovery after surgery (ERAS) programs, many hospitals continue to keep patients intubated following on-pump CABG surgery. The coronavirus disease 2019 (COVID-19) pandemic further strained intensive care unit (ICU) capacities, leading to the consideration of immediate extubation after elective surgeries like CABG surgeries. The aim of this study was to assess whether extubation in the operating room after elective on-pump CABG surgery would reduce the ICU length of stay, the ICU readmission, and the ICU mortality in a population of patients undergoing on-pump CABG surgery as opposed to the conventional approach with patients remaining intubated.</p><p><strong>Methods: </strong>This study is a retrospective single-center study, including data from the University Hospital Aachen, Germany. Clinical data from 2019 to 2022 were analyzed, focusing on patients who underwent on-pump CABG surgery. Primary endpoints studied were the duration of ICU stay, rates of ICU readmission, and ICU mortality. Secondary outcomes included the hospital length of stay, hospital mortality, and the occurrence of postoperative pneumonia.</p><p><strong>Results: </strong>Ninety-seven patients who underwent elective on-pump CABG surgery were identified. There were no variations in outcomes, including ICU and hospital stays, mortality, ICU readmission, or postoperative pneumonia between the two groups.</p><p><strong>Conclusion: </strong>Extubation in the operating room after on-pump CABG surgery did not result in significant differences in outcomes compared to patients who remained intubated.</p><p><strong>Graphical abstract: </strong></p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s12055-025-01908-9.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 7","pages":"863-873"},"PeriodicalIF":0.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325545","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":"FFR-guided PCI in multivessel disease: a close match, or an underpowered verdict on CABG?","authors":"Pradeep Narayan","doi":"10.1007/s12055-025-01973-0","DOIUrl":"10.1007/s12055-025-01973-0","url":null,"abstract":"<p><p>In this review, we critically examine the 5-year outcomes of the Fractional Flow Reserve-Guided Percutaneous Coronary Intervention and Coronary Artery Bypass Graft Surgery in Patients With Multivessel Coronary Artery Disease (FAME 3) trial. While the composite outcome of death, stroke, or myocardial infarction showed no significant difference between the two strategies at 5 years, percutaneous coronary intervention was associated with higher rates of myocardial infarction and repeat revascularization. Coronary artery bypass graft surgery demonstrated greater benefit in patients with more complex coronary lesions. These findings stress the need for cautious interpretation of the trial findings and emphasize the value of long-term follow-up in assessing meaningful differences in clinical outcomes.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 7","pages":"955-957"},"PeriodicalIF":0.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325546","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":"Traumatic bronchial injury management.","authors":"Venkata Mukunda, Anuj Mehta, Nirav Panchal","doi":"10.1007/s12055-024-01878-4","DOIUrl":"10.1007/s12055-024-01878-4","url":null,"abstract":"<p><p>Airway injuries or tracheobronchial injuries are defined as the injury to the larynx, trachea, carina, and main bronchi, and the bifurcation to lobar or secondary bronchi. These can be grossly divided into upper and lower airways. Trauma, both the penetrating variety as well as blunt forces, leads to disruption of these structures leading onto potentially fatal injuries. Tracheobronchial injuries need a high degree of suspicion for early diagnosis. Prompt resuscitation and early intubation with ICD insertion are a life-saving measure. Where required, early exploration and primary anastomosis with early weaning off ventilatory support offers the best chance of recovery, and where necessary a decision to pursue conservative management is also essential.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 7","pages":"924-932"},"PeriodicalIF":0.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170486/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325560","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":"Total endoscopic resection of left atrial myxoma.","authors":"Cong Huu Nguyen, Phuong Thanh Mai, Huu Uoc Nguyen, Hoang Nam Nguyen","doi":"10.1007/s12055-025-01931-w","DOIUrl":"10.1007/s12055-025-01931-w","url":null,"abstract":"<p><p>Myxoma is a rare benign cardiac tumor occurring mostly in the left atrium. Surgical removal of the lesion is indicated to avoid intracardiac obstruction and systemic embolism. We performed surgical removal of left atrial myxoma by total endoscopic surgery without robotic assistance in 40 patients. In this technique, surgical instruments are inserted through four incisions with trocars < 1.5 cm in size. The mean cardiopulmonary bypass and aortic cross-clamp times were 141.3 ± 33.7 and 74.8 ± 28.3 min, respectively. There were no cases of death or conversion to median sternotomy, and the postoperative hospital stay was 7.2 ± 5.0 days. No cases of tumor recurrence or septal leakage occurred over follow-up periods of 3-61 months. Our technique was shown to be both feasible and safe for the removal of left atrial myxoma.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 7","pages":"887-891"},"PeriodicalIF":0.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325559","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":"Systematic reviews and meta-analyses for cardiothoracic surgeons: part 7 - synthesizing evidence.","authors":"H Shafeeq Ahmed","doi":"10.1007/s12055-025-01940-9","DOIUrl":"10.1007/s12055-025-01940-9","url":null,"abstract":"<p><p>Systematic reviews and meta-analyses are powerful tools within the evidence-based framework, with significant utility in cardiothoracic surgery. Systematic reviews represent the gold standard in evidence synthesis and adhere to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, ensuring a reproducible methodology. They include subtypes such as qualitative and mixed-methods reviews, as well as extrapolations like umbrella reviews. A meta-analysis (plural: meta-analyses) is a statistical technique used to synthesize results from multiple studies, providing a more precise and reliable estimate of an effect size. Together, these approaches help inform clinical practice and shape evidence-based guidelines. However, their findings should be interpreted in light of their limitations.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 7","pages":"958-969"},"PeriodicalIF":0.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325556","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":"Struck by Cupid's arrow: penetrating chest trauma.","authors":"Vivek Tewarson, Bhupendra Kumar, Mohammad Zeeshan Hakim, Kumar Rahul, Sarvesh Kumar, Sushil Kumar Singh","doi":"10.1007/s12055-024-01869-5","DOIUrl":"10.1007/s12055-024-01869-5","url":null,"abstract":"<p><p>Penetrating cardiac injuries are among the leading causes of immediate or early mortality following trauma, consequent to haemorrhage and acute trauma coagulopathy. A 50-year-old male presented 6 h following injury from structural collapse with stable vitals. He was impaled by an iron bar passing through his right hilum, entering the left atrium near the right superior pulmonary vein, and exiting through the right ventricle. Surgical removal of the rod was accomplished without cardiopulmonary bypass and minimal blood loss.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 7","pages":"915-918"},"PeriodicalIF":0.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325553","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":"Improvement of aortic exposure by superior vena cava snaring and traction during lower partial sternotomy.","authors":"Dhirav Ramesh, Veeresh Gollarahally Siddappa, Nagananda Lokanath, Rakesh Naik Lachma, Prasanna Simha Mohan Rao","doi":"10.1007/s12055-025-01921-y","DOIUrl":"10.1007/s12055-025-01921-y","url":null,"abstract":"<p><p>A midline lower partial sternotomy without any lateral cuts gives good exposure to all structures of the heart but exposure of the aortic valve may be difficult. The aim of this study was to determine the impact of snaring and traction of superior vena cava (SVC) during lower hemisternotomy for aortic valve surgeries on surgical visibility. A prospective study was carried out requiring the measurement of degree of movement of the aorta anteriorly before and after snaring and traction of SVC. All adult patients requiring aortic valve surgeries and other valve surgeries along with aortic valve surgeries were included. Aortic valve surgeries requiring transection of aorta and redo surgeries were excluded. A total of 71 patients were studied. We found that after snaring and traction of the SVC, the mean depth of the aorta from the outer table of sternum reduced by 2.45 cm and the mean angle of the aorta with the right ventricular outflow tract (RVOT) was increased by 9.11°. In our study, we concluded that, when the SVC is snared and given traction towards the right shoulder of the patient, it brings the aorta anteriorly and makes the aorta more upright allowing better exposure.</p>","PeriodicalId":13285,"journal":{"name":"Indian Journal of Thoracic and Cardiovascular Surgery","volume":"41 7","pages":"882-886"},"PeriodicalIF":0.7,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12170958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325547","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}