Portuguese journal of cardiac thoracic and vascular surgery最新文献

{"title":"Descending Necrotizing Mediastinitis: A 7-Year Single-Centre Experience.","authors":"Catarina Pereira Moita, Catarina Figueiredo, Zenito Cruz, Ana Inácio, Ana Rita Costa, João Maciel, João Santos Silva, João Eurico Reis, Paulo Calvinho","doi":"10.48729/pjctvs.564","DOIUrl":"10.48729/pjctvs.564","url":null,"abstract":"<p><strong>Introduction: </strong>Descending necrotizing mediastinitis (DNM) is a life- threatening condition that originates from head and neck infections, subsequently extending into the mediastinum. Prompt diagnosis and emergent surgical intervention are critical for patient survival. This study aims to present our experience in managing DNM.</p><p><strong>Methods: </strong>The present study retrospectively analyzed patients with DNM who underwent surgical treatment in our center, between 2017 and 2023.</p><p><strong>Results: </strong>We identified 14 adult patients treated in our center in the 7- year period, with male predominance and a mean age of 45 years. The primary infection sites were pharyngeal in 7, cervical in 5 and odontogenic in 2 patients. At diagnosis, 4 patients had type I DNM, 3 had type IIA and 7 had type IIB. Disease progression to stage II occurred in the majority of patients (n = 12). A total of 34 cervical procedures and 20 thoracic surgeries were performed, with a median of 2 cervical [1- 7] and 1 thoracic [0- 3] interventions per patient. Combined cervicotomy and thoracotomy was the preferred surgical approach. There was a low rate of long- term morbidity and no mortality.</p><p><strong>Conclusion: </strong>Successful management of DNM relies on early diagnosis trough computed tomography scan, appropriate antibiotic therapy, and urgent surgical drainage of the affected cervical and mediastinal planes. Our experience highlights favorable outcomes, underscoring the value of a well- coordinated multidisciplinary approach.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"33 1","pages":"25-32"},"PeriodicalIF":0.0,"publicationDate":"2026-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977675","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":"A Retrospective Analysis on Level of Suction in Digital Drainage Devices After Video-assisted Lobectomy in a Thoracic Surgery Centre.","authors":"Anita Paiva, Nuno Barros Ferreira, Ana Santos Cardoso, João Serra, Rita Costa, Carlos Pinto, Pedro Fernandes","doi":"10.48729/pjctvs.607","DOIUrl":"10.48729/pjctvs.607","url":null,"abstract":"<p><strong>Introduction: </strong>The management of chest tubes after pulmonary resection remains non- standardized, and suction levels are often determined by the surgeon's preference. This retrospective study aimed to compare the clinical outcomes of low suction -2cmH2O-2cmH2​O versus the conventional suction level used in our institution -15cmH2O-15cmH2​O using digital drainage devices after videoassisted thoracic surgery (VATS) lobectomy for suspected or confirmed lung cancer in a thoracic surgery centre.</p><p><strong>Methods: </strong>We analysed 120 patients who underwent pleural drainage after VATS lobectomy between January 2023 and September 2024. The primary outcome was drainage duration. Secondary outcomes included hospital stay, prolonged air leak, complications, and readmissions.</p><p><strong>Results: </strong>No significant differences were observed in drainage duration (2.0 vs. 4.0 days; p=0.125p=0.125) or hospital stay (3.0 vs. 4.0 days; p=0.104p=0.104 ). The incidence of prolonged air leak was similar between groups (20.3% vs. 24.6%; p=0.578p=0.578 ). However, subcutaneous emphysema occurred more frequently in the low suction group (22% vs. 8.2%; p=0.04p=0.04 ), with a higher need for intervention, despite comparable baseline forced expiratory volume in the first second (FEV1) values between suction level groups. Importantly, patients who developed subcutaneous emphysema had significantly lower baseline FEV1 values, regardless of suction level. COPD was identified as a significant predictor of longer drainage duration, longer hospital stay, and higher complication rates.</p><p><strong>Conclusion: </strong>Although suction level did not significantly influence postoperative recovery, the higher incidence of subcutaneous emphysema in the low suction group warrants further investigation. The presence of COPD and impaired baseline lung function should be considered when selecting suction levels after VATS lobectomy.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"33 1","pages":"19-23"},"PeriodicalIF":0.0,"publicationDate":"2026-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977616","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":"Spontaneous Splenic Rupture in Vascular Ehlers-Danlos Syndrome: a Case Report Managed by Coil Embolization of the Splenic Artery.","authors":"Marta Ferreira Martins, Miguel Maia, Bernardo Moreira, Paula Ferreira Pinto, João Almeida Pinto, Carla Freitas","doi":"10.48729/pjctvs.567","DOIUrl":"10.48729/pjctvs.567","url":null,"abstract":"<p><p>Vascular Ehlers-Danlos Syndrome (VEDS) is a rare genetic disorder characterized by arterial fragility and a high risk of spontaneous vascular rupture. Splenic artery rupture is an uncommon but life-threatening manifestation of this condition. We report the case of a 34-year-old male with VEDS who presented with sudden abdominal pain and rapid progression to hemorrhagic shock. Imaging confirmed active bleeding from the distal splenic artery. After multidisciplinary evaluation, endovascular embolization via a left humeral approach was performed using multiple coils. The procedure achieved hemostasis, and the patient showed immediate clinical improvement. He was discharged after 27 days following immunization against encapsulated organisms due to presumed hyposplenism. This case highlights the critical role of endovascular techniques in managing vascular emergencies in VEDS patients, offering a minimally invasive and effective alternative to open surgery, minimizing vascular manipulation in fragile tissues.  Splenic artery embolization may be life-saving, but long-term surveillance and preventive strategies are crucial, given the risk of recurrence and complications.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"33 1","pages":"45-49"},"PeriodicalIF":0.0,"publicationDate":"2026-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977626","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":"Comparing Treatment Modalities For Parapneumonic Pleural Empyema In Children: What To Choose And When, A Retrospective Study.","authors":"Carolina Soares-Aquino, Sofia Vasconcelos-Castro, Norberto Estevinho, Miguel Campos, Mariana Borges-Dias","doi":"10.48729/pjctvs.627","DOIUrl":"10.48729/pjctvs.627","url":null,"abstract":"<p><strong>Introduction: </strong>Parapneumonic pleural empyema (PPE) is common in children, however, the most appropriate treatment is not established. We aimed to analyse and compare treatments for PPE and its outcomes.</p><p><strong>Methods: </strong>Single-centre retrospective analysis of PPE cases from 2012-2024, concerning demographics, times until treatment and resolution, failure, alternative treatments, complications and follow-up. Lung necrosis contraindicated fibrinolysis; simple effusions and bilateral pneumonias were excluded. Time until treatment was considered after the diagnosis of PPE.</p><p><strong>Results: </strong>77 cases were identified with a median age of 5 years. The most common initial treatment was intrapleural fibrinolysis (58%), followed by thoracoscopic decortication (29%) and simple drainage (13%). Failure happened after all (10/10) drainages, 22% (10/45) of fibrinolysis and 9% (2/22) of thoracoscopies. Compared to thoracoscopy, fibrinolysis had no difference in failure (p=0.310) but had a longer treatment duration (17 versus 13 days, p=0.004). Excluding failures, no difference was found in treatment duration, postoperative fever and complications.</p><p><strong>Conclusion: </strong>While simple drainage of PPE should not be attempted, thoracoscopic decortication and fibrinolysis seem equally effective. There was a shorter treatment duration with thoracoscopic decortication and no increase in complications, so the authors recommend it should be employed promptly when fibrinolysis is contraindicated, as in necrotizing pneumonia.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"33 1","pages":"6-12"},"PeriodicalIF":0.0,"publicationDate":"2026-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977682","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":"Treatment of Vascular Anomalies With Sirolimus: An Updated Comprehensive Review.","authors":"Paulo Miguel Santos, Luís Loureiro, Andreia Pinelo, Rui Machado","doi":"10.48729/pjctvs.614","DOIUrl":"10.48729/pjctvs.614","url":null,"abstract":"<p><strong>Background: </strong>Sirolimus, an mTOR inhibitor, has transformed the management of complex slow- flow vascular malformations (VAMs), particularly those driven by PI3K/AKT/mTOR pathway activation. Evidence from prospective trials and real- world cohorts supports its use in venous, lymphatic and combined malformations, as well as in PIK3CA- related overgrowth spectrum (PROS) and PTEN hamartoma tumor syndrome (PHTS). However, sirolimus shows poor or absent benefit in fast- flow lesions such as arteriovenous malformations (AVMs).</p><p><strong>Methods: </strong>This narrative review of the recent literature (2020- 2025) was performed using PubMed, focusing on molecular mechanisms, clinical efficacy, safety, quality of life, therapeutic drug monitoring (TDM) and cost- utility of sirolimus in vascular anomalies.</p><p><strong>Results: </strong>Sirolimus demonstrates high response rates in slow- flow malformations, with partial responses in approximately 60-85%60-85% of patients and clinically meaningful improvements in health- related quality of life (HRQoL). Lower trough levels (4- 10 ng/mL) provide comparable efficacy with reduced toxicity. Adverse effects include oral mucositis, dyslipidemia, fatigue and infections. In contrast, fast- flow malformations show negligible benefit, consistent with their distinct genetic architecture, which predominantly activates RAS/MAPK rather than PI3K/AKT/mTOR signalling.</p><p><strong>Conclusions: </strong>Sirolimus is an effective targeted therapy for refractory slow- flow vascular malformations but should not be considered a universal treatment for all vascular anomalies. Future directions include molecularly guided therapy, rational combination regimens and integration with PI3K- and AKT- directed agents.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"33 1","pages":"33-39"},"PeriodicalIF":0.0,"publicationDate":"2026-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977703","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":"Bilateral Iatrogenic Pneumothorax, Pneumo-mediastinum and Pneumoperitoneum Following Per-oral Endoscopic Myotomy for Achalasia type I: A Case Report.","authors":"Aymar Kassa Boukat, Mohamed Bhairis, Massine El Hammoumi, El Hassane Kabiri","doi":"10.48729/pjctvs.563","DOIUrl":"10.48729/pjctvs.563","url":null,"abstract":"<p><p>Iatrogenic pneumothorax is most frequently descripted in the literature, but the association with pneumo-mediastinum and pneumoperitoneum is rare We report a case of bilateral suffocating pneumothorax associated with pneumo-mediastinum and pneumoperitoneum following a per oral endoscopic myotomy for Chicago-type I Achalasia managed by urgent exsufflation and a drainage.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"33 1","pages":"41-43"},"PeriodicalIF":0.0,"publicationDate":"2026-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147977670","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":"The Year Behind and the Year Ahead.","authors":"Filipe Ferreira Leite","doi":"10.48729/pjctvs.616","DOIUrl":"https://doi.org/10.48729/pjctvs.616","url":null,"abstract":"","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"32 4","pages":"9"},"PeriodicalIF":0.0,"publicationDate":"2026-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146260374","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":"Thoracic Surgery - notes for its history in Brazil (Part II): Lung transplantation.","authors":"Roger Normando, João Pedro Normando","doi":"10.48729/pjctvs.600","DOIUrl":"10.48729/pjctvs.600","url":null,"abstract":"<p><p>Pulmonary transplantation arrived in Brazil after being well grounded in operative technique, in the use of anti-rejection drugs, as well as advances in pulmonary preservation, allowing longer ischemia time with less reperfusion injury. Consistent with this fact, there was advancement in understanding the mechanism of rejection and infection. The first Brazilian pulmonary transplant occurred in Porto Alegre, in May 1989. It was also the first in Latin America. The author was José de Jesus Peixoto Camargo, surgeon at the Pereira Filho Pavilion of the Santa Casa of Porto Alegre. It was a 27-year-old man, suffering from bronchiolitis obliterans, who received a left lung transplant and survived more than nine years, dying from infectious complications resulting from bronchiolitis and bronchiectasis, associated with pulmonary tuberculosis that he developed eight years after the transplant. From then on, more Brazilian centers created transplant programs. The implementation of each service incorporated infrastructure that guaranteed multidisciplinary care. The emphasis of these programs was due to: care for the donor, selection of recipients, adequate rehabilitation of candidates during the waiting time, anesthetic and surgical training in the management of pertinent technical peculiarities, highly qualified intensive care, and follow-up of a regulated, inflexible, and permanent postoperative protocol. Thus, one understands how we arrived at the current moment to be reported in the form of history. The historiographic material (method) collected by the authors was based on reading scientific texts, informative materials, and oral reports. It follows the methodological line of the previous article(Part I) whose events served to build the history of the specialty in Brazil, under the pioneering work of José de Jesus Peixoto Camargo.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"32 4","pages":"13-17"},"PeriodicalIF":0.0,"publicationDate":"2026-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146260304","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":"Unmasking an Anomalous Vein: Surgical Repair of Left Upper Pulmonary Vein Drainage into the Innominate Vein.","authors":"Maria Resende, Márcio Madeira, Cláudia Silva, Marta Marques, Miguel Abecasis","doi":"10.48729/pjctvs.592","DOIUrl":"10.48729/pjctvs.592","url":null,"abstract":"<p><p>Partial anomalous pulmonary venous return (PAPVR) is a rare congenital anomaly characterized by one or more pulmonary veins draining into the systemic venous system. We present the case of a 51-year-old woman with PAPVR involving the left upper pulmonary vein (LUPV) draining into the left innominate vein via a vertical vein, diagnosed after investigation of progressive dyspnea and lower limb edema. The diagnosis was confirmed through contrast-enhanced CT and echocardiography. The patient underwent surgical correction of the anomalous return along with tricuspid valve repair. Postoperative recovery was uneventful. This case highlights the importance of recognizing PAPVR in adult patients presenting with unexplained right heart dilation or symptoms of right heart overload.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"32 4","pages":"47-49"},"PeriodicalIF":0.0,"publicationDate":"2026-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146260283","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":"Misconnected: Valve Failure from an Unexpected Chordal Insertion.","authors":"Catarina Novo, Mariana Campos, Paulo Neves, Miguel Guerra","doi":"10.48729/pjctvs.575","DOIUrl":"10.48729/pjctvs.575","url":null,"abstract":"<p><p>A 64-year-old woman with no significant past medical history presented with heart failure symptoms secondary to severe mitral regurgitation. She was referred for mitral valve repair with the intention of valve preservation. Initial transthoracic echocardiography (TTE) suggested that the regurgitation was due to a ruptured chordae resulting in prolapse of the A2 segment. Intraoperative inspection following atriotomy revealed an aberrant chordae tendineae inserting anomalously into the left atrial wall, which was contributing to the A2 prolapse. The aberrant chordae was excised and replaced with polytetrafluoroethylene (Gore-Tex) neochords. A mitral annuloplasty ring was placed to complete the repair. Intraoperative transesophageal echocardiography confirmed excellent valve function with only minimal residual regurgitation. The patient had an uneventful recovery and was discharged on the fourth postoperative day. Aberrantly inserted chordae tendineae are an exceedingly rare finding and may lead to significant valvular dysfunction. Prompt surgical recognition and correction can result in successful valve preservation and excellent clinical outcomes.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"32 4","pages":"59-60"},"PeriodicalIF":0.0,"publicationDate":"2026-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146260363","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}