Portuguese journal of cardiac thoracic and vascular surgery最新文献

{"title":"Cerebral Embolism: A Challenging Complication In Libman-Sacks Endocarditis.","authors":"Souhayla Souaf Khalafi, Jhonny Javier Montesino Villafranca, Jose Andrés Donoso Mera, Angel Luis Fernández González","doi":"10.48729/pjctvs.497","DOIUrl":"https://doi.org/10.48729/pjctvs.497","url":null,"abstract":"<p><p>Libman-Sacks endocarditis is an uncommon disorder that can be a risk factor for neurocognitive dysfunction, and brain lesions, either separately or in a combination. We report 57-year-old woman from Colombia who presented with a history of dyspnea, associated with general malaise and arthralgia of small joints. On examination, she had signs of chronic arthropathy and purpuric plantar lesions. Her cardiac exam revealed a pan-systolic murmur of mitral regurgitation, harsh, grade 5/6, best heard at the apex, and a diastolic murmur in the aortic focus. Her echocardiography revealed severe mitral regurgitation and moderate aortic regurgitation with nodular thickening of both valves, consistent with a diagnosis of LSE. Blood cultures and serologic tests were negative. After starting anticoagulant treatment, the patient suffered a stroke, and it was finally decided that she would undergo surgery. She suffered a second stroke with status epilepticus in the immediate postoperative period. She eventually recovered without serious neurological sequelae.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"32 3","pages":"57-61"},"PeriodicalIF":0.0,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145515112","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":"3d Model For Chest Wall Reconstruction - Utility Survey.","authors":"Luís Lourenço Graça, Filipe Leite, Gonçalo Paupério","doi":"10.48729/pjctvs.521","DOIUrl":"https://doi.org/10.48729/pjctvs.521","url":null,"abstract":"<p><strong>Introduction: </strong>Three-dimensional (3D) models contributed to many improvements in surgical planning, presenting irrefutable advantages in many fields and may play a relevant role in chest wall surgeries. This study aims to evaluate their usefulness for chest wall reconstruction surgeries.</p><p><strong>Materials and methods: </strong>All thoracic surgeons and residents practicing in the Iberian Peninsula and Latin America were asked to complete an online survey questionnaire, distributed through their respective national scientific societies. Results were analyzed using descriptive statistics and Mann-Whitney U test to access differences among surgeons with experience with 3D models and those without experience.</p><p><strong>Results: </strong>A total of 145 answers were gathered from 15 countries. Most respondents had never performed thoracic wall reconstruction surgeries using rigid prosthesis with 3D patient-specific modeling. Most consensus was obtained regarding the positive contribution of a 3D model for preoperative communication with the patient, improvement in preoperative planning, and its positive role in training of less experienced surgeons. A tendency for neutral opinion was observed regarding its impact in avoidance of perioperative complications. Regarding 3D printing of a physical model, 74.8% agreed or strongly agreed that it is advantageous in comparison with a digital model, and 72.8% agreed or strongly agreed that it is advantageous for all candidates considered for chest wall reconstruction with rigid prothesis. Surgeons without experience with 3D models value significantly more than those with experience their contribution for a more precise preoperative planning (p=0.036), planning of surgery duration (p=0.008), and consider 3D printed models to be advantageous for all candidates to chest wall reconstruction surgery (p=0.028).</p><p><strong>Conclusion: </strong>3D patient-specific models are not accessible to most surgeons but the overall opinion on their usefulness is very positive. Printed models seem to be advantageous over digital ones, and beneficial for all patients undergoing chest wall reconstruction surgery.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"32 3","pages":"25-31"},"PeriodicalIF":0.0,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145515041","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":"Comparison Of Prognostic Factors In Patients With Lung Cancer Operated After Neoadjuvant Treatment.","authors":"Dilvin Ozkan, Muhammet Sayan, Sevki Mustafa Demiroz, Olgun Kadir Aribas, Ismail Cuneyt Kurul, Ali Celik, Abdullah Irfan Tastepe","doi":"10.48729/pjctvs.534","DOIUrl":"https://doi.org/10.48729/pjctvs.534","url":null,"abstract":"<p><strong>Aim: </strong>Lung cancer is the leading cause of cancer-related deaths worldwide. The most favorable treatment option for early-stage non-small cell lung cancer is surgical resection. In locally advanced lung cancer, surgery can be performed as part of multimodal treatment regimens. In this study, we aimed to investigate the survival outcomes and prognostic factors of non-small cell lung cancers operated on after neoadjuvant treatment.</p><p><strong>Methods: </strong>The data of patients who were operated on after neoadjuvant treatment in our clinic between 2012 and 2022 were collected. Data were analyzed according to age, gender, complete resection, applied treatment regimen, operation type, presence of viable tumor, histopathology, N status, tumor diameter, and presence of progression.</p><p><strong>Results: </strong>A total of 96 patients were included in the study. There were 9 female (9.4%) and 87 male (90.6%) patients. The mean age was 65.2 ± 8.3. Median overall survival was 41 months (15.7-66.2), and 5-year overall survival was 42.4%. Poor prognostic factors for overall survival in our study are being older than 65 years (p=0.02), tumor progressing despite treatment (p=0.008), tumor diameter greater than 2.65 cm (p=0.01), incomplete resection (p=0.002), and tumor stage higher than stage I according to TNM classification 8th edition (p=0.02). There was no significant correlation between survival and gender, tumor histopathology, neoadjuvant treatment protocol, presence of viable tumor, presence of persistent N2, and type of surgery performed (p>0.05) Conclusion: When planning surgery after neoadjuvant treatment in locally advanced lung cancer, there are some parameters to take into consideration which are age, tumor diameter after treatment, complete resectability, and the presence of diameter progression despite treatment.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"32 3","pages":"39-47"},"PeriodicalIF":0.0,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145515069","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":"Systemic Arterial Supply to a Congenital Pulmonary Airway Malformation: Imaging of a rare Hybrid BPS/CPAM Lesion.","authors":"Mário Rui Correia, Filipa Coelho, Fátima Carvalho, Gonçalo Paupério","doi":"10.48729/pjctvs.539","DOIUrl":"https://doi.org/10.48729/pjctvs.539","url":null,"abstract":"","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"32 3","pages":"63"},"PeriodicalIF":0.0,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145515186","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":"Blood Prime Of The Cardiopulmonary Bypass Circuit In Congenital Heart Surgery.","authors":"Valdir Assis Dos Reis Filho, José Cícero Stocco Guilhen, Mariana Leticia Matias, Karina Aparecida Antonelli Novello, Diego Gamarra Moreira, Jesus Antonio Gutierrez Saurith, Omar Alonzo Pozo Ibanez, Luiz Antonio Rivetti","doi":"10.48729/pjctvs.557","DOIUrl":"https://doi.org/10.48729/pjctvs.557","url":null,"abstract":"<p><strong>Introduction: </strong>The use of cardiopulmonary bypass (CPB) is necessary during the repair of most congenital heart disease (CHD). The surface area of the CPB circuit and the volume of the filling prime are relatively large concerning the volume of neonatal and pediatric patients. Consequently, blood is often required to maintain an adequate hematocrit (HCT) level throughout the procedure.</p><p><strong>Objective: </strong>To evaluate the effects of ultrafiltration (UF) of the blood prime from the cardiopulmonary bypass circuit in children undergoing surgical procedures to correct heart disease.</p><p><strong>Methods: </strong>This is a prospective interventional study with convenience sampling of fifty-five children undergoing elective one of two groups as follows: control group (group 1) not using ultrafiltration of blood prime and experimental group (group 2) with UF of the prime before CPB. Blood samples were obtained for analysis of CPB circuit prime, during the intraoperative and after surgery in immediate postoperative period (IPO). The duration of mechanical ventilation (MV), intensive care unit (ICU) stay, and length of postoperative hospital stay were compared between the 2 groups.</p><p><strong>Results: </strong>Levels of glucose, potassium and lactate values demonstrated a significant decrease after prime ultrafiltration in group 2, however an increase in sodium values was revealed (p= <0,001). In the present study, to postoperative clinical outcomes, there was not difference between groups in the duration of mechanical ventilation and ICU stay. However , length of postoperative hospital stay, group 1 demonstrated longer time in comparison with the group 2 [13 (6 - 35) vs 9 (6 - 34); Median (interquartile range) and p= 0.032]. Group 2 demonstrated lower lactate values in intraoperative and in the immediate postoperative period (p= 0.008). It was observed in the first postoperative 24 hours, stability in lactate levels between the groups.</p><p><strong>Conclusion: </strong>Analysis of intraoperative and postoperative laboratory outcomes showed overall stability in blood parameters, with some specific variations in potassium and lactate levels. The observation of a shorter hospital stay in the group that had the prime ultrafiltration, it is suggested that this technique may help shorten the hospitalization period.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"32 3","pages":"15-23"},"PeriodicalIF":0.0,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145515038","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":"Pulsatile Danger: Anterior Tibial Artery Pseudoaneurysm After Orthopaedic Intervention.","authors":"Samuel Cardoso, Duarte Rego","doi":"10.48729/pjctvs.591","DOIUrl":"https://doi.org/10.48729/pjctvs.591","url":null,"abstract":"","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"32 3","pages":"65"},"PeriodicalIF":0.0,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145515193","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":"Influence Of Clinical Presentation Of Diabetic Patients With Chronic Limb Threatening Ischemia Submitted To Distal Revascularization.","authors":"Catarina Rolo Santos, Diogo Cunha E Sá, Tony R Soares, José Gimenez, Tiago Costa, Gonçalo Cabral, José Tiago, Armanda Duarte","doi":"10.48729/pjctvs.477","DOIUrl":"https://doi.org/10.48729/pjctvs.477","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this article was to evaluate the clinical impact of diabetic foot ulcer (DFU) severity in patients with chronic limb-threatening ischemia (CLTI) who underwent distal open revascularization.</p><p><strong>Methods: </strong>This study included a single-center retrospective analysis of diabetic patients with CLTI who underwent distal revascularization between January 2012 and December 2019. The sample was divided into two groups according to DFU severity; group 1 was defined if observed Wound grade ≥ 2 and Infection grade ≥ 1 and group 2 was defined if observed Wound grade < 2 and Infection grade < 1, according to Wound, Ischemia, and foot Infection (WIfI) classification. The primary endpoint was achieving freedom from CLTI at 1 year. Secondary endpoints encompassed the recurrence of CLTI, limb salvage, amputation-free survival, overall survival, and primary patency over a 4-year follow-up period.</p><p><strong>Results: </strong>A total of 258 distal bypasses were performed in diabetic patients with CLTI. Among these, 95 patients had infected major foot lesions (group 1), while the remaining 163 limbs comprised group 2. Group 1 patients were slightly younger, with a median age of 72 years (IQR 14), compared to 74 years (IQR 14) in group 2 (p=0.045). Most of the patients achieved freedom from CLTI at 12 months (82%), with no significant differences between groups (HR 0.75, CI 0.53-1.04, p=0.084; aHR 0.77, CI 0.54-1.08, p=0.130). At 4 years of follow-up, recurrence rates of CLTI and limb salvage were no different between groups (HR 0.68, CI 0.34-1.35, p=0.266; aHR 0.71, CI 0.34-1.48, p=0.355 and HR 1.18, CI 0.63-2.24, p=0.591; aHR 1.81, CI 0.80-4.11, p=0.155, respectively). Survival-related end points were not different between groups, except when adjusted for baseline characteristics and graft type (survival: HR 1.50, CI 0.96-2.33, p=0.072; aHR 2.49, CI 1.54-4.05, p<0.001; amputation-free survival: HR 1.37, CI 0.97-1.92, p=0.071; aHR 2.03, CI 1.40-2.93, p<0.001).</p><p><strong>Conclusion: </strong>The present study emphasizes the value of distal revascularization in limb salvage of patients with diabetic foot, independently of the DFU severity. However, these results suggest a lower survival in patients with infected major foot lesions. Further studies are needed to assert these findings.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"32 2","pages":"25-30"},"PeriodicalIF":0.0,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981578","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 on Its History in Brazil.","authors":"Roger Normando, João Pedro Normando","doi":"10.48729/pjctvs.561","DOIUrl":"https://doi.org/10.48729/pjctvs.561","url":null,"abstract":"","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"32 2","pages":"9-15"},"PeriodicalIF":0.0,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981833","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":"Real World Applicability Of Voyager-Pad According To Oac3pad Score.","authors":"Luís Fernandes, Diogo Silveira, João Peixoto, Marta Machado, Francisco Basílio, Patrícia Carvalho, Beatriz Guimarães, Alexandra Canedo","doi":"10.48729/pjctvs.522","DOIUrl":"https://doi.org/10.48729/pjctvs.522","url":null,"abstract":"<p><strong>Introduction: </strong>Lower extremity peripheral artery disease (PAD) is associated with a high risk of cardiovascular and limb adverse events. Optimal post intervention antithrombotic strategy may significantly impact medium to long-term outcomes. The VOYAGER PAD trial showed a clinical benefit of combining low dose rivaroxaban plus aspirin by reducing cardiovascular and limb major adverse events. However, safety of this dual pathway inhibition (DPI) may be questionable. Current European Society for Vascular Surgery guidelines on this subject suggest DPI for symptomatic PAD patients undergoing invasive treatment, in the absence of high bleeding risk. However, real-world patients differ from those enrolled in the VOYAGER PAD trial, especially chronic limb threatening ischemia (CLTI) patients. The OAC3PAD score is a novel risk stratification tool to assess bleeding risk in PAD patients that may help balance the benefits and risks of antithrombotic therapy.</p><p><strong>Methods: </strong>Single center retrospective study analyzing data all patients admitted for lower limb revascularization procedures between 2020 and 2023. The primary objective was to evaluate the proportion of patients, as categorized into the different categories of the OAC3PAD score, eligible for DPI, according to the VOYAGER PAD trial criteria.</p><p><strong>Results: </strong>A total of 652 patients were included in this study. Mean age of the patients was 69,6 ±10,3 years, and 76,8% were male. Out of the 652 patients, 12% were classified as high bleeding risk, 23% as intermediate to high bleeding risk, 46% as low to moderate bleeding risk, and 19% as low bleeding risk. Based on the VOYAGER PAD trial criteria, 441 patients (67,6%) were identified as potential candidates for low-dose rivaroxaban therapy. Eligibility for DPI varied significantly (p<0.001) across OAC3PAD scores, with the highest proportion of patients observed in the low to intermediate bleeding risk patients, while the lowest was in the high bleeding risk patients.</p><p><strong>Conclusion: </strong>Current evidence points to a higher bleeding risk of PAD patients than previous stated, especially when CLTI patients are being considered. Despite showing promising results, DPI with low dose rivaroxaban plus aspirin may require special caution in almost 50% of CLTI patients due to bleeding risk. This is a more frail and older population were adverse cardiovascular and limb events are more common and would benefit the most from strategies to reduce such events.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"32 2","pages":"37-42"},"PeriodicalIF":0.0,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981843","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":"Tracheal Surgery - a 10-year Center Experience.","authors":"Patricia M Castro, Cátia Silva, António Lima, José Miranda, Miguel Guerra","doi":"10.48729/pjctvs.507","DOIUrl":"https://doi.org/10.48729/pjctvs.507","url":null,"abstract":"<p><strong>Background: </strong>Tracheal surgery is a specialized field in which many disciplines work jointly due to the variety of indications and the extended topography. The main indications for surgery include inflammatory (generally post-intubation), congenital or post-traumatic stenoses, benign or malignant neoplasms and tracheal lacerations, whether iatrogenic or traumatic. The purpose of this study is to review the management of one institution's approach to a wide variety of tracheal lesions over the last 10 years.</p><p><strong>Methods: </strong>We retrospectively analyzed data of all subjects submitted to tracheal surgery in our center, between January 1, 2014 and December 31, 2023. The preoperative and postoperative data were retrospectively evaluated through the consultation of the clinical files and the computer registry system.</p><p><strong>Results: </strong>We included 24 patients, mean age of 53 years (min 19; max 87), 54% being female. The most frequent indication for surgery was post-intubation tracheal stenosis (16, 67%) followed by tracheal laceration (6, 25%) and pleomorphic adenoma of the trachea (2, 8%). The mean operative time was 148 minutes (min: 80; max. 205). The mean tracheal length resected was 2,14 cm (min: 1; max: 3,2). Postoperative complications included: vocal cord paralysis (2, 8%), surgical wound site infection (2, 8%), anastomotic dehiscence (1, 4%) and mediastinitis (1, 4%). Re-stenosis occurred in 1 patient who was treated with prosthesis placement via bronchoscopy and 1 patient required definitive tracheostomy due to vocal cord paresis. Median chin stitch duration and median length of stay was 10 and 15 days, respectively. In-hospital mortality was 8% (2 cases). Overall mortality during mean follow-up time (51 months) was 8% (2 cases).</p><p><strong>Conclusions: </strong>Tracheal surgery seems a valid and safe technique in selected patients and can be performed safely with low morbidity and mortality, according to our center results.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"32 2","pages":"43-46"},"PeriodicalIF":0.0,"publicationDate":"2025-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144981802","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}