Journal of Cardiothoracic Surgery最新文献

{"title":"Multidisciplinary management of thoracic aortic injury with hemodynamically unstable pelvic fracture in the elderly.","authors":"Lei Wang, Huamin Ge, Ziyi Wang, Haiping Zhao, Yufang Zhang, Shouyin Jiang, Shanxiang Xu","doi":"10.1186/s13019-025-03391-0","DOIUrl":"https://doi.org/10.1186/s13019-025-03391-0","url":null,"abstract":"<p><p>Blunt thoracic aortic injury (BTAI) is a critical clinical emergency often presenting as severe trauma. The early diagnosis and treatment of BTAI pose significant challenges in its management, especially when patients experience early-stage hemodynamic instability. Presently, in the context of multiple traumas, there is an absence of clearly-defined and comprehensive guidelines capable of accurately determining the optimal timing and sequence of interventions for aortic injuries. This issue is particularly prominent when aortic injuries are complicated by abdominal vascular injuries, which exacerbate hemodynamic instability. This study aims to present two distinct cases of patients with BTAI complicated by pelvic vascular injuries, resulting in hemodynamic instability. These cases were treated at different trauma centers. The successful treatment strategies included the implantation of covered stents for aortic repair and arterial embolization for pelvic vascular injuries. By sharing these cases, we intend to enhance the understanding of the complex management of such combined - injury situations. We underscore that comprehensive aortic computed tomography angiography (CTA) is of crucial importance in the early detection of aortic injuries and other major vascular injuries in high-energy trauma scenarios. Although regional trauma centers have demonstrated positive impacts on patient outcomes, the retrospective nature of this study and its limited sample size necessitate further large-scale research to validate our findings and proposed management strategies.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"171"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deciphering myocardial fibrosis: a comprehensive bibliometric analysis of mechanism over the period 1992-2023.","authors":"Jiaojiao Zhang, Wenhui Wang, Zhen Wang, Meiqi Zhou, Shengbing Wu","doi":"10.1186/s13019-025-03404-y","DOIUrl":"https://doi.org/10.1186/s13019-025-03404-y","url":null,"abstract":"<p><strong>Background: </strong>Myocardial fibrosis is a critical link in preventing the progression of heart disease. This study conducted a bibliometric analysis of its mechanism to identify trends and hotspots, aiming to provide valuable references for heart disease prevention and treatment.</p><p><strong>Methods: </strong>This research relies on the Web of Science Core Collection, capturing all related publications on the mechanism of myocardial fibrosis up to November 11, 2023. For the bibliometric analysis, CiteSpace 6.2.R5 (64-bit) and VOSviewer 1.6.19 software tools were utilized.</p><p><strong>Results: </strong>The mechanism of myocardial fibrosis research involves 14,931 authors from 2,370 institutions in 71 countries/regions, resulting in 2,431 published studies. Nattel Stanley is the most prolific author, while Francogianis Ng is noted for the highest co-publication frequency. The United States leads in countries/regions, with the University of California System being the top institution. Cardiovascular Research is a primary outlet for new studies, and Circulation is a key reference in this research community. Current research primarily examines how myocardial fibrosis contributes to heart failure, myocardial infarction, and myocardial hypertrophy. This emerging field also explores the role of fibroblasts in myocardial injury and investigates innovative treatments to reduce myocardial fibrosis.</p><p><strong>Conclusions: </strong>Preventing myocardial fibrosis is a crucial strategy in the fight against heart disease. This study utilises bibliometric analysis to explore the vast array of literature on the mechanism of myocardial fibrosis, mapping the research landscape and provide literature references for potential breakthroughs in heart disease prevention and treatment strategies.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"170"},"PeriodicalIF":1.5,"publicationDate":"2025-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mediastinal A5: a novel artery variant of the pulmonary artery system: a case report.","authors":"Gang Li, Sheng Gong, Ning Wang, Yong Peng, Xiao-Jun Yao","doi":"10.1186/s13019-025-03399-6","DOIUrl":"https://doi.org/10.1186/s13019-025-03399-6","url":null,"abstract":"<p><strong>Background: </strong>Variations in the pulmonary artery require increased attention from thoracic surgeons prior to or during lobectomy to avoid severe intraoperative bleeding. Patients with pleural and/or hilar adhesions typically experience more intraoperative bleeding and need longer surgical time. Neglect of the variant pulmonary arteries in the context of strong adhesions may result a fatal bleeding, especially in patients with adhesions caused by pulmonary tuberculosis.</p><p><strong>Case presentation: </strong>A 52-year-old man who presented with tuberculoma and strong hilar adhesions of the right upper lobe underwent tri-portal video-assisted thoracoscopic(VATS) lobectomy in our department. In this case, we identified a variant pulmonary artery (mediastinal A5) through three-dimensional computed tomography bronchography and angiography(3D-CTBA). It was an artery that originated from the proximal pulmonary artery trunk, and coursed between the branches of central vein and V1 + 3. The precise identification of this mediastinal A5 artery ensured a safe surgery procedure (Right upper lobectomy) without severe intraoperative bleeding. It is the first report that illustrated a variant mediastinal A5. Misdiagnosis of this variant pulmonary artery may result in severe intraoperative bleeding. 3D-CTBA which could illustrate the variant pulmonary arteries is essential in planning the surgical procedures.</p><p><strong>Conclusion: </strong>3D-CTBA can help illustrating a variant pulmonary artery, and identification of the mediastinal A5 is essential in preforming right upper lobectomy.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"168"},"PeriodicalIF":1.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unveiling the hidden risk: a case of severe jaundice triggered by intra-aortic balloon pump after cardiac surgery.","authors":"Han Wang, Zerui Chen, Liming Lei, Miaoxian Fang","doi":"10.1186/s13019-025-03388-9","DOIUrl":"https://doi.org/10.1186/s13019-025-03388-9","url":null,"abstract":"<p><strong>Background: </strong>The Intra-Aortic Balloon Pump (IABP) is a widely utilized technique to provide circulatory support for critically ill patients with cardiac dysfunction. While IABP therapy offers clinical benefits, the placement of an IABP catheter can potentially lead to a range of complications in certain high-risk patients. This case report presents a rare instance of progressive jaundice associated with IABP implantation.</p><p><strong>Case presentation: </strong>The patient was a 56-year-old female who had undergone cardiac valve surgery due to rheumatic combined valve disease. She subsequently developed postoperative low cardiac output syndrome, necessitating the implementation of IABP support. However, the patient exhibited a rapid deterioration in jaundice, coupled with aberrant liver function and suspicion of concurrent pancreatitis. Further thoracoabdominal computed tomography (CT) examinations revealed that when the IABP balloon was fully inflated, the aorta was completely occluded. The diagnosis of hepatic impairment was suspected to likely result from a reduced hepatic blood flow caused by obstruction of the celiac trunk related to the occlusive IABP balloon. Therefore, the IABP was removed, leading to a gradual amelioration of jaundice symptoms as well as bilirubin levels.</p><p><strong>Conclusions: </strong>This case advocates a reevaluation of the strategy for selecting the size of the IABP balloon, particularly in high-risk patient populations. A marginally smaller balloon size may be warranted to mitigate the risk of vascular-related complications. In cases presenting with progressive jaundice and hepatic impairment following IABP insertion, proactive imaging studies should be promptly conducted to ascertain their correlation with the IABP placement. If there is suspicion of visceral ischemia associated with the IABP balloon, immediate removal of the device should be undertaken to prevent irreversible adverse events.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"169"},"PeriodicalIF":1.5,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143742856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anal-cardiac reflex leading to coronary spasm and cardiac arrest during abdominoperineal excision of the rectum (MILES): case report and review of the literature.","authors":"Yimei Lin, Jingyi Wu, Junmei Wu, Juanlan Liu, Chao Liang","doi":"10.1186/s13019-025-03387-w","DOIUrl":"10.1186/s13019-025-03387-w","url":null,"abstract":"<p><strong>Background: </strong>Coronary artery spasm (CAS) has been frequently documented during regional or general anesthesia. However, severe cardiac arrest induced by CAS as a result of anal-cardiac and vasovagal reflexes is relatively uncommon.</p><p><strong>Case presentation: </strong>This report describes a patient with a history of CAS and percutaneous coronary angioplasty (PTCA) who experienced coronary artery spasm and subsequent cardiac arrest during anal anastomosis in a transabdominal perineal radical resection of rectal cancer (MILES procedure).</p><p><strong>Conclusion: </strong>This case study offers significant insights into the pathophysiology of cardiac arrest induced by surgical intervention in the anal region, which is densely innervated by the vagus nerve at the terminal portion of the rectum. This phenomenon may be associated with the anal cardiac reflex and vagus nerve reflexes. It is imperative to recognize the potential for catastrophic outcomes due to vagus nerve excitation during rectal end surgery, particularly in patients with a history of acute CAS.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"165"},"PeriodicalIF":1.5,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tricuspidization: repair of a quadricuspid aortic valve.","authors":"Wenzong Luo, Peng Hu, Liang Ma","doi":"10.1186/s13019-025-03394-x","DOIUrl":"10.1186/s13019-025-03394-x","url":null,"abstract":"<p><p>Quadricuspid aortic valve (QAV) is rare. However, to repair a quadricuspid aortic valve is not as easy to realize as in bicuspid aortic valve. The surgical design is crucial to rebuild the stable structure. Here we present a case of repair of quadricuspid aortic valve using the strategy of tricuspidization.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"166"},"PeriodicalIF":1.5,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719362","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MitraClip combined with PTSBME for the treatment of obstructive hypertrophic cardiomyopathy with severe mitral regurgitation: a case report.","authors":"Xuewen Wang, Ziwei Liang, Mingxin Liu, Shihao Huang, Gang Pan","doi":"10.1186/s13019-025-03395-w","DOIUrl":"10.1186/s13019-025-03395-w","url":null,"abstract":"<p><strong>Background: </strong>Hypertrophic cardiomyopathy (HCM) is the hereditary cardiomyopathy with the highest incidence rate. Its main pathological changes are ventricular septal myocardial hypertrophy and myocardial disorder, which are prone to fatal arrhythmia and heart failure. If left ventricular outflow tract (LVOT) obstruction is combined, it is called obstructive hypertrophic cardiomyopathy (oHCM). There is currently no report on the use of MitraClip combined with percutaneous transluminal septal branch microsphere embolization (PTSBME) for treating patients with oHCM complicated with severe mitral regurgitation (MR).</p><p><strong>Case presentation: </strong>This report describes a 51-year-old male patient who was admitted to the hospital due to \"repeated chest tightness and shortness of breath for 2 years, worsening for 6 months\". Ultrasound, left ventricular angiography (LVA), and left cardiac catheterization confirmed oHCM with moderate MR. We used MitraClip combined with PTSBME to relieve the patient's LVOT obstruction and MR simultaneously.</p><p><strong>Conclusions: </strong>Traditionally, both interventricular septal and mitral valve lesions are treated simultaneously through surgical intervention. However, the surgical conditions are relatively strict, and many patients are unable to undergo surgical treatment, resulting in delays in their condition. For such patients, minimally invasive intervention may be used to simultaneously treat interventricular septal and mitral valve lesions, further reducing surgical risks and enhancing surgical efficacy. In this case, MitraClip combined with PTSBME was first performed. After the surgery, the patient's LVOT obstruction and MR were simultaneously relieved, and clinical symptoms improved significantly.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"167"},"PeriodicalIF":1.5,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11948753/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143719360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative analysis of sleep duration and stroke prevalence in China and the U.S. before and during COVID-19.","authors":"Jingxue Bai, Genping Lei, Xian Lu, Dong Yang, Paliza Julaiti, Jian Wang","doi":"10.1186/s13019-025-03376-z","DOIUrl":"10.1186/s13019-025-03376-z","url":null,"abstract":"<p><strong>Background: </strong>This study compares sleep duration and stroke risk between residents of China and the U.S. during and outside the COVID-19 pandemic, examining age as an interaction effect.</p><p><strong>Methods: </strong>This study analyzed data from the National Health and Nutrition Examination Survey (NHANES) and the China Health and Retirement Longitudinal Study (CHARLS). A total of 9131 American adults participated from 2017 to March 2020, and 7678 from August 2021 to August 2023. In China, 13,514 adults participated in 2018 and 9441 in 2020. Stroke incidence was assessed via survey responses, with \"yes\" indicating a history of stroke. Participants were categorized by age, and multivariable logistic regression and interaction analyses evaluated age effects, supported by subgroup and sensitivity analyses. Restricted cubic splines (RCS) examined nonlinear associations between sleep duration and stroke risk, while mediation analyses investigated the roles of hypertension, diabetes, and lipid abnormalities.</p><p><strong>Results: </strong>The study found that during the pandemic, in the multivariable-adjusted model, there was a \"U-shaped\" association between sleep duration and the prevalence of stroke (China: P for trend = 0.009, P non-linear = 0.0004; the United States: P for trend = 0.012, P non-linear = 0.0004). Similarly, in the multivariable-adjusted model, during the COVID-19 pandemic, compared with the non-pandemic period, long sleep duration (≥ 9 h) was potentially a risk factor for the prevalence of stroke among American adults (for those under 60 years old: odds ratio (OR) 95% confidence interval (CI)[1.836(1.138, 2.962)], P = 0.013; for those 60 years old and above: OR 95%CI[1.44(1.15, 1.436)], P = 0.044). In contrast, in China, compared with the pandemic period, the association between long sleep duration (≥ 9 h) and the prevalence of stroke was stronger during the non-pandemic period (for those 60 years old and above: OR 95%CI[1.342(1.132, 1.59)], P = 0.001), but no association was found among those under 60 years old. Mediation analysis indicated that in China, lipid abnormalities partially influenced the association between long sleep duration (≥ 9 h) and the prevalence of stroke. The mediation proportion was 8.39% in the overall population, and as high as 20.25% among the elderly aged 60 years and above.</p><p><strong>Conclusion: </strong>During the COVID-19 pandemic, the association between prolonged sleep duration (≥ 9 h) and stroke risk among U.S. adults aged under 60 significantly increased, although this trend was less pronounced in China. These findings suggest that public health interventions should account for the varying impact of sleep duration across different populations.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"164"},"PeriodicalIF":1.5,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11938782/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of long non-coding RNA A2M-AS1 in early diagnosis and prognosis evaluation of acute myocardial infarction.","authors":"Chunming Cao, Qiyuan Hu, Xinyue Hu, Lijun Zhu, Huili Jia, Yongjian Shen, Jun Chen, Bin Xu, Boqing Zhang","doi":"10.1186/s13019-025-03381-2","DOIUrl":"10.1186/s13019-025-03381-2","url":null,"abstract":"<p><strong>Aim: </strong>The objective was to assess the clinical efficacy of long non-coding RNA (lncRNA) alpha-2-macroglobulin-antisense 1 (A2M-AS1) in acute myocardial infarction (AMI).</p><p><strong>Methods: </strong>One hundred patients with AMI and eighty patients with chest pain were recruited in the case-control study. A2M-AS1 expression was examined by quantitative real-time polymerase chain reaction (qRT-PCR). Receiver operating characteristic (ROC) analysis was utilized for evaluating the diagnostic value. Pearson's correlation analysis was used to analyze the correlation between A2M-AS1 and conventional AMI biomarkers. AMI-associated risk indicators were identified using logistic regression analysis.</p><p><strong>Results: </strong>A significant reduction of serum A2M-AS1 was measured in AMI patients relative to chest pain patients. A2M-AS1 had an area under the curve (AUC) of 0.927 to distinguish AMI patients from those with chest pain. Pearson's correlation analysis showed that A2M-AS1 was adversely correlated with white blood cell (WBC) (r=-0.6682, P < 0.001), low density lipoprotein cholesterol (LDL-C) (r=-0.5795, P < 0.001), creatine kinase MB (CK-MB) (r=-0.6022, P < 0.001) and cTnl (r=-0.5473; P < 0.001), while positively correlated with high density lipoprotein cholesterol (HDL-C) (r = 0.6445, P < 0.001). Relative to non-Major Adverse Cardiovascular Events (non-MACE) group, serum A2M-AS1 was obviously declined in the MACE group of AMI patients with high capacity to distinguish the MACE group from the non-MACE patients (AUC = 0.802). Additionally, A2M-AS1 (P = 0.013; OR = 0.268; 95%CI = 0.095-0.760) was a risk indicator for predicting MACE with AMI patients, as well as age (P = 0.014; OR = 3.478; 95%CI = 1.285-9.414).</p><p><strong>Conclusion: </strong>A reduction in A2M-AS1 expression was observed in AMI patients, suggesting its potential as an underlying indicator for AMI diagnosis.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"163"},"PeriodicalIF":1.5,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143709913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A new guiding strategy for treating the free margin of the leaflet in an aortic root remodelling procedure.","authors":"Xinjin Luo, Shaoye Wang, Juntao Qiu, Xuanshu Li, Peng Zhang, Yuetang Wang, Cuntao Yu","doi":"10.1186/s13019-025-03392-z","DOIUrl":"10.1186/s13019-025-03392-z","url":null,"abstract":"<p><strong>Backgroud: </strong>In valve-sparing aortic root replacement procedure, leaflet prolapse can be corrected by shortening the length of the free margin. But precisely determining the extent of the reduction remains a problem. This study wants to explore the effectiveness of a guiding strategy in treating the free margin of the leaflet in a modified aortic root remodelling procedure with external sub-valvular ring.</p><p><strong>Methods: </strong>Between January 2021 and May 2024, 12 patients with aortic root aneurysms underwent modified aortic root remodelling with an external sub-valvular ring (10 males and two females). Their mean age was 42 ± 14 years. The graft diameter was determined according to the criteria of the Lansac group, based on the aortic annulus diameter. The free margin of the leaflet was treated with central plication based on a standard (target length of the free margin of the leaflet = the diameter of the selected graft + 3 ~ 5 mm).</p><p><strong>Results: </strong>The surgery was successfully completed in all 12 patients, with no hospital deaths or complications. Four patients required central plication of the free margin of three leaflets, two required treatment of two leaflets, three required treatment of one leaflet, and three did not require treatment of the free margin of the leaflet. No more than mild degree of residual aortic regurgitation was observed postoperatively. After reconstruction of the aortic root, the measured effective height and coaptation length were 8.9 ± 1.3 mm and 5.3 ± 0.9 mm, respectively.</p><p><strong>Conclusions: </strong>A guiding strategy based on the diameter of the selected graft can be effectively used to manage the length of the free margin of the leaflet in a modified aortic root remodelling procedure with external sub-valvular ring.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"162"},"PeriodicalIF":1.5,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11929233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692229","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}