Journal of Cardiothoracic Surgery最新文献

{"title":"Transesophageal echocardiography as the final defense in impending paradoxical embolism: a case report.","authors":"Zhuangyuan Chen, Mingjing Chen, Haibo Song, Yauwai Chan","doi":"10.1186/s13019-025-03386-x","DOIUrl":"https://doi.org/10.1186/s13019-025-03386-x","url":null,"abstract":"<p><strong>Background: </strong>Impending paradoxical embolism (IPDE) involves venous thrombi crossing a patent foramen ovale, posing high risks of systemic embolization.</p><p><strong>Case presentation: </strong>A 64-year-old male was admitted to the operation theater due to heart failure symptoms, with the original plan of undergoing atrial mass resection and mitral valve replacement. Intra-operative transesophageal echocardiography (TEE) diagnosed the patient with IPDE and acute pulmonary embolism. And this critical diagnosis immediately altered the surgical decision-making process, which included pulmonary artery thrombectomy. The successful treatment of this case was significantly attributed to the intraoperative TEE examination, which provided essential real-time diagnostic information guiding the surgical approach. This case highlighted the importance of intra-operative TEE in management of IPDE for surgical planning.</p><p><strong>Conclusions: </strong>TEE is the final defense in IPDE. To optimize surgical outcomes and avert misdiagnosis, routine utilization of intraoperative TEE is highly recommended for similar cases.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"212"},"PeriodicalIF":1.5,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12007277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016480","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":"Early acetaminophen administration is associated with lower mortality among ARDS patients after coronary artery bypass grafting: a retrospective study.","authors":"Long Gui, Heshan Cao, Min Zheng, Yu Pan, Chengdong Ning, Mingjin Cheng","doi":"10.1186/s13019-025-03421-x","DOIUrl":"https://doi.org/10.1186/s13019-025-03421-x","url":null,"abstract":"<p><strong>Background: </strong>Acetaminophen (APAP) is widely used in the treatment of patients after surgery, but the prognosis of patients with coronary artery bypass grafting (CABG)-related acute respiratory distress syndrome (CABG-ARDS) is still unclear. This study aims to explore the role of APAP in the management of CABG related ARDS.</p><p><strong>Methods: </strong>We collected clinical data on patients with CABG-ARDS from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. The primary outcome was early mortality after ARDS, and the secondary outcomes were length of hospital stay and duration of mechanical ventilation (MV). Multivariate logistic regression and Cox regression models were used for statistical analysis, and inverse probability processing weighting (IPTW), overlap weighting (OW) and propensity score matching (PSM) were used to explore the robustness of the outcomes.</p><p><strong>Results: </strong>A total of 5459 patients were enrolled in the analysis. Multivariate logistic regression analysis revealed that the 14-day mortality in APAP group was significantly lower than that in non-APAP group (0.5% vs. 2.7%, OR = 0.301; 95% CI, 0.170-0.531; P < 0.001). The APAP group also showed a significant advantage in Cox regression analysis (0.5% vs. 2.7%, HR = 0.329; 95% CI, 0.187-0.577; P < 0.001). IPTW, OW, and PSM analyses were conducted between the two groups, and the differences remained significant. These results were consistent in 30-, 60-, and 90-day mortality analyses. Meanwhile, exposure to APAP was associated with a shorter length of hospital stay and a reduced duration of MV (P < 0.001).</p><p><strong>Conclusion: </strong>The administration of APAP was associated with reduced early mortality in patients with CABG-ARDS, as well as shorter length of hospital stay and duration of MV.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"209"},"PeriodicalIF":1.5,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12007132/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143985188","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":"GPER1-mediated suppression of acute cellular rejection in murine cervical heart transplantation by estradiol.","authors":"Yiwei Liu, Ran Wang, Bater Han, Benben Zhu, Yu Ma, Yongjun Yu, Lu Bai, Qiyou Wei, Pengjie Yang","doi":"10.1186/s13019-025-03432-8","DOIUrl":"https://doi.org/10.1186/s13019-025-03432-8","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the inhibitory effect of estradiol (E2) on acute cellular rejection following murine cervical heart transplantation and the role of G protein-coupled estrogen receptor 1 (GPER1).</p><p><strong>Method: </strong>A murine cervical heart transplantation model was established and categorized into four groups: syngeneic group (C57BL/6 to C57BL/6), allogenic control group (BALB/c to C57BL/6), E2 group (BALB/c to C57BL/6), and E2 + G15 group (G15: one of GPER1 blocker) (BALB/c to C57BL/6). Survival time, pathological rejection grade, intimal hyperplasia area of coronary artery in donor heart, mRNA expression levels of TGF-β, IL-10, and Foxp3 in spleen, and protein expression levels of CD4 and CD25 in spleen membrane proteins, were compared among these groups.</p><p><strong>Results: </strong>The syngeneic group showed 100% survival, while survival in the allogenic control group was significantly reduced. E2 treatment prolonged survival compared to the allogenic control group, but survival decreased with the addition of E2 + G15. Rejection was reduced in the E2 group compared to the allogenic control group, whereas the E2 + G15 group exhibited increased rejection compared to the E2 group. Intimal hyperplasia was absent in the syngeneic group, significant in the allogenic control group, reduced in the E2 group compared to the allogenic control group, but greater in the E2 + G15 group compared to the E2 group. The expression of IL-10, Foxp3, and TGF-β in the allogenic control group was higher than in the syngeneic group. In the E2 group, IL-10, Foxp3, and CD25 were higher than in the allogenic control group, while TGF-β and CD4 expression were lower. The E2 + G15 group had lower IL-10, Foxp3, and CD25 expression but higher TGF-β expression than the E2 group.</p><p><strong>Conclusion: </strong>Severe acute cellular rejection was observed following murine cervical heart transplantation. E2 suppresses acute rejection by enhancing Treg cell expression, mediated by GPER1.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"208"},"PeriodicalIF":1.5,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12004865/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144002174","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":"Impact of preoperative pleural effusion on ultrasound- and pressure-guided thoracic paravertebral block: a prospective observational study.","authors":"Yaoping Zhao, Shuang Yu, Dong Zhang, Shaoqiang Zheng, Nan Cai, Qiang Zhang, Geng Wang","doi":"10.1186/s13019-025-03437-3","DOIUrl":"https://doi.org/10.1186/s13019-025-03437-3","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of preoperative pleural effusion on the ultrasound visualization of the paravertebral space (PVS), thoracic paravertebral nerve block administered by anesthesiologists, and to investigate whether ultrasound combined with pressure guidance can assist in locating the paravertebral space in patients with pleural effusion.</p><p><strong>Methods: </strong>This prospective observational study enrolled patients undergoing thoracic surgery at Beijing Jishuitan Hospital between September 2021 and September 2022. Patients were categorized into two groups based on preoperative CT findings: the pleural effusion group (n = 40) and the non-pleural effusion group (n = 40). Prior to the induction of general anesthesia, all patients were placed in a lateral position. Thoracic paravertebral nerve block (TPVB) was administered using ultrasound guidance combined with pressure monitoring, with a 20 ml of 0.5% ropivacaine.</p><p><strong>Results: </strong>Parameters recorded included the duration of puncture and ultrasound pre-scan for TPVB, the ultrasound image definition score of the PVS, the pressure in the external intercostal muscle and PVS, and additional relevant indicators. Mean arterial pressure (MAP) and heart rate (HR) were measured before anesthesia induction, post-induction, and during skin incision. Compared to the non-pleural effusion group, the pleural effusion group demonstrated prolonged ultrasound pre-scan and puncture durations. The PVS definition score, the ventral displacement of the pleura, and the accuracy of resident anesthesiologists in identifying the PVS were all significantly lower in the pleural effusion group (p < 0.05). Compared to non-pleural effusion group, the pleural effusion group had significantly higher pressure in PVS. In the pleural effusion group, the pressure in PVS was significantly lower than that in external intercostal muscle (p < 0.05). No significant differences were observed in MAP and HR between the two groups before anesthesia induction, post-induction and during skin incision (p > 0.05).</p><p><strong>Conclusion: </strong>Preoperative pleural effusion is associated with reduced clarity of ultrasound visualization of the PVS, and extended procedural durations for anesthesiologists, thereby increasing the complexity of TPVB. Pressure detection during TPVB implementation can assist in locating the position of the puncture needle. For anesthesiologists with less experience, TPVB should be carefully performed in patients with preoperative pleural effusion.</p><p><strong>Trial registration: </strong>The trial was prospectively registered with the Chinese Clinical Trial Registry under registration number ChiCTR2100050582, on August 30, 2021.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"207"},"PeriodicalIF":1.5,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12004804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982341","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":"LncRNA MAGI2-AS3 promotes the progression of atherosclerosis by sponging miR-525-5p.","authors":"Lingfeng Zhu, Chan Yan","doi":"10.1186/s13019-025-03451-5","DOIUrl":"https://doi.org/10.1186/s13019-025-03451-5","url":null,"abstract":"<p><strong>Background: </strong>Increasing evidence showed that lncRNAs are involved in the procession of atherosclerosis (AS). This study detected MAGI2-AS3 expression in the serum of AS patients and further investigated the mechanism of MAGI2-AS3 in AS.</p><p><strong>Methods: </strong>MAGI2-AS3 and miR-525-5p in the AS patients' serum and oxidized low-density lipoprotein (ox-LDL) induced human coronary artery smooth muscle cells (HCASMCs) were quantified by qRT-PCR. Spearman correlation was calculated between MAGI2-AS3 and clinical indexes or miR-525-5p. ROC curve analyzed the clinical diagnostic performance of MAGI2-AS3. Small interfering RNA targeting MAGI2-AS3 (si-MAGI2-AS3) silenced MAGI2-AS3 expression. HCASMCs proliferation, migration, and apoptosis were assayed by CCK-8, transwell, and flow cytometry, respectively. The target miR-525-5p was predicted by StarBase and verified by dual-luciferase reporter assay and co-transfection.</p><p><strong>Results: </strong>MAGI2-AS3 increased in the AS patients' serum and ox-LDL-induced HCASMCs. MAGI2-AS3 was negatively associated with C-reactive protein (CRP) and carotid intima-media thickness (CIMT). The ROC curve confirmed the efficacy of MAGI2-AS3 in distinguishing AS from control subjects. Silencing MAGI2-AS3 reversed the enhancement of proliferation and migration and the reduction of apoptosis caused by ox-LDL in HCASMCs. MiR-525-5p was predicted as a target and further verified by dual-luciferase assay. MiR-525-5p declined in both the serum of AS patients and ox-LDL-induced HCASMCs. Rescue experiments showed that miR-525-5p downregulation inverted the decrease in proliferation and migration, and the increase in apoptosis due to si-MAGI2-AS3 treatment.</p><p><strong>Conclusions: </strong>In summary, our study demonstrated that MAGI2-AS3 participates in AS progression by sponging the miR-525-5p, indicating that MAGI2-AS3 may be a potential biomarker of AS.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"206"},"PeriodicalIF":1.5,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12004554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001682","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 two-centre study investigating the association between brain natriuretic peptides & outcomes in continuous flow left ventricular assist device recipients.","authors":"Maria Lambadaris, Farid Foroutan, Julie Kk Vishram-Nielsen, Marie Sophie S Knudsen, Filio Billia, Vivek Rao, Finn Gustafsson, Ana C Alba","doi":"10.1186/s13019-025-03422-w","DOIUrl":"https://doi.org/10.1186/s13019-025-03422-w","url":null,"abstract":"<p><strong>Background: </strong>Natriuretic peptides are useful prognostic markers in patients with heart failure and this study aims to evaluate the association between N-terminal pro-brain natriuretic peptide and outcomes in patients with a continuous-flow left ventricular assist device.</p><p><strong>Methods: </strong>Adult patients with a continuous-flow left ventricular assist device as bridge to transplant or destination therapy and discharged from hospital were included in the study. Multi-variable Cox regression models with natriuretic peptide as a time-dependent covariate modelling multiple measures per patient, and cubic spline analysis were used to evaluate the association between natriuretic peptides and patient outcomes, taking median N-terminal pro-brain natriuretic peptide of 244 pmol/L as the reference value. Heart transplant was considered a competing event for mortality analysis, while death was considered a competing event for transplantation analysis. A multivariable cause-specific Cox regression model evaluated the relationship between natriuretic peptides and heart failure hospitalizations while considering heart failure hospitalizations as recurring events and adjusting for competing risks of death and transplant.</p><p><strong>Results: </strong>This retrospective cohort study included 161 adults. During a median follow-up of 4.7 years, 49 patients died, 79 received a heart transplant and 66 were hospitalized for heart failure. In comparison to the median N-terminal pro-brain natriuretic peptide level, patients exceeding 350 pmol/L had a 19% increased mortality (HR 1.19, 95%CI 1.01-1.15) while patients exceeding 330 pmol/L had a 16% higher risk of hospitalization (HR 1.16, 95%CI 1.01-1.12).</p><p><strong>Conclusion: </strong>In patients with a continuous-flow left ventricular assist device, serial assessments of natriuretic peptides may help provide personalized patient care.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"200"},"PeriodicalIF":1.5,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12001697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994691","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":"Prognostic impact of surgery on thymic malignancies with concurrent or previous extrathymic malignancies: a retrospective analysis from 1998 to 2021.","authors":"Guo-Sheng Li, Gui-Yu Feng, Jun Liu, Zhan-Yu Xu, Jian-Ji Guo, Tao Huang, Hua-Fu Zhou, Guan-Biao Liang, Nuo Yang","doi":"10.1186/s13019-025-03442-6","DOIUrl":"https://doi.org/10.1186/s13019-025-03442-6","url":null,"abstract":"<p><strong>Objective: </strong>There is limited research on the impact of surgery on the cancer-specific survival (CSS) of patients with malignant thymoma and concurrent or previous extrathymic malignancies (PMTEMs). This retrospective analysis evaluated the prognostic value of surgery in PMTEMs.</p><p><strong>Methods: </strong>Data were sourced from the SEER database, encompassing PMTEMs aged 20-90 with confirmed diagnoses and comprehensive clinical information. Patients were categorized into surgical (n = 105) and nonsurgical (n = 25) groups. Propensity score matching (PSM) was employed to mitigate selection bias, resulting in well-balanced baseline characteristics between the groups. Kaplan-Meier curves and the log-rank test were used to investigate the prognostic value of surgery in PMTEMs.</p><p><strong>Results: </strong>Using PSM, the matching of characteristics between the surgical and nonsurgical groups was well-balanced, ensuring the reliability of subsequent analyses. Pre-PSM, the CSS in the surgical group was significantly better than that in the nonsurgical group (p <.001). Similarly, according to the post-PSM data, the CSS for PMTEMs in the surgical group remained superior to that in the nonsurgical group, which indicates that the survival advantage of the surgical group persisted after PSM (p =.030). Additionally, PMTEMs with smaller thymomas (≤ 5 cm) had a significant advantage in CSS compared to those with larger thymomas (p = .046).</p><p><strong>Conclusions: </strong>In conclusion, this study shows that surgery may significantly improve the survival rate of PMTEMs.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"205"},"PeriodicalIF":1.5,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12001537/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968223","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":"Predictors of secondary revascularization after coronary artery bypass graft surgery and role of dual antiplatelet therapy.","authors":"Iftikhar Ali Ch, Khurram Nasir, Azhar Chaudhry, Pei-Tzu Wu, Muhammad Siddique, Raja Ullah, Mashal Tahirkheli, Abdul Qadar, Hunter Weitzel, Rahat Jamal, Naeem Tahirkheli","doi":"10.1186/s13019-025-03434-6","DOIUrl":"https://doi.org/10.1186/s13019-025-03434-6","url":null,"abstract":"<p><strong>Background: </strong>Despite advancements in surgical techniques, interventional procedures, novel pharmacotherapies, and other contemporary treatments, patients after coronary artery bypass graft surgery (CABG) remain at risk for graft failure and progression of native vessel disease progression. Consequently, secondary revascularization is often required.</p><p><strong>Methods: </strong>This is a retrospective observational study evaluating the incidence, trends, and predictors of revascularization after CABG surgery.</p><p><strong>Results: </strong>Of 2,476 patients followed in this post-CABG study, 1458 patients received dual antiplatelet therapy (DAPT) compared to 1005 patients received aspirin monotherapy (AMT). The overall incidence of revascularization was significantly higher in the DAPT group (14.54%, 212 out of 1458) compared to the AMT group (7.07%, 71 out of 1005), with an odds ratio (OR) of 2.24 (95% CI: 1.69-2.97, p < 0.001). 770 patients who received DAPT for six months or more after surgery were compared in sub-analysis and were noted to have significantly higher incidence of revascularization compared to AMT (22.08% vs. 6.96%; OR = 3.157, 95% CI: 2.734-4.940; p < 0.001). The binary regression model revealed that younger patients ( hazard ratio (HR) = 0.964, 95% CI: 0.95-0.97; p < 0.001), diabetics (HR = 1.50, 95% CI: 1.12-2.00, p = 0.007), patients who had fewer internal mammary artery grafts (HR = 0.54, 95% CI: 0.36-0.81, p = 0.003), and patients receiving DAPT of any duration after CABG (HR = 3.47, 95% CI: 2.55-4.72, p < 0.001) were more likely to receive revascularization after CABG. The model, comprising these four predictors, was able to explain 12.8% of the variance in post-CABG revascularization (Nagelkerke R² = 0.128; p < 0.001). The survival rates were 96.5% for the DAPT group and 92.0% for AMT (odds ratio (OR) = 0.421, 95% confidence interval (95% CI): 0.269-0.658; p < 0.001).</p><p><strong>Conclusion: </strong>Diabetes mellitus, younger age, fewer Internal mammary artery grafts, and the use of DAPT after CABG were strong predictors of the need for secondary revascularization.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"197"},"PeriodicalIF":1.5,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12001649/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144009456","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":"Surgical management of type A aortic dissection during the second trimester: a case report.","authors":"Zhenqing Zhao, Tumin Sha, Peng Zhang, Jianqiang Li, Chaoliang Liu","doi":"10.1186/s13019-025-03446-2","DOIUrl":"https://doi.org/10.1186/s13019-025-03446-2","url":null,"abstract":"<p><strong>Background: </strong>Acute aortic dissection during pregnancy is a relatively rare but often life-threatening conditio. A previous study showed that the overall incidence of the disease was about 4 in 1 million women aged 15-45 years. Hormonal and Hemodynamics changes during pregnancy are a major cause of aortic dissection, and these changes may begin in the first and second trimesters, but are most pronounced in the third trimesters(about 50% and 33%, respectively).In addition, some genetic disorder such as Marfan syndrome may be associated with AD during pregnancy.</p><p><strong>Case presentation: </strong>A 29-year-old pregnant woman at 21 weeks of gestation presented with acute, non-radiating retrosternal tearing pain lasting 15 h, unrelieved and accompanied by three episodes of vomiting. Ultrasonography identified aortic root dilatation with aortic regurgitation, and contrast-enhanced aortic computed tomography (CT) confirmed type A aortic dissection (AD). Emergency surgery was performed, including ascending aortic replacement, total arch replacement with prosthetic graft placement, stented elephant trunk implantation (Sun's procedure), and aortic valvuloplasty under cardiopulmonary bypass (CPB). The patient was discharged on postoperative day (POD) 9, and the fetus remained viable. At 26 weeks of gestation, the family expressed concerns regarding maternal safety, prompting an early request for cesarean delivery due to cervical insufficiency and preeclampsia, resulting in the delivery of a healthy infant with no adverse events.</p><p><strong>Conclusion: </strong>Although AD during pregnancy is uncommon, clinicians must maintain a high index of suspicion for pregnant women presenting with severe chest pain. CTA is essential for diagnosing the condition and determining surgical options. After 28 weeks of pregnancy, cesarean section should be prioritized [17-18]. In the early second trimester, ensuring fetal safety involves appropriately increasing mean arterial pressure, minimizing circulatory arrest time, and closely monitoring the fetus post-surgery.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"201"},"PeriodicalIF":1.5,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12001569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020664","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":"Anomalous origin of the right coronary artery with severe stenosis of the left coronary artery orifice: a case study.","authors":"Rong-Hui Zheng, An-Biao Wang, Chun Zhao, Jie Zhang, Bo Han, Mei Zhu","doi":"10.1186/s13019-025-03414-w","DOIUrl":"https://doi.org/10.1186/s13019-025-03414-w","url":null,"abstract":"<p><strong>Background: </strong>Anomalous aortic origin of the coronary artery (AAOCA) represents a form of congenital heart disease. Several primary types of anomalous origin of the coronary artery (AOCA) exist. Patients with certain AOCA types may be at risk of sudden cardiac death (SCD) if timely intervention is delayed.</p><p><strong>Case description: </strong>This study reports a case of an 11-year-old female pediatric patient who experienced multiple episodes of syncope before being evaluated at our hospital. She was diagnosed with an anomalous origin of the right coronary artery from the left coronary sinus, along with severe stenosis at the left coronary artery orifice, following transthoracic echocardiography (TTE) and other detailed examinations. The patient subsequently responded well to surgical unroofing for AAOCA combined with single internal mammary artery-coronary artery bypass grafting.</p><p><strong>Conclusion: </strong>As advancements in ultrasonic medicine progress, TTE has proven to be a valuable non-invasive method for diagnosing AAOCA. In this paper, the findings from echocardiography, computed tomography angiography (CTA), and ascending aortography of the patient were analyzed retrospectively to explore the diagnostic value of echocardiography for this condition and to enhance its diagnostic efficacy.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"20 1","pages":"198"},"PeriodicalIF":1.5,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12001497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968220","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}