Journal of Cardiothoracic Surgery最新文献

{"title":"Pulmonary metastasectomy: a 14-year single-center experience and literature review.","authors":"Ramin Dabiri, Ali Mehri, Hossein Sadidi, Ghazale Ahmadi, Hussein Fattahi","doi":"10.1186/s13019-026-04614-8","DOIUrl":"10.1186/s13019-026-04614-8","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary metastasectomy (PM) is a commonly performed surgical procedure in selected patients with metastatic disease. The characteristics of patients undergoing PM and the spectrum of primary malignancies considered for surgical resection vary across institutions. We aim to provide a better understanding of current practice patterns by describing the characteristics and perioperative outcomes of patients who underwent PM at our institution.</p><p><strong>Methods: </strong>We conducted a retrospective descriptive study of patients who underwent pulmonary metastasectomy between 2008 and 2022 at Ghaem Hospital, Mashhad, Iran. Demographic and clinicopathological data, including age, sex, primary tumor type, histology, and postoperative outcomes, were collected and analyzed.</p><p><strong>Results: </strong>A total of 128 patients (mean age, 38.9 ± 18.0 years) were included in the analysis. The most common primary tumor sites were bone (25.8%) and soft tissue (16.4%), followed by head and neck (9.4%), colorectal (7.0%), and testicular (7.0%) malignancies. Sarcoma was the predominant histologic subtype (57.8%), followed by squamous cell carcinoma (11.7%), adenocarcinoma (10.9%), and germ cell tumors (7.8%). Postoperative complications included air leakage (n = 35), vascular injury requiring blood transfusion (n = 34), and one surgical site infection.</p><p><strong>Conclusion: </strong>Pulmonary metastasectomy is performed in patients with a wide range of primary malignancies, with sarcoma representing the most common indication in our cohort. Review of the literature suggests that the role of pulmonary metastasectomy varies across different primary malignancies and depends on careful patient selection. Further prospective studies are needed to better define the clinical utility of pulmonary metastasectomy in different tumor types.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520626","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":"Analysis of the anatomical relationship between the anterior segment (S³) and adjacent segments in the left upper lobe.","authors":"Xinfeng Xu, Yihan Yang, Qianrui Ren, Wei Wen, Zhibo Wang, Quan Zhu, Liang Chen","doi":"10.1186/s13019-026-04495-x","DOIUrl":"10.1186/s13019-026-04495-x","url":null,"abstract":"<p><strong>Background: </strong>S³ of the left upper lobe (LUL), situated between S^1 + 2 and S^4 + 5, serves as a vital anatomical bridge. This study examines the anatomical relationships of S³ with surrounding segments to enhance surgical accuracy and minimize complications.</p><p><strong>Methods: </strong>A total of 120 patients with LUL lesions scheduled for surgery from October 2024 to March 2025 were included. Three-dimensional CT bronchography and angiography (3D-CTBA) allowed us to analyze S3 anatomy, its spatial relationships with S^1 + 2 and S^4 + 5, and lesion locations. Trans-segmental and trans-subsegmental arteries were defined.</p><p><strong>Results: </strong>S³-related lesions accounted for 46% (61/133) of all LUL lesions. B³ branching was classified into three types, with B³a; B³b + c being the most common (86%, 103/120). An independent origin of B^1 + 2c limited S³a to the central region of the LUL, while the two-branch LUL bronchus and semi-central vein were associated with S³a extension to the oblique fissure (p = 0.029, 0.001, 0.002). The predominant pattern was independent A³ (73%, 88/120), with trans-subsegmental arteries most frequently seen (31%, 22/72). Only 24% (19/79) matched the typical B³ bronchial pattern. Arterial common trunks between S³-S^1 + 2 and S³-S^4 + 5 occurred in 55% (66/120) and 30% (36/120), respectively; venous common trunks occurred in 70% (84/120) and 31% (37/120).</p><p><strong>Conclusions: </strong>Frequent trans-subsegmental arteries, variable S³a boundaries, and shared vascular trunks complicate surgery, making preoperative 3D reconstruction essential for precise segmentectomy planning.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673844/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520597","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":"Selective and non-selective carotid ultrasound screening and perioperative stroke incidence in the coronary artery bypass grafting population: a systematic review and meta-analysis.","authors":"Ben King-O'Reilly, Daniel Lewis Graves, Kabeshan Sandrasekaran, Norman Briffa","doi":"10.1186/s13019-026-04616-6","DOIUrl":"10.1186/s13019-026-04616-6","url":null,"abstract":"<p><strong>Objectives: </strong>A systematic review and meta-analysis was performed to observe the incidence of perioperative stroke associated with selective and non-selective carotid ultrasound (CU) screening in the isolated coronary artery bypass grafting (CABG) population.</p><p><strong>Methods: </strong>PubMed, Scopus and CENTRAL databases were searched for studies published between January 1995 and October 2025. Inclusion criteria for the review focused on studies reporting primary data related to perioperative stroke in adult patients scheduled to undergo non-emergency isolated CABG who underwent either selective or non-selective preoperative CU screening. The primary outcome was perioperative stroke. Study quality was assessed using the ROBINS-I tool. Data related to the primary outcome was synthesised using an exploratory random-effects model meta-analysis. This review was reported as per PRISMA guidelines.</p><p><strong>Results: </strong>2398 studies were identified to undergo title and abstract screening; 63 studies were identified to undergo full-text screening of which 15 studies were eligible for inclusion within the review (Total N = 25,931). For the 13 studies utilising a non-selective screening strategy, the pooled perioperative stroke rate was 1.78% (95% CI: [1.28;2.48]). Independently, the two cohorts utilising a selective screening strategy reported perioperative stroke rates of 1.16% and 1.23%. Due to the structural limitations of the existing literature these findings are presented as independent descriptive cohorts.</p><p><strong>Conclusions: </strong>This review provides a descriptive synthesis of perioperative stroke rates across the two previously mentioned screening cohorts and does not establish comparative effectiveness. Although the low absolute event rates observed within the selective screening cohort align with current guideline recommendations, the structural limitations and high disproportion of the available evidence base prevent definitive comparison.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497701","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":"Rare coexistence of isolated celiac artery dissection and superior mesenteric artery dissection: diagnosis, treatment, follow-up outcomes of a single patient and clinical implications.","authors":"Sida Liu, Xinxin Xu, Zhaoyu Zhang, Kai Yang, Weiqiang Chen, Wenfeng Cao, Shuqiang Dong, Yu Zhang","doi":"10.1186/s13019-026-04590-z","DOIUrl":"10.1186/s13019-026-04590-z","url":null,"abstract":"<p><strong>Background: </strong>Spontaneous isolated celiac artery dissection (ICAD) coexisting with spontaneous isolated superior mesenteric artery dissection (ISMAD) is exceedingly rare, and the underlying etiology, natural history, and optimal management strategy remain poorly understood.</p><p><strong>Case presentation: </strong>We report a 58-year-old man in whom contrast-enhanced computed tomography angiography (CTA) disclosed ICAD (Sakamoto type I) coexisting with ISMAD (Sakamoto type IIIa). Conservative management resulted in complete symptom resolution. Follow-up CTA at one month demonstrated stable dissections without adverse events. A systematic review of the literature was undertaken to evaluate the impact of classification systems, timing of intervention, antithrombotic strategies, and radiologic surveillance protocols on clinical outcomes.</p><p><strong>Conclusions: </strong>These data indicate that meticulous conservative therapy coupled with rigorous imaging follow-up can yield favorable results in this rare clinical entity.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520621","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":"Adenoid cystic carcinoma of the thymus: a case report and literature review.","authors":"Shota Awane, Kanji Otsubo, Moeka Tamura, Norifumi Kakizaki, Takayuki Hatakeyama, Hiroki Sakai, Takahiro Homma, Hideki Marushima, Koji Kojima, Hirotaka Koizumi, Junki Koike, Hisashi Saji","doi":"10.1186/s13019-026-04565-0","DOIUrl":"10.1186/s13019-026-04565-0","url":null,"abstract":"<p><p>Primary adenoid cystic carcinoma (ACC) of the thymus is extremely rare. Although thymic ACC is generally slow growing, complete surgical resection is essential due to its tendency for local invasion. Here, we report a case of primary thymic ACC successfully treated by complete resection using a single-port subxiphoid thoracoscopic approach. A 63-year-old asymptomatic male patient was referred after an anterior mediastinal mass was incidentally detected during a routine health screening. Imaging revealed a small, well-circumscribed tumor without evidence of invasion. At 2.2 cm, the lesion was among the smallest thymic ACCs reported to date. Thymoma was suspected and single-port subxiphoid thoracoscopic thymectomy was performed. The patient's postoperative course was uneventful. The histopathological and immunohistochemical findings were consistent with ACC, and no other primary lesion was identified. Complete resection was achieved with minimally invasive thymectomy. This case illustrates that thymic ACC may rarely present as a small, early-stage tumor indistinguishable from thymoma, and it highlights the importance of complete resection with negative margins and long-term surveillance given the potential for delayed recurrence.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663310/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520582","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":"SRPRA affects hyperoxia-induced bronchopulmonary dysplasia by modulating endoplasmic reticulum stress through the CHOP pathway.","authors":"Yanlin Tan, Shisi Xiong, Wenchang Ni, Liyan Wang, Junmei Bian","doi":"10.1186/s13019-026-04519-6","DOIUrl":"10.1186/s13019-026-04519-6","url":null,"abstract":"<p><strong>Background: </strong>Bronchopulmonary dysplasia (BPD) is a prevalent chronic lung disease among preterm infants, largely attributed to hyperoxia-induced injury to alveolar epithelial cells. Excessive endoplasmic reticulum (ER) stress plays a vital role in BPD progression. SRPRA, a subunit of the ER-localized SRP receptor, is upregulated in BPD, while its function and link with ER stress remain largely unclear. This study aimed to explore the role of SRPRA in hyperoxia-induced BPD and its underlying mechanism.</p><p><strong>Methods: </strong>A hyperoxia-exposed alveolar type II epithelial cell (AECII) model was established to mimic BPD in vitro. Cell viability, cell proliferation and apoptosis were detected by CCK-8, EdU assay and flow cytometry, respectively. The secretion of inflammatory factors was evaluated via ELISA assay. ROS levels were detected by DCFH-DA fluorescence staining. Commercial kits were used to detect MDA and SOD levels. The SRPRA mRNA level and protein expression was measured using qRT-PCR and Western blot. Expression levels of apoptosis-related proteins (Bax, Bcl2), inflammation-related proteins (iNOS, Cox2) and CHOP pathway-related proteins were assessed by western blotting.</p><p><strong>Results: </strong>SRPRA was markedly upregulated in hyperoxia-induced alveolar epithelial cells. Hyperoxia stimulation decreased viability and proliferation, and enhanced apoptosis in AECIIs, accompanied by elevated inflammatory responses and oxidative stress. SRPRA knockdown alleviated hyperoxia-induced cell damage, inflammation and oxidative stress, and downregulated the expression of CHOP (a key mediator of ER stress). The protective effects mediated by SRPRA silencing were largely reversed by thapsigargin.</p><p><strong>Conclusion: </strong>SRPRA knockdown alleviates hyperoxia-induced AECII injury by attenuating CHOP-mediated ER stress. Our findings reveal the pathogenic role of SRPRA in BPD, and suggest SRPRA as a potential therapeutic target for this disease.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13670498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497667","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":"Impaired thyroid hormone sensitivity is associated with cardiovascular disease risk and mortality in euthyroid subjects.","authors":"Yang Jiao, Juan Sun, Yuanmeng Li, Feng Mao","doi":"10.1186/s13019-026-04589-6","DOIUrl":"10.1186/s13019-026-04589-6","url":null,"abstract":"<p><strong>Background: </strong>Fluctuations in thyroid function among euthyroid individuals have been linked to cardiovascular disease (CVD). We investigated whether central thyroid hormone sensitivity correlates with CVD risk, CVD-related death, and overall mortality in subjects with normal thyroid function, particularly examining how age modifies these associations.</p><p><strong>Methods: </strong>We analyzed data from 6,374 euthyroid adults enrolled in NHANES 2007-2012. Central thyroid hormone sensitivity was quantified using three indices: the thyroid feedback quantile-based index (TFQI), the thyrotropin-thyroxine resistance index (TT4RI) and the TSH index (TSHI). The Framingham Risk Score (FRS) estimated each participant's 10-year probability of developing CVD. CVD mortality and all-cause mortality were ascertained by linkage to the National Death Index through December 31, 2015. Associations were evaluated using logistic regression (10-year CVD risk) and Cox proportional hazards models (mortality), adjusted for sex and race, with analyses stratified by age (< 40 and ≥ 40 years).</p><p><strong>Results: </strong>Of the 6,374 participants (mean age 48.24 ± 17.59 years; 52.0% male), 18.5% had a 10-year CVD risk > 10%; during follow-up. In sex- and race-adjusted models, all three indices were positively associated with an elevated 10-year CVD risk (> 10%): TFQI (OR 1.40, 95% CI 1.15-1.71), TSHI (OR 1.27, 95% CI 1.11-1.45), and TT4RI (OR 1.01, 95% CI 1.01-1.02). Each index was also significantly associated with higher CVD mortality and all-cause mortality, with TFQI showing the strongest associations (CVD mortality: HR 3.30, 95% CI 2.24-4.85; all-cause mortality: HR 2.19, 95% CI 1.83-2.62). These associations remained significant in participants aged ≥ 40 years (p < 0.001) but not in those aged < 40 years.</p><p><strong>Conclusion: </strong>Impaired central thyroid hormone sensitivity shows association with elevated CVD risk, CVD mortality, and all-cause mortality in euthyroid individuals aged 40 years and older.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520546","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":"Partial carinal resection, reconstruction, and left pneumonectomy under median sternotomy combined with cardiopulmonary bypass: a case report.","authors":"Yunlong Guo, Jiaqi Wang, Guangxin Zhang, Ti Tong, Chengyan Jin","doi":"10.1186/s13019-026-04578-9","DOIUrl":"10.1186/s13019-026-04578-9","url":null,"abstract":"<p><strong>Background: </strong>There is limited clinical data to guide surgical decisions for ACC with extensive carinal involvement in the left main bronchus. In this case, it is shown that median sternotomy and CPB are feasible in this particular anatomical setting.</p><p><strong>Case presentation: </strong>Cough and sputum were the presenting symptoms in a middle-aged female patient. Imaging examinations identified a left hilar mass that extended to involve the carina. The surgical intervention performed via a median sternotomy with CPB support encompassed both a left pneumonectomy and partial carinal resection along with reconstruction. Based on postoperative histopathological analysis, the diagnosis was adenoid cystic carcinoma (ACC); the tumor staging was determined as pT2bN0Mx, which is equivalent to stage IIA. The patient experienced an uneventful postoperative recovery, and during the 6-month follow-up, no recurrence of the tumor was observed.</p><p><strong>Conclusion: </strong>The case illustrates that complex airway tumors can be resected with R0 margin using median sternotomy and CPB, and verifies the feasibility of surgical treatment for similar surgical cases.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497652","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":"Malignant melanoma identified within a pulmonary sequestration- a case report.","authors":"Tomislav Bečejac, Mihovil Penavić, Marko Vrančić, Ivan Bunjevac, Ana Mataić, Andrej Šitum, Ivan Martinez, Marko Popović, Luka Simetić, Dubravko Jalšovec","doi":"10.1186/s13019-026-04594-9","DOIUrl":"10.1186/s13019-026-04594-9","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary sequestration (PS) is a congenital lung malformation, which is defined by an anomalous arterial supply from systemic circulation and an absence of communication with the tracheobronchial tree. It is further divided into intralobar and extralobar PS. Pulmonary sequestrations are usually treated surgically, especially if they are symptomatic. Malignant tumors are rarely found within such malformations, mainly adenocarcinomas. We report a case of a malignant melanoma found in a patient operated for intralobar pulmonary sequestration, which is, to the best of our knowledge, the first reported case of a malignant melanoma occurring within a pulmonary sequestration.</p><p><strong>Case presentation: </strong>We present a case of an 84-year-old male patient who underwent surgical treatment for a symptomatic pulmonary sequestration. The patient was first diagnosed with an intralobar PS two years prior to the surgery by a multislice computed tomography (MSCT) scan. It was located in the left lower lung lobe and had an anomalous arterial supply from an artery arising from the thoracic aorta. Two years later, the patient presented twice to the emergency department with hemoptysis and was thereafter referred to the thoracic surgeon. Another MSCT scan conducted before the surgery showed a newly formed solid lesion within the previously described PS. The thoracic surgeon therefore performed a left lower lobectomy and lymphadenectomy via thoracotomy. Histopathological analysis discovered two melanomas in the specimen, measuring 6 × 5 × 4 cm and 1.7 × 1.7 × 1.5 cm. The patient was referred to an oncologist. A positron emission tomography/computed tomography (PET/CT) scan, along with other diagnostic procedures, didn't show any other signs of malignant disease elsewhere in the body. Several other skin lesions were excised and biopsied, but none have turned out to be melanomas. A year after surgery, the disease disseminated.</p><p><strong>Conclusions: </strong>Although the origin of the melanoma in this case could not be definitively established, this report demonstrates that pulmonary sequestration may harbor malignant neoplasm and highlights the diagnostic challenges in distinguishing primary pulmonary melanoma from metastatic melanoma. The appearance of a new solid lesion within a pulmonary sequestration necessitates careful evaluation and consideration of surgical resection.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663114/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497606","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":"Single-stage total correction of severe aortic stenosis and dysphagia lusoria via a single extended median sternotomy: a case report.","authors":"Dahong Moon, Se Jin Oh, You Jung Ok, Yong Won Seong, Hyeon Jong Moon, Jae Hwa Jeong, Jae-Sung Choi","doi":"10.1186/s13019-026-04610-y","DOIUrl":"10.1186/s13019-026-04610-y","url":null,"abstract":"<p><p>Aberrant right subclavian artery (ARSA) is the most common anomaly of the aortic arch and is usually asymptomatic. In a minority of patients, ARSA may cause dysphagia due to esophageal compression (dysphagia lusoria). The coexistence of symptomatic ARSA and severe aortic stenosis requiring surgical treatment is extremely rare, and the optimal management strategy remains unclear. A 43-year-old woman presenting with acute decompensated heart failure was diagnosed with severe aortic stenosis and concomitant dysphagia lusoria. Following medical stabilization in the intensive care unit, she underwent a single-stage total correction. To minimize surgical trauma and avoid multiple incisions, a conventional median sternotomy was slightly extended into the right supraclavicular region, serving as a single unified incision. Through this approach, transposition of the ARSA to the right common carotid artery was performed first, followed by mechanical aortic valve replacement with bovine pericardial patch repair of a focal annular defect secondary to decalcification and primary closure of a patent foramen ovale. Postoperatively, valve hemodynamics improved markedly, and dysphagia resolved completely, leading to a significant recovery of the patient's nutritional status. This case demonstrates that a single-stage, single-incision approach is a highly effective and viable strategy, providing valuable clinical insight into the management of these combined rare pathologies.</p>","PeriodicalId":15201,"journal":{"name":"Journal of Cardiothoracic Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2026-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13663158/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520570","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}