Journal of Cardiothoracic Surgery最新文献

{"title":"Left-sided surgical approach for tricuspid valve replacement in congenitally corrected transposition of the great arteries with dextrocardia and situs inversus totalis: A case report.","authors":"Chuanjie Yue, Tong Tan, Peng Sun, Jinhua Li, Changwei Ren, Yongqiang Lai, Hao Cui","doi":"10.1186/s13019-026-04150-5","DOIUrl":"10.1186/s13019-026-04150-5","url":null,"abstract":"<p><strong>Background: </strong>Congenitally corrected transposition of the great arteries (ccTGA) is a rare congenital cardiac anomaly characterized by atrioventricular and ventriculoarterial discordance, resulting in a physiologically corrected circulation. When ccTGA is combined with dextrocardia and situs inversus totalis, surgical management becomes particularly challenging because of the mirror-image anatomy and altered spatial orientation.</p><p><strong>Case presentation: </strong>A 61-year-old man presented with progressive dyspnea and was diagnosed with ccTGA accompanied by dextrocardia and situs inversus totalis. Transthoracic echocardiography revealed severe regurgitation of the systemic atrioventricular valve (morphological tricuspid valve) with dilation and systolic dysfunction of the systemic right ventricle. Comprehensive preoperative imaging confirmed atrioventricular and ventriculoarterial discordance, right-sided cardiac apex, and complete visceral inversion. Tricuspid valve replacement was performed via a median sternotomy with the surgeon standing on the patient's left side to accommodate the mirror-image anatomy. Cardiopulmonary bypass was established safely after meticulous identification of the great vessels. A mechanical prosthetic valve was successfully implanted. The postoperative course was uneventful, and follow-up echocardiography at six months confirmed satisfactory prosthetic valve function without complications.</p><p><strong>Conclusions: </strong>This case illustrates that tricuspid valve replacement can be safely and effectively performed in patients with ccTGA complicated by dextrocardia and situs inversus totalis. A left-sided surgical approach, combined with thorough preoperative imaging and careful intraoperative anatomical verification, may help restore operative orientation and reduce technical complexity in patients with mirror-image cardiac anatomy.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"21 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220108","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":"Conservative management of postoperative bronchopleural fistula in elderly lung cancer patient: a case report with literature review.","authors":"Kun Deng, Ke He, Long Wang, Yong Chen","doi":"10.1186/s13019-026-04652-2","DOIUrl":"10.1186/s13019-026-04652-2","url":null,"abstract":"<p><strong>Background: </strong>Bronchopleural fistula (BPF) after thoracic surgery is a rare but highly lethal complication due to the tricky nature of its treatment.</p><p><strong>Case presentation: </strong>We reported a case of BPF after pulmonary surgery and a satisfactory outcome with conservative measures such as continuous closed-chest drainage, strong nutritional support, and appropriate antibiotics.</p><p><strong>Conclusions: </strong>In highly selected patients with stable hemodynamics, adequate drainage, and controlled infection, conservative management may be considered when surgical or endoscopic options are contraindicated or declined.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"21 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220110","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":"Re: Trans-catheter versus open surgical aortic valve replacement in severe symptomatic aortic stenosis.","authors":"Ercan Keleş, Ömer Faruk Rahman","doi":"10.1186/s13019-026-04653-1","DOIUrl":"10.1186/s13019-026-04653-1","url":null,"abstract":"","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"21 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13393240/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148562124","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":"Emergency ascending aortic replacement for acute type a aortic dissection in a 31-week pregnant patient with Marfan syndrome.","authors":"Krišjānis Upenieks, Kristiāns Meidrops, Ivars Brečs, Andris Veiss","doi":"10.1186/s13019-026-04575-y","DOIUrl":"10.1186/s13019-026-04575-y","url":null,"abstract":"<p><strong>Background: </strong>Acute type A aortic dissection during pregnancy is a rare but life-threatening condition, with an estimated incidence of approximately 4 cases per 1 million women aged 15-45 years. Hormonal and hemodynamic changes during pregnancy are factors that may predispose to aortic dissection. These changes begin in the first and second trimesters but are most pronounced in the third trimester and the early postpartum period. Genetic syndromes, such as Marfan syndrome, significantly increase the risk of aortic dissection.</p><p><strong>Case presentation: </strong>A 41-year-old pregnant woman at 31 weeks of gestation with genetically confirmed Marfan syndrome presented with acute, severe, sharp retrosternal chest pain lasting four hours, radiating to the neck, accompanied by weakness and dizziness. Transthoracic echocardiography revealed dilation of the ascending aorta without significant aortic valve regurgitation. Computed tomography angiography confirmed the diagnosis of Stanford type A aortic dissection. Following a multidisciplinary team decision, an initial cesarean section with subsequent uterine artery embolization was performed, followed by emergency ascending aortic replacement. The patient and the newborn were successfully discharged on postoperative day 20.</p><p><strong>Conclusions: </strong>Although aortic dissection during pregnancy is rare, clinicians must maintain a high suspicion index for pregnant women presenting with severe chest pain. Careful monitoring of patients with suspected or confirmed connective tissue disorders is essential. This case demonstrates that acute type A aortic dissection may occur in pregnant patients with Marfan syndrome despite only moderate aortic root enlargement and highlights the value of rapid multidisciplinary management, including coordinated obstetric, endovascular, and cardiac surgical intervention.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"21 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220139","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":"Delayed intrathoracic closed-loop small bowel obstruction due to iatrogenic diaphragmatic hernia two years after subxiphoid pericardial window: a case report.","authors":"Gladys Bruyninx, Basil Nasir","doi":"10.1186/s13019-026-04627-3","DOIUrl":"https://doi.org/10.1186/s13019-026-04627-3","url":null,"abstract":"<p><strong>Background: </strong>Diaphragmatic hernia following pericardial window is a rare complication, typically presenting in the early postoperative period. Delayed presentation with intrathoracic closed-loop small bowel obstruction is exceedingly uncommon (1,2).</p><p><strong>Case presentation: </strong>A 74-year-old male presented with nausea, vomiting, abdominal distension, and epigastric pain two years after a subxiphoid pericardial window for recurrent pericardial effusion. Computed tomography demonstrated herniation of small bowel into the thoracic cavity through a diaphragmatic defect with features of closed-loop obstruction. The patient underwent urgent exploratory laparotomy, which confirmed viable small bowel herniated into the thoracic cavity. The bowel was reduced without resection, and the diaphragmatic defect was repaired using Gore-Tex mesh. The postoperative course was uneventful.</p><p><strong>Conclusion: </strong>Delayed diaphragmatic hernia after pericardial window is a rare but potentially life-threatening complication. This case underscores the importance of maintaining a high index of suspicion in patients presenting with obstructive symptoms, even years after the initial procedure (3,4).</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"21 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224215","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 trap device retrieves the detached stent that is floating within the ascending aorta.","authors":"Li-An Liao, Meng Liang, Rong-Tai Luo, Hua-Qing Yao, Xin-Ping Lan","doi":"10.1186/s13019-026-04655-z","DOIUrl":"10.1186/s13019-026-04655-z","url":null,"abstract":"<p><strong>Background: </strong>Coronary stent dislodgement is a relatively infrequent iatrogenic complication associated with percutaneous coronary intervention (PCI). It can result in severe outcomes, including vascular embolism, coronary rupture, malignant arrhythmia, and even death. We reported a patient who previously underwent stent implantation in the left anterior descending artery (LAD) and required a second-stage surgery. During the insertion of a new stent into the left circumflex artery (LCX), the guidewire passed through the mesh of the original stent. This caused the new stent to pull and deform the original stent during advancement. Consequently, the new stent dislodged, and the two stents intertwined and floated in the aorta. Eventually, the two stents were successfully removed using a stent snare, and a new stent was reimplanted in the LAD, thereby avoiding the risk of the dislodged stent falling into other arteries and causing embolism. In our case, the characteristic of the original stent protruding into the left main coronary artery (LM) and the surgeon's failure to promptly confirm the position of the guidewire were the main causes of this incident, which provide valuable experience for future interventional surgeries.</p><p><strong>Discussion: </strong>When the original stent located at the bifurcation of the blood vessel is passed through, preoperative assessment of the spatial relationship between the blood vessels, careful confirmation of the position of the guidewire, and timely analysis of whether stent dislodgement, traction, etc. occurs when advancement is impeded are critical to procedural success.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"21 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149030635","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":"Delayed life-threatening aortic rupture after rib fractures: a case report.","authors":"Li-Ning Tseng, Ying-Cheng Chen, Wei-Jung Chang, Ya-Fu Cheng","doi":"10.1186/s13019-026-04657-x","DOIUrl":"https://doi.org/10.1186/s13019-026-04657-x","url":null,"abstract":"<p><strong>Background: </strong>Aortic injury secondary to rib fractures is an extremely rare but life-threatening complication of blunt thoracic trauma. Most of the documented cases result in prehospital mortality or death shortly after arrival because of massive hemothorax. Although the surgical stabilization of rib fractures (SSRF) has become increasingly integrated into thoracic trauma care, there remains a lack of awareness regarding the potential for posteriorly displaced rib fractures to cause delayed aortic injury.</p><p><strong>Case presentation: </strong>A 71-year-old female patient sustained multiple left posterior rib fractures and solid-organ injuries following a traffic accident. Initial management involved exploratory laparotomy and splenectomy for hemoperitoneum. Several hours later in the intensive care unit, a sudden massive hemothorax developed, and cardiac arrest occurred due to active bleeding from a descending aortic laceration caused by displaced posterior rib fragments. Emergency thoracotomy revealed a 6-mm descending aortic laceration with diffuse intramural hematoma, which was repaired with proximal aorta clamped. After opening adventitial layer, the intima layer was repaired primarily using 5-0 Prolene sutures. Bovine pericardium was used as a reinforcement patch to restore the integrity of the adventitial layer rather than as a pledget for the primary repair. Following hemodynamic stabilization, SSRF was performed to fix the displaced sixth and seventh ribs and prevent further complications with plates and screws (MatrixRIB™ system). The patient was discharged on postoperative day 19 in good condition without any complication.</p><p><strong>Conclusions: </strong>This case illustrates a rare instance of survival following aortic injury induced by rib fractures and emphasizes the need for high clinical suspicion in similar presentations. Early vascular control combined with prompt rib fixation may reduce morbidity rates by restoring chest wall stability, improving respiratory mechanics, and preventing secondary complications.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"21 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224174","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":"Distinct hemodynamic implications of junctional rhythm versus sinus rhythm on cardiac reverse remodeling after the Maze procedure.","authors":"Hee Jeong Lee, YoHan Bae, Jung Uk Woo, Sungsil Yoon, Woo Sung Jang, Yun Seok Kim, Jonghoon Yoo, Kyungsub Song","doi":"10.1186/s13019-026-04550-7","DOIUrl":"10.1186/s13019-026-04550-7","url":null,"abstract":"<p><strong>Background: </strong>Surgical success after the Maze procedure is conventionally defined as \"freedom from atrial fibrillation (AF),\" often grouping junctional rhythm (JR) with normal sinus rhythm (NSR). However, the specific hemodynamic impact of JR remains poorly understood. This study investigated whether JR truly represents a successful outcome compared to NSR and AF.</p><p><strong>Methods: </strong>We retrospectively analyzed patients undergoing the Maze procedure (2012-2024). After designating the first postoperative month as a blanking period for rhythm instability, we included only patients maintaining a consistent rhythm without crossover from 1 to 12 months postoperatively: AF (n = 71), NSR (n = 213), and JR (n = 35). Outcomes included cardiac reverse remodeling-assessed by left atrial contractile strain (LASct) and chamber dimensions-and permanent pacemaker (PPM) implantation.</p><p><strong>Results: </strong>In the IPTW-adjusted cohort, the NSR group achieved significant cardiac reverse remodeling, characterized by improved LVEF (58.5%), reduced LA volume index (75.1 mL/m²), and notable recovery of LASct. In stark contrast, the JR group failed to show any reverse remodeling or mechanical recovery, exhibiting hemodynamic stagnation indistinguishable from the AF group. Consequently, no significant difference in cardiac function was observed between the JR and AF groups. Furthermore, the JR group faced a drastically elevated risk of PPM implantation compared to both the NSR and AF groups (P < 0.001).</p><p><strong>Conclusions: </strong>JR is not a benign alternative to sinus rhythm; it mimics AF in preventing cardiac reverse remodeling and carries a high risk of pacemaker dependency. Therefore, JR should be clinically differentiated from NSR and recognized as a suboptimal hemodynamic outcome similar to AF.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"21 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149220190","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":"Sudden cardiac arrest during diagnostic workup: a rare case of high-risk interarterial left anterior descending artery anomaly.","authors":"Yorlenis Givairis Buzzelle Smith, Bryant Eliécer Pérez Barrows, Pedro E Rujano Mendieta, Miguel A Guerra Núñez","doi":"10.1186/s13019-026-04663-z","DOIUrl":"https://doi.org/10.1186/s13019-026-04663-z","url":null,"abstract":"<p><strong>Background: </strong>Coronary artery anomalies are anatomical abnormalities involving abnormal origin, course, or termination of any of the three main epicardial arteries. These abnormalities may go unnoticed during a person's lifetime; however, they can occasionally present acutely or chronically as angina, myocardial infarction, cardiac arrhythmias, or even sudden cardiac death.</p><p><strong>Case presentation: </strong>A 65-year-old woman with angina and stress-induced ST-segment depression in a treadmill test. Coronary angiography showed the absence of the left main coronary artery with separate origins of the left anterior descending artery and circumflex artery. During a planned cardiac computed tomography angiography scan, the patient presented with cardiac arrest secondary to ventricular fibrillation and was hospitalized. A high-risk interarterial course of the left anterior descending artery was identified, and coronary artery bypass grafting with surgical mobilization of the left anterior descending artery along its interarterial course, where it was ligated with a hemoclip prior to the first septal branch to prevent competitive flow. The postoperative course was uneventful.</p><p><strong>Conclusions: </strong>When this rare anomaly is detected in the population, clinicians must identify the risk of fatal events and determine appropriate management based on age, symptoms, vascular anatomy, and the presence of arrhythmia.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":"21 1","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227930","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":"Exercise preconditioning reduces the electrostimulation-induced incidence of arrhythmias in exhausted rats by regulating the CaMKⅡ-RyR2 signaling pathway.","authors":"Yibo Wang, Yang Wang, Peng Xu, Chenyan Wang, Heling Huang, Xiangnong Li, Huanhuan Huang, Xiaoli Zhang, Xuebin Cao","doi":"10.1186/s13019-026-04074-0","DOIUrl":"10.1186/s13019-026-04074-0","url":null,"abstract":"<p><strong>Background: </strong>Intense or exhaustive exercise is known to increase the risk of ventricular arrhythmias. One important mechanism is the disruption of intracellular calcium homeostasis. Exercise preconditioning (EP) has been reported to exert cardioprotective effects. However, under exercise-induced stress, how EP reduces arrhythmia susceptibility through regulation of calcium-handling signaling pathways remains unclear. This study aimed to investigate whether EP reduces exercise-induced arrhythmias by modulating the CaMKII-RyR2-PLN signaling pathway.</p><p><strong>Results: </strong>In this study, a rat model of repeated exhaustive exercise (EE) was established. The effects of EE and EP on myocardial electrophysiological properties were compared. The results showed that EE significantly shortened exhaustion time. EE also increased the incidence of electrically induced ventricular arrhythmias. In addition, EE markedly altered the expression of proteins related to calcium homeostasis. Specifically, EE significantly increased CaMKII activation and enhanced RyR2 phosphorylation at the Ser2814 site. These changes were accompanied by reduced SERCA2a expression and elevated PP1 levels. These findings indicated impaired sarcoplasmic reticulum calcium reuptake and increased calcium leakage. EP significantly prolonged exhaustion time and preserved myocardial structural integrity. EP reduced the occurrence of ventricular arrhythmias. Moreover, EP suppressed CaMKII activity and prevented excessive RyR2 phosphorylation. SERCA2a expression was restored, and PP1 levels were partially normalized. The CaMKII inhibitor KN-93 acted synergistically with EP. This result further confirmed the central role of CaMKII overactivation in exercise-induced ventricular arrhythmias.</p><p><strong>Conclusion: </strong>EP effectively reduced susceptibility to exercise-induced ventricular arrhythmias by regulating the CaMKII-RyR2-PLN signaling pathway and maintaining calcium homeostasis. These findings highlight CaMKII as a potential therapeutic target. In addition, they provide mechanistic evidence for the cardioprotective effects of exercise preconditioning under extreme exercise stress.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549009","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}