General Thoracic and Cardiovascular Surgery Cases最新文献

{"title":"Fatal outcome after self-expanding transcatheter aortic valve replacement of the bicuspid valve due to infolding: a case report.","authors":"Nagi Hayashi, Junji Yunoki, Keijiro Shigetomi, Kouhei Baba, Masahide Shichijo, Koki Jinnouchi, Hiroyuki Morokuma, Manabu Itoh, Keiji Kamohara","doi":"10.1186/s44215-025-00224-3","DOIUrl":"https://doi.org/10.1186/s44215-025-00224-3","url":null,"abstract":"<p><strong>Background: </strong>Infolding is a rare but potentially life-threatening complication of self-expanding transcatheter aortic valve replacement (TAVR).</p><p><strong>Case presentation: </strong>We describe the case of an 80-year-old man who was referred for the treatment of severe aortic stenosis complicated by heart failure. Transthoracic echocardiography revealed the following: peak velocity, 6.1 m/s; mean pressure gradient, 102 mmHg; and aortic valve area, 0.26 cm². Computed tomography (CT) showed a bicuspid aortic valve with a R-L raphe, an annular area of 529 mm², and a perimeter of 83.4 mm. Considering the patient's severe emphysema, transfemoral TAVR was performed with the patient under deep sedation. A 34-mm Evolut FX valve was implanted after predilation with a 20-mm Inoue balloon. During deployment up to the point of no recapture, hypotension occurred without improvement, and mild infolding was suspected. However, full deployment was performed, as valve optimization was considered likely to stabilize hemodynamics. Post-deployment balloon dilation was performed; however, valve under-expansion and moderate aortic regurgitation persisted. Initial hemodynamics were stabilized; however, the patient gradually developed respiratory distress. Follow-up CT confirmed substantial valve infolding. Pulmonary hypertension, alveolar hemorrhage, and disseminated intravascular coagulation developed. Surgical aortic valve replacement with a 21-mm valve was performed 15 days post-TAVR. The explanted TAVR valve exhibited marked structural deformation. Although the patient's circulatory status improved postoperatively, he died of respiratory failure due to pneumonia.</p><p><strong>Conclusion: </strong>This case highlights the importance of comprehensive preoperative anatomical assessment and intraoperative decision making in high-risk patients, particularly those with bicuspid valves. Valve selection (considering the valve type and size) must be meticulously tailored to the anatomical features surrounding the annulus. In addition, upon its recognition, substantial infolding should be promptly addressed by recapturing the valve, adjusting the valve size, or redeploying the valve with additional balloon aortic valvuloplasty.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"4 1","pages":"39"},"PeriodicalIF":0.1,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145294900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unanticipated stenosis of the distal edge of frozen elephant trunk caused by retrograde perfusion: A case report.","authors":"Taiki Niki, Jiro Esaki","doi":"10.1186/s44215-025-00223-4","DOIUrl":"https://doi.org/10.1186/s44215-025-00223-4","url":null,"abstract":"<p><strong>Background: </strong>Total arch replacement with frozen elephant trunk (FET) has been reported to be associated with favorable aortic remodeling when used for aortic dissection. However, several complications associated with FET have been reported, including distal stent graft-induced new entry (dSINE), which potentially results in aortic rupture and late mortality. Frozenix Partial ET (Japan Lifeline Inc., Tokyo, Japan) is a unique FET device that has a non-stent zone at the distal 2 cm end to decrease the radial force to lower the incidence of dSINE. Owing to its novelty, there are few preceding literatures regarding its efficacy and complications. In this report, we present a case of an unanticipated complication arising from the use of Frozenix Partial ET subsequent to the initiation of extracorporeal membrane oxygenation (ECMO).</p><p><strong>Case presentation: </strong>A 54-year-old male diagnosed with Stanford type A acute aortic dissection underwent emergency total aortic arch replacement, frozen elephant trunk with Frozenix partial ET (Japan Lifeline Inc., Tokyo, Japan), the Bentall procedure, and coronary artery bypass grafting. The patient developed cardiogenic shock, requiring extracorporeal membrane oxygenation with left common femoral artery and vein cannulation on postoperative day 1. Despite adequate ECMO flow, high doses of catecholamines were required to maintain blood pressure measured at the right radial artery. Transesophageal echocardiography revealed stenosis of the distal part of the FET presumably due to retrograde perfusion from the femoral artery. The addition of left axillary artery cannulation improved systemic circulation, reducing the dose of catecholamine.</p><p><strong>Conclusion: </strong>Although designed to reduce the risk of dSINE, Frozenix Partial ET may induce unforeseen complications. Particularly, its non-stent distal part can become stenotic under conditions of retrograde perfusion. Surgeons should carefully choose where to cannulate in patients with this device requiring redo surgery or ECMO support.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"4 1","pages":"41"},"PeriodicalIF":0.1,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145294910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delayed aortic injury following multiple rib fractures: a case report.","authors":"Kei Nakano, Tomohiko Matsuzaki, Shota Fujino, Masaya Ohara, Takashi Ishihara, Kazuhiro Matsuo, Tomoki Higeta, Kie Maita, Hiroto Onozawa, Takaaki Tsuboi, Atsushi Wada, Naohiro Aruga, Tomoki Nakagawa, Ryota Masuda","doi":"10.1186/s44215-025-00225-2","DOIUrl":"https://doi.org/10.1186/s44215-025-00225-2","url":null,"abstract":"<p><strong>Background: </strong>Delayed hemothorax due to aortic injury is rare, and its delayed diagnosis can be fatal. Herein, we report a case of delayed hemothorax owing to aortic injury following blunt chest trauma, which was successfully treated through emergency surgery.</p><p><strong>Case presentation: </strong>A woman in her 70s fell on an escalator at a train station and was brought to our emergency department. Initial evaluation with computed tomography (CT) imaging revealed a thoracic vertebral fracture, bilateral lower rib fractures, and a right-sided hemothorax. She was admitted for observation and supportive care, and her condition remained stable for days. On day 9 of hospitalization, the patient suddenly experienced cardiac arrest. A plain chest X-ray showed a massive pleural effusion on the left side, prompting the insertion of a chest tube. The drainage was hemorrhagic, and laboratory tests showed a significant decline in the hemoglobin level to 4.9 g/dL. Following successful cardiopulmonary resuscitation and the return of spontaneous circulation, a contrast-enhanced CT scan of the chest was performed. However, no active extravasation or apparent source of bleeding was observed. Owing to ongoing hemodynamic instability and the substantial volume of hemothorax, emergency surgery was conducted to identify and control the source of hemorrhage. Intraoperatively, after evacuating a large hematoma from the left thoracic cavity, a small ulcerated hole was identified in the descending thoracic aorta, which appeared tortuous. Pulsatile bleeding was observed from this site. Manual compression was applied to achieve temporary homeostasis. Intraoperative ultrasound showed no evidence of aortic dissection. The bleeding site was sutured directly, and hemostasis was achieved. No additional significant intrathoracic injuries were identified. The aortic injury had resulted from mechanical irritation or penetration by the adjacent fractured lower rib. This represented a case of delayed hemothorax secondary to traumatic aortic injury, a rare but potentially fatal complication.</p><p><strong>Conclusions: </strong>In cases of delayed hemothorax following blunt thoracic trauma-particularly with fractures of the lower left posterior ribs, clinicians should maintain a high index of suspicion for aortic injury. Prompt recognition and surgical intervention are critical for patient survival in such cases.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"4 1","pages":"42"},"PeriodicalIF":0.1,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145294876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complete thoracoscopic resection for TXN2aM0 primary lung cancer: a case series with 5-year follow-up.","authors":"Daiki Yoshikawa, Takeshi Kawaguchi, Ryo Miyata, Keiji Yamanashi, Maiko Takeda, Akihiko Yoshizawa, Takao Osa, Kazuya Tanimura, Shigeto Hontsu, Shigeo Muro, Sachiko Miura, Mitsuharu Hosono, Masatsugu Hamaji","doi":"10.1186/s44215-025-00228-z","DOIUrl":"https://doi.org/10.1186/s44215-025-00228-z","url":null,"abstract":"<p><p>Management of resectable TXN2aM0 primary lung cancer is controversial, and data regarding the long-term outcomes and guideline recommendations for such cases are lacking. We present the characteristics and long-term outcomes of four patients who underwent complete thoracoscopic resection of TXN2aM0 primary lung cancer. All patients experienced an uneventful postoperative course and survived for 5 to 10 years postoperatively; however, one patient experienced local recurrence at 2 years postoperatively and one patient experienced local recurrence at 5 years postoperatively. Our limited experience suggested that long-term survival may be achieved with complete resection of TXN2aM0; however, late recurrence and local recurrence are possible.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"4 1","pages":"40"},"PeriodicalIF":0.1,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145294947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful Commando procedure using the superior transseptal approach in a high-risk case.","authors":"Hiroki Moriuchi, Mamoru Orii, Takayuki Fujii, Kohei Narayama, Nobuhiro Shimabukuro, Akihiko Yamauchi","doi":"10.1186/s44215-025-00220-7","DOIUrl":"10.1186/s44215-025-00220-7","url":null,"abstract":"<p><strong>Background: </strong>The Commando procedure, which involves replacement of both the aortic and mitral valves along with reconstruction of the intervalvular fibrous body, is technically demanding. Commando procedure typically performed via an incision extending from the ascending aorta to the roof of the left atrium. However, in patients with extensive adhesions due to prior cardiac surgery, adding a superior transseptal incision can provide good exposure and reduce the risk of surrounding tissue injury.</p><p><strong>Case presentation: </strong>A 48-year-old woman with end-stage kidney disease on dialysis, diabetes mellitus, bilateral leg amputations from critical limb ischemia, and chronic steroid use presented in cardiogenic and septic shock. The patient had undergone mitral valve repair and coronary bypass surgery using saphenous vein grafts. Echocardiography revealed severe aortic and mitral valves stenosis. Given the extensive adhesions and complex anatomy, the Commando procedure was performed using a superior transseptal approach. A 25-mm MITRIS was implanted in the mitral position, and a 25-mm INSPIRIS in the aortic position. A tailored oval-shaped patch made of bovine pericardium was used to reconstruct the intervalvular fibrous body. The patient recovered without major complications.</p><p><strong>Conclusion: </strong>The superior transseptal approach provided excellent exposure and a stable operative field, facilitating standardized surgical maneuvers throughout the Commando procedure.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"4 1","pages":"38"},"PeriodicalIF":0.1,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406415/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144985897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary pulmonary artery sarcoma treated with simultaneous pulmonary valve replacement, artificial vessel replacement, and total right pneumonectomy: a case report.","authors":"Kento Fujii, Hideki Morita, Hiroshi Nagano, Hiroyuki Kawaura, Hidetaka Kariya, Minoru Kowada, Takehiro Shirasugi","doi":"10.1186/s44215-025-00221-6","DOIUrl":"10.1186/s44215-025-00221-6","url":null,"abstract":"<p><strong>Background: </strong>Primary pulmonary artery sarcoma progresses extremely rapidly and has a poor prognosis. This condition is managed with surgical resection and multimodality therapy. However, standardized treatment is not available.</p><p><strong>Case presentation: </strong>A 54-year-old woman was brought to the emergency department because of chest pain and worsening dyspnea that had developed in the past month. Contrast-enhanced computed tomography scan revealed severe stenosis extending from the pulmonary artery trunk to the right pulmonary artery due to an embolic substance. Because primary pulmonary artery sarcoma was suspected, emergency surgery was performed to improve the patient's symptoms. In addition to maximal tumor resection, pulmonary artery valve replacement, artificial vessel replacement, and right total pneumonectomy were performed. Based on the assessment performed using the specimen collected perioperatively, a pathological diagnosis of angiosarcoma of the right pulmonary artery was made. The patient was discharged on postoperative day 17 with a good postoperative course. However, because of dyspnea, she was readmitted to the hospital on day 85. Tumor recurrence was noted, and chemotherapy was initiated. The patient developed cardiac failure and died on postoperative day 119. A pathological postmortem examination was performed. Metastatic lesions were found in the pericardial sac, left lung, right chest wall and pleura, and mediastinum.</p><p><strong>Conclusions: </strong>In the present case, postoperative recurrence was observed despite maximal resection of the surrounding tissues with tumor invasion and simultaneous reconstruction. Chemotherapy was initiated but was ineffective. Gene panel testing can help identify novel treatment options for patients with neoplastic diseases without standardized treatment. In addition, preparations should be made before surgery.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"4 1","pages":"37"},"PeriodicalIF":0.1,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12382254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144985839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Usefulness of somatosensory-evoked potentials for monitoring cerebral perfusion during transcarotid transcatheter aortic valve replacement: a case report.","authors":"Koji Okamoto, Yuma Motomatsu, Meikun Kano, Kyohei Meno, Yujiro Ura, Takahiro Mori, Kisho Otani, Shujiro Inoue, Hiromichi Sonoda, Akira Shiose","doi":"10.1186/s44215-025-00219-0","DOIUrl":"10.1186/s44215-025-00219-0","url":null,"abstract":"<p><strong>Background: </strong>Transcarotid transcatheter aortic valve replacement (TAVR) is a safe procedure with a low incidence of cerebral infarction and has recently become the first-choice alternative approach. This procedure requires temporary occlusion of the common carotid artery (CCA). CCA clamping during surgery may help reduce the risk of embolism caused by debris; however, the risk of hemodynamic stroke cannot be entirely ruled out. Therefore, intraoperative monitoring of cerebral ischemia is essential. Regional oxygen saturation (rSO₂) monitoring is commonly used, but can only measure local mixed venous oxygen saturation in the frontal lobes. During carotid endarterectomy (CEA), a combination of multiple monitoring methods for intraoperative cerebral ischemia is recommended. Similarly, we used somatosensory-evoked potentials (SEPs) in conjunction with rSO₂ monitoring.</p><p><strong>Case presentation: </strong>A 92-year-old male patient with a history of dyspnea on exertion was diagnosed with severe aortic valve stenosis (AS) using transthoracic echocardiography (TTE). Contrast-enhanced computed tomography (CT) revealed a shaggy aorta extending from the aortic arch to the descending aorta. Preoperative magnetic resonance angiography (MRA) of the head showed slight narrowing of the anterior communicating artery. Considering the patient's age, frailty, and vascular pathology, we performed transcarotid TAVR while monitoring rSO₂ and SEPs for intraoperative cerebral ischemia. No significant decreases in rSO₂ values or SEPs amplitudes due to occlusion of the left CCA. The procedure was successful, with no postoperative stroke, and the patient had an uneventful recovery.</p><p><strong>Conclusions: </strong>In transcarotid TAVR requiring CCA occlusion, monitoring cerebral ischemia with both rSO₂ and SEPs may help prevent perioperative hemodynamic cerebral infarction.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"4 1","pages":"36"},"PeriodicalIF":0.1,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12363108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144877810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early surgical explantation of a TAVI valve for severe hemolytic anemia caused by mild paravalvular leak.","authors":"Reo Sakakura, Masazumi Fukuzawa, Hirotaro Sugiyama, Kazuhiro Tani, Taiji Yoshida, Arata Murakami, Hidenobu Terai, Katsushi Ueyama","doi":"10.1186/s44215-025-00218-1","DOIUrl":"10.1186/s44215-025-00218-1","url":null,"abstract":"<p><strong>Background: </strong>Hemolytic anemia following transcatheter aortic valve implantation (TAVI) is an uncommon complication, particularly in patients with only mild paravalvular leak (PVL). Although reports of TAVI valve explantation are increasing, the procedure remains technically demanding and is associated with high morbidity and mortality. This case highlights the importance of early surgical consideration when hemolytic anemia occurs post-TAVI, despite only mild PVL.</p><p><strong>Case presentation: </strong>An 83-year-old man with symptomatic severe aortic stenosis underwent transfemoral TAVI via a 26-mm SAPIEN 3 Ultra RESILIA® valve. Although classified as low surgical risk, TAVI was chosen on the basis of patient preference and age. The procedure was uneventful, with only mild PVL observed via transesophageal echocardiography. The patient was discharged on postoperative day 10. One month later, he presented with fatigue and laboratory findings indicating severe hemolytic anemia. Echocardiography revealed a PVL jet from the non-coronary to left coronary cusp commissure. Preoperative CT revealed bulky annular calcification, especially at the NCC-LCC commissure. Owing to worsening anemia and ongoing hemolysis, surgical explantation and aortic valve replacement were performed. Intraoperatively, a gap was found between the valve and the annulus at the calcified commissure. The TAVI valve was successfully explanted and replaced with a surgical bioprosthesis. Postoperative recovery was uneventful, and hemolysis resolved completely.</p><p><strong>Conclusions: </strong>This case demonstrates that mild PVL after TAVI may still cause clinically significant hemolysis depending on anatomical features. Careful preprocedural assessment of annular calcification and commissural geometry is critical, even in low-risk patients. Surgical explantation should be considered early when hemolysis occurs, as delayed intervention may lead to increased morbidity. This case reinforces the need for individualized valve selection and close follow-up to address the adverse hemodynamic consequences of PVL promptly, regardless of its apparent severity.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"4 1","pages":"35"},"PeriodicalIF":0.1,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12305989/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful treatment for distal-arch aortic aneurysm in a cold agglutinin-positive patient via physician-modified thoracic endovascular aortic repair: a case report.","authors":"Rika Oshima, Tetsuya Sato, Ryotaro Yamada, Takuya Kawahara, Riki Sumiyoshi, Kosuke Miyoshi, Kazunori Hashimoto, Kenichi Hashizume, Satoshi Itoh","doi":"10.1186/s44215-025-00195-5","DOIUrl":"10.1186/s44215-025-00195-5","url":null,"abstract":"<p><strong>Background: </strong>Cold agglutinin disease (CAD) is sometimes incidentally detected before cardiovascular surgery. Several methods to prevent complications associated with CAD after cardiac surgery have been reported, but there are no reports of the use of physician-modified TEVAR to date.</p><p><strong>Case presentation: </strong>A 76-year-old man with an arch aortic saccular aneurysm was scheduled to undergo arch aortic replacement. However, cold agglutinin syndrome was incidentally detected before open heart surgery. The safety of cardiopulmonary surgery under hypothermia for patients with cold agglutinin disease is unknown, as intravascular hemolysis is a source of concern for patients sensitive to cold stimulation. Instead, we performed physician-modified thoracic endovascular aortic repair (3 fenestrations and 1 branch), as the aneurysm in this case was suitable for thoracic endovascular aortic repair (TEVAR). As a result, the patient recovered well without any complication.</p><p><strong>Conclusions: </strong>The long-term prognosis of physician-modified thoracic endovascular aortic repair remains unclear, and its use is limited to high-risk patients who require open chest surgery. Also, the impact of cold agglutination on stent grafts in CAD patients has not been reported. Despite that situation, this case illustrated that physician-modified TEVAR can be safely performed without significant postoperative complications, such as coagulation-fibrinolytic abnormalities or embolic events. Further studies are needed to establish the indications for this procedure in CAD patients.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"4 1","pages":"34"},"PeriodicalIF":0.1,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12305938/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COR-KNOT-induced aortic root injury during minimally invasive aortic valve replacement of a bicuspid aortic valve: a case report.","authors":"Takahiro Ishigaki, Kazuma Okamoto, Satoshi Asada, Genichi Sakaguchi","doi":"10.1186/s44215-025-00217-2","DOIUrl":"10.1186/s44215-025-00217-2","url":null,"abstract":"<p><strong>Background: </strong>The COR-KNOT device is widely used in minimally invasive cardiac surgery, and its efficacy in reducing operative time is well established. However, it has been associated with complications, such as valve leaflet perforation and prosthetic valve damage.</p><p><strong>Case presentation: </strong>We report a rare case of aortic root injury caused by COR-KNOT usage. A 72-year-old man with severe aortic stenosis due to a bicuspid aortic valve and distorted aortic root anatomy underwent minimally invasive aortic valve replacement using the COR-KNOT. After aortotomy closure, vigorous bleeding from the aortic root was observed. Punctate injuries of the aortic root, corresponding to the COR-KNOT clip sites, were identified following re-aortic cross-clamping. The procedure was converted to median sternotomy, the aortic root injury was repaired with an autologous pericardial patch, and the bioprosthetic valve was re-implanted using hand-tied sutures. The patient recovered uneventfully.</p><p><strong>Conclusions: </strong>This case highlights the importance of careful device selection and clip positioning in anatomically challenging cases to avoid life-threatening complications.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"4 1","pages":"33"},"PeriodicalIF":0.1,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12291292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144710523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}