Journal of Cardiothoracic Surgery最新文献

{"title":"Successful thoracoscopic-assisted resection of a functional paraganglioma in the mediastinum with extracorporeal circulation: a case report.","authors":"Zhihui Yang, Xiaojie Huang, Danting Zhou, Tao Tang, Hengxing Liang, Wenliang Liu, Fenglei Yu, Chen Chen","doi":"10.1186/s13019-024-03222-8","DOIUrl":"https://doi.org/10.1186/s13019-024-03222-8","url":null,"abstract":"<p><strong>Background: </strong>Paragangliomas are rare neoplasms arising from extra-adrenal chromaffin cells, with mediastinal paragangliomas representing an exceptionally rare subset. This report details the surgical management of a complex mediastinal paraganglioma case, presenting with refractory hypertension and invasion of critical surrounding structures. A comprehensive review of the current literature is included to underscore existing cases, enhance clinical awareness, and share our insights and experience in the diagnosis and treatment of this challenging condition.</p><p><strong>Case presentation: </strong>A 16-year-old female presented with recurrent headaches and persistent hypertension lasting over one year. Based on clinical findings and imaging studies, she was preliminarily diagnosed with a mediastinal paraganglioma. The patient underwent comprehensive preoperative management, including oral α- and β-adrenergic blockade, preoperative arterial embolization, and intravenous fluid volume expansion, to optimize endocrine control. Thoracoscopic resection of the mediastinal mass was initially attempted; however, the procedure became complex due to the high risk of uncontrolled hemorrhage and invasion of adjacent vital structures. Following the preoperative surgical plan, the incision was converted to a lateral thoracotomy, and cardiopulmonary bypass was initiated. Meticulous dissection enabled the complete removal of the tumor along with the affected posterior wall of the left atrium, followed by reconstruction of the left atrium and the right pulmonary vein. The surgery was successfully completed, and follow-up assessments showed no signs of tumor recurrence or metastasis.</p><p><strong>Conclusions: </strong>Functional mediastinal paraganglioma is a rare neuroendocrine tumor, with complete surgical resection being the gold standard treatment. Stringent perioperative management is crucial to mitigate the risk of cardiovascular complications associated with functional tumors. Lifelong surveillance is recommended to detect potential recurrence or metastasis. Effective collaboration within a multidisciplinary team is essential for ensuring accurate diagnosis and delivering optimal, individualized care.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"10"},"PeriodicalIF":1.5,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927355","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":"Heparin rebound in patients undergoing off-pump coronary artery bypass grafting surgery: a single-center retrospective study.","authors":"Fei Jiang, Yang Xu, Shan-Shan Hu, Jin-Quan Wang, Yun-Tai Yao","doi":"10.1186/s13019-024-03267-9","DOIUrl":"https://doi.org/10.1186/s13019-024-03267-9","url":null,"abstract":"<p><strong>Background: </strong>Heparin, an anticoagulant used in cardiac surgery, can result in heparin rebound (HR), where it returns postoperatively despite being neutralized with protamine. This study was designed to investigate the prevalence of HR in patients undergoing off-pump coronary artery bypass grafting (OPCAB) and evaluate the impact of HR on their short-term outcomes.</p><p><strong>Methods: </strong>HR was defined by a 10% increase in activated coagulation time (ACT) following two hours of heparin neutralization with protamine, bleeding over 200 mL/h, and abnormal laboratory coagulation examination results. We analyzed 503 OPCAB patients aged 31-80 years from September 2019 to June 2022, who were categorized into HR (n = 56) and Non-HR (n = 447) groups. The primary outcome was postoperative bleeding volume. Secondary outcomes included the incidence of postoperative reoperation for bleeding, allogenic blood transfusion incidences and volumes, and laboratory variables.</p><p><strong>Results: </strong>Significant differences were observed in preoperative platelet counts (P < 0.001) and the ACT measured 2 h post-heparin neutralization (P = 0.012). The group HR exhibited higher 24-hour bleeding volumes, increased reoperation rates, and greater total bleeding volumes (all P < 0.001).</p><p><strong>Conclusions: </strong>Postoperative HR was found to be prevalent in OPCAB patients and increased bleeding risks. These findings indicate the need for future randomized controlled trials to confirm the impact of HR and guide patient blood management.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"18"},"PeriodicalIF":1.5,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927308","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":"Obstructive shock secondary to an unusual cause: primary cardiac lymphoma.","authors":"Gregoire Ottavy, Laurent Camous, Claire Fieschi, Lucas Della Torre, Jean-David Pommier","doi":"10.1186/s13019-024-03261-1","DOIUrl":"https://doi.org/10.1186/s13019-024-03261-1","url":null,"abstract":"<p><strong>Background: </strong>The medico-surgical management of cardiac tumors when there is a suspicion of malignancy is complex. Moreover, in a critically ill setting, the choice of diagnostic tools seems crucial.</p><p><strong>Case presentation: </strong>We present the case of a sixty-four-year-old patient with no prior medical history who was admitted to the intensive care unit with obstructive shock secondary to a right heart mass and pulmonary embolism. Clinical and biological features revealed secondary hemophagocytic lympho-histiocytosis (HLH). The patient underwent a diagnostic procedure with dual thoracoscopic and mediastinoscopy with biopsies. Following the diagnosis of primary cardiac lymphoma, the patient received sequential chemotherapy without undergoing cardiac surgery leading to initial improvement, with reductions in intracardiac obstruction and in biomarkers associated with hemophagocytic lympho-histiocytosis.</p><p><strong>Conclusion: </strong>When a cardiac mass is associated with extracardiac symptoms indicative of a hematological malignancy, the preferred treatment is chemotherapy, and cardiac surgery should be avoided.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"17"},"PeriodicalIF":1.5,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927315","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":"Relationship between systemic immune-inflammation index and depression among individuals with and without cardiovascular disease.","authors":"Dan Liu, Chaojie He, Xinguo Luo","doi":"10.1186/s13019-024-03314-5","DOIUrl":"https://doi.org/10.1186/s13019-024-03314-5","url":null,"abstract":"<p><strong>Objective: </strong>Depression is a common comorbidity in cardiovascular disease (CVD), and both conditions are associated with chronic inflammation. The systemic immune-inflammation index (SII) has emerged as a promising marker of systemic inflammation, but its role in association with depressive symptoms, particularly in the context of CVD, remains unclear. This study aims to investigate the association of SII with depressive symptoms in individuals with and without CVD using cross-sectional data from NHANES (2005-2016).</p><p><strong>Methods: </strong>A total of 29,479 participants from the National Health and Nutrition Examination Survey (NHANES) 2005-2016 waves were included. Depressive symptoms were assessed through Patient's Health Questionnaire (PHQ-9). SII was calculated as the platelet count × neutrophil count/lymphocyte count. In order to determine the relationships between SII and depressive symptoms in participants with and without CVD, binary logistic regression model and smooth curve fitting were used. We also performed sensitivity analyses and subgroup analysis.</p><p><strong>Results: </strong>The total prevalence of depressive symptoms was 8.73% among the 29,479 participants analyzed. After adjusting for confounding factors, a higher SII was significantly associated with increased depressive symptoms in the total population (OR per SD increase: 1.101, 95% CI: 1.060-1.144, P < 0.0001). This association was stronger in participants without CVD (OR: 1.121, 95% CI: 1.073-1.172, P < 0.0001) compared to those with CVD (OR: 1.055, 95% CI: 0.973-1.144, P = 0.19571). Participants in the highest SII tertile had a significantly higher risk of depressive symptoms compared to those in the lowest tertile, particularly in the non-CVD group (OR: 1.161, 95% CI: 1.026-1.313, P = 0.01765).</p><p><strong>Conclusion: </strong>The SII is independently associated with an increased risk of depressive symptoms, particularly in individuals without CVD. These findings suggest that the SII may serve as a valuable predictor of depressive symptoms in the general population, with potential implications for early screening and intervention strategies. Further research is needed to elucidate the mechanisms underlying this association and to explore the clinical utility of SII in depressive symptoms assessment, especially in the context of cardiovascular health.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"15"},"PeriodicalIF":1.5,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927321","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":"The expression of MALAT1, plasma brain natriuretic peptide, and Tei index in sepsis-induced myocardial injury.","authors":"Guangqing Huang, Wenzi Yang, Xu Zhao, Yong Bai, Xing Jiang, Jie Liu","doi":"10.1186/s13019-024-03274-w","DOIUrl":"https://doi.org/10.1186/s13019-024-03274-w","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;We sought to investigate the expression of MALAT1, plasma brain natriuretic peptide, and Tei index in sepsis-induced myocardial injury.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The current retrospective analysis focused on 146 sepsis patients admitted to our hospital from February 2021 to March 2023. Based on the presence or absence of myocardial injury, the patients were divided into two groups: the sepsis group (n = 80) and the sepsis-induced myocardial injury group (n = 66). Based on the 28-day mortality status of the patients, they were also divided into a survival group of 143 cases and a death group of 3 cases. The study compared the levels of MALAT1, plasma brain natriuretic peptide, and Tei index between the sepsis group and sepsis-induced myocardial injury group, as well as the comparison of two sets of ultrasound indicators. Univariate logistic regression analysis was performed to identify the influencing factors of sepsis-induced myocardial injury, followed by multivariate logistic regression analysis to identify the influencing factors of such condition. MALAT1, plasma brain natriuretic peptide and cardiac Tei index between the survival and death groups were compared and Pearson correlation analysis was conduct to assess their correlations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In terms of general information, there were no significant differences in gender, age, BMI, mean arterial pressure, systolic pressure, diastolic pressure, respiratory rate, oxygenation index, basic diseases and infection site between the two groups (P &gt; 0.05). However, significant differences were observed in heart rate, SOFA score, and APACHE II score between the two groups (P &lt; 0.05). The levels of MALAT1, plasma brain natriuretic peptide, and Tei index in the sepsis-induced myocardial injury group were significantly higher than those in the sepsis group (P &lt; 0.05). Furthermore, the sepsis-induced myocardial injury group exhibited lower left ventricular end-diastolic diameter and left ventricular end-systolic diameter compared to the sepsis group, along with higher levels of E, E/e', and e', showing significant differences (P &lt; 0.05). The independent variables considered in the analysis included general data, ultrasound indicators with significant differences, as well as MALAT1, plasma brain natriuretic peptide, and Tei index. The dependent variable was sepsis-induced myocardial injury, and univariate logistic regression analysis identified E, E/e', e', MALAT1, plasma brain natriuretic peptide, and Tei index as influencing factors of sepsis-induced myocardial injury. Subsequently, a multivariate logistic regression analysis was conducted with the independent variables set as E, E/e', e', MALAT1, plasma brain natriuretic peptide, and Tei index, and the dependent variable as sepsis-induced myocardial injury. The results indicated that MALAT1, plasma brain natriuretic peptide, and Tei index were influencing factors of sepsis-induced myocardial inju","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"16"},"PeriodicalIF":1.5,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927357","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":"The limitations for cardiac surgeons made by stenting at mid part of left anterior descending artery.","authors":"Amir Mirmohammadsadeghi, Mohaddeseh Behjati, Mohammad Hashemi, Shayan Mirshafiee, AliAkbar Tavassoli","doi":"10.1186/s13019-024-03299-1","DOIUrl":"https://doi.org/10.1186/s13019-024-03299-1","url":null,"abstract":"","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"14"},"PeriodicalIF":1.5,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927412","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":"Downregulation of serum miR-30c-5p serves as a biomarker to predict disease onset and short-term prognosis in acute coronary syndrome patients.","authors":"Bo Chang, Xiangfeng Zhang, Riliang Fang, Huibin Li, Youdan Zhou, Yakun Wang","doi":"10.1186/s13019-024-03258-w","DOIUrl":"https://doi.org/10.1186/s13019-024-03258-w","url":null,"abstract":"<p><strong>Background & objective: </strong>Timely intervention for Acute coronary syndrome (ACS) could effectively reduce the mortality rate of ACS patients. This study aimed to investigate the clinical significance of miR-30c-5p for ACS and to provide a convenient biomarker for diagnosing of ACS.</p><p><strong>Methods: </strong>Baseline information was collected from a total of 173 subjects (98 ACS subjects and 65 healthy subjects). The miR-30c-5p expression was evaluated by the Polymerase chain reaction (PCR). The predictive value of miR-30c-5p for ACS was assessed by Receiver Operating Characteristic (ROC) curve and multivariate logistic regression analysis. The relationship between miR-30c-5p expression and ACS severity was assessed by correlation analysis. Furthermore, the prognostic value of miR-30c-5p on Major Adverse Cardiovascular Events (MACE) occurrence was assessed by the Kaplan-Meier (K-M) curve to evaluate its prognostic significance.</p><p><strong>Results: </strong>Downregulation of miR-30c-5p was observed in ACS subjects and its diagnostic value on ACS was confirmed by the ROC curve. MiR-30c-5p could also discriminate acute myocardial infarction (AMI) from unstable angina pectoris (UAP) subjects in ACS. The expression of miR-30c-5p was negatively correlated with the cardiac troponin I (cTnI) levels and the Gensini score. A lower miR-30c-5p expression was observed in ACS subjects who developed MACE (P = 0.020), and the K-M curve further confirmed the close correlation between miR-30c-5p expression and MACE occurrence in ACS. MiR-30c-5p was also identified as an independent prognostic factor for MACE in ACS.</p><p><strong>Conclusions: </strong>Serum miR-30c-5p expression was correlated with the severity of ACS, and downregulated miR-30c-5p expression showed a diagnostic and prognostic value in ACS.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"12"},"PeriodicalIF":1.5,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927274","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":"Analysis of the effect of initial hemostasis resuscitation with recombinant human coagulation factor VII a on the treatment of postoperative hemorrhage in cardiac surgery.","authors":"Yan Yu, Maomao Liu, Xuran Lu, Li Yu, Nan Liu","doi":"10.1186/s13019-024-03278-6","DOIUrl":"https://doi.org/10.1186/s13019-024-03278-6","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the effectiveness of initial hemostatic resuscitation(IHR) on the treatment of bleeding with recombinant human coagulation factor VIIa after cardiac surgery.</p><p><strong>Methods: </strong>The clinical data of patients who received rFVIIa hemostatic treatment after cardiac surgery at Beijing Anzhen Hospital, Capital Medical University, from January 1, 2021, to December 31, 2021 were retrospectively collected. A total of 152 cases were included in the study. In this study, initial hemostatic resuscitation was defined as a platelet count > 50,000 per µL and fibrinogen > 1.5 g/L when rFVIIa was used. Based on whether initial hemostatic resuscitation was completed during the application of rFVIIa, patients were divided into an initial hemostatic resuscitation group and an un-initial hemostatic resuscitation group. Baseline information, medical history, surgery-related data, postoperative bleeding volume, transfusion product volume, and overall mortality data were collected for each patient, and the postoperative bleeding volume, transfusion volume, and overall mortality rate were compared between the two groups, thus evaluating the effectiveness of initial hemostatic resuscitation on the treatment of postoperative bleeding with recombinant human coagulation factor VIIa in cardiac surgery.</p><p><strong>Result: </strong>In this study, patients in the initial hemostasis resuscitation group received a lower dose of recombinant activated factor VII (rFVIIa) [29.41 (26.23, 34.63) µg/kg vs. 36.04 (28.57, 59.27) µg/kg, P = 0.002], had lower blood product requirements [41 (40.2%) vs. 31 (62%), P = 0.011], received fewer units of packed red blood cells within 24 h postoperatively [0 (0, 2) U vs. 2 (0, 6) U, P = 0.018], had a lower volume of plasma transfusion [0 (0, 0) ml vs. 0 (0, 400) ml, P = 0.021], exhibited a lower peak value of D-dimer after surgery [756 (415.5, 2140.5) ng/ml vs. 1742.5 (675.25, 3392) ng/ml, P = 0.003], experienced fewer postoperative neurological complications [4 (3.92%) vs. 12 (24%), P < 0.001], had a lower mortality rate [8 (7.84%) vs. 14 (28%), P = 0.001], and had a shorter duration of mechanical ventilation [17 (12, 60.13) hours vs. 39.5 (15.75, 115.13) hours, P = 0.022].</p><p><strong>Conclusion: </strong>Initial hemostasis resuscitation can significantly reduce the bleeding volume and blood product requirements in patients with bleeding complications after cardiac surgery who were treated with rFVIIa, thus improving patient prognosis. And it is crucial to closely monitor for symptoms and signs of thromboembolic complications during the application of rFVIIa.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"13"},"PeriodicalIF":1.5,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927248","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":"Unveiling the uncommon: hypoplasia of external iliac artery-a case report and literature review.","authors":"Yu Xu, Jingbin Yuan, Chao Li","doi":"10.1186/s13019-024-03202-y","DOIUrl":"https://doi.org/10.1186/s13019-024-03202-y","url":null,"abstract":"<p><p>The absence or dysplasia of the iliac artery(IA) is an exceedingly rare condition, with limited cases documented in the literature. In this report, we present a case of hypoplasia of the right external iliac artery (EIA) in a 69-year-old male patient. The patient presented with right lower abdominal pain attributed to an aneurysm of the right internal iliac artery (IIA), yet notably, there was no evidence of lower limb ischemia at the time of consultation. Computed tomography angiography (CTA) of the aorta revealed a slender and occluded right EIA. Additionally, aneurysms were identified in the abdominal aorta (AA), the common iliac artery (CIA), and the right IIA, with collateral circulation involving the deep femoral artery and internal pathways. We performed aortoiliac aneurysm repair with a bifurcated synthetic graft on the patient's AA and iliac artery (IA), successfully excising the abdominal aorta aneurysms (AAA) and the CIA aneurysm. Postoperatively, thrombosis of the internal iliac aneurysm was observed, and the patient experienced a resolution of pain symptoms in the right lower abdomen. This paper delineates the vascular variations and treatment strategies employed and provides a review of the existing literature on IA malformations.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"7"},"PeriodicalIF":1.5,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927413","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":"Robotically assisted mitral valve repair using the butterfly technique in a patient with a narrow chest.","authors":"Suguru Tatsuki, Makoto Hashimoto, Ryuji Koshima","doi":"10.1186/s13019-024-03275-9","DOIUrl":"https://doi.org/10.1186/s13019-024-03275-9","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive cardiac surgery for mitral regurgitation is challenging in patients with narrow chests due to limited thoracic space. The butterfly technique can prevent systolic anterior motion in patients with degenerative mitral regurgitation and redundant posterior leaflets, but it is difficult to perform via minimally invasive cardiac surgery. Few reports have described mitral valve repair using the butterfly technique or in a narrow chest. This case report demonstrates the feasibility and utility of robotically assisted mitral valve repair using the butterfly technique in a patient with a narrow chest, addressing the challenges involved through innovative port insertion and visualization.</p><p><strong>Case presentation: </strong>A 70-year-old woman with a narrow chest (58 mm from spine to sternum) presented with shortness of breath on exertion. Transesophageal echocardiography revealed severe mitral regurgitation with posterior leaflet prolapse. Robotically assisted mitral valve repair was performed. Skin incisions were made in the third, fourth, and sixth intercostal spaces on the right anterior axillary line. A port for the atrial retractor was placed slightly medial to the right mid-clavicular line in the fifth intercostal space, inserted more shallowly than usual to achieve mitral valve exposure. The P2 leaflet was resected and reconstructed using the butterfly technique, followed by mitral annuloplasty with a semirigid partial band. The patient was discharged 6 days postoperatively with excellent valve function. One year later, she remained asymptomatic without obvious mitral regurgitation.</p><p><strong>Conclusions: </strong>Robotically assisted mitral valve repair using the butterfly technique is feasible in patients with narrow chests. Robotic assistance facilitates mitral valve exposure and manipulation in challenging anatomical conditions through enhanced dexterity and visualization.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"6"},"PeriodicalIF":1.5,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927345","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}