Portuguese journal of cardiac thoracic and vascular surgery最新文献

{"title":"Sequential Double-Lung Transplantation In Kartagener Syndrome: A Case Report.","authors":"Catarina Nunes Figueiredo, João Santos Silva, João Maciel, Luísa Semedo, Paulo Calvinho","doi":"10.48729/pjctvs.465","DOIUrl":"10.48729/pjctvs.465","url":null,"abstract":"<p><p>Kartagener syndrome (KS) is a rare congenital disorder, characterized by sinusitis, bronchiectasis and situs inversus. Lung transplantation is an effective treatment for end-stage lung failure, but dextrocardia and differences between hilar structures and pulmonary lobes require adjustments to conventional surgical technique. We present a case of a double-lung transplant without extracorporeal oxygenation in a 48-year-old male patient with KS. Through a Clamshell incision, right-left rotation was identified. To provide an end-to-end arterial and bronchial anastomosis, longer donor PA's and right main bronchus were preserved. Wedge resection of right inferior lobe was unnecessary and there was no left residual cardiac chamber. Patient was discharged 32 days after surgery without complications. Despite being anatomically challenging, lung transplant was done successfully without the need for plastic maneuvers or extracorporeal circulation. This reinforces the idea that it should be an option in end-stage lung disease.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"31 3","pages":"83-86"},"PeriodicalIF":0.0,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017976","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":"Segmentectomies: 5-Year Experience Of A Center.","authors":"Catarina Nunes Figueiredo, Catarina Moita, Zenito Cruz, Ana Rita Costa, João Santos Silva, João Eurico Reis, João Maciel, Paulo Calvinho","doi":"10.48729/pjctvs.419","DOIUrl":"10.48729/pjctvs.419","url":null,"abstract":"<p><strong>Introduction: </strong>Segmental anatomical resections have been a subject of debate in recent years. There is increasing evidence that these procedures may offer some advantages in the treatment of early-stage lung cancer, with overall survival (OS) and disease-free survival (DFS) similar to those seen in lobar anatomical resections.</p><p><strong>Materials and methods: </strong>We conducted a retrospective analysis of patients who underwent segmentectomy at Santa Marta Hospital (HSM) between January 2018 and September 2022. Patients undergoing trauma-related segmentectomy or as a secondary procedure were excluded.</p><p><strong>Results: </strong>37 segmentectomies were performed, of which 34 were included in this analysis. 29 (85.3%) were performed for malignancies, 5 (14.7%) for benign conditions. Of the malignancies, 24 (82.8%) were primary lung cancer (PLC): 18 (75%) adenocarcinomas (ADC), 2 (8.3%) squamous cell carcinomas (SCC), 4 (16.7%) typical carcinoids (TC); 5 (17.2%) were colorectal-origin metastases. Among the benign cases: 3 (60%) were aspergillomas. Mean age of PLC patients was 71 years (min=56;max=88), with 9 (37.5%) females and 15 (62.5%) males. In 11 (45.8%), FEV1 or DLCO was <60%. 18 (75%) were smokers. Lesions were mostly solid nodules (N=12;50%). Others included subsolid lesions (N=11;45%) and 1 (4.2%) cystic formation. At surgery, only 3 (12.5%) patients had a pre-operative histological diagnosis (ADC=2; SCC=1). 21 (87.5%) were stage IA, 2 (8.33%) patients were stage IB and 1 (8.33%) patient was stage IIA. Procedures were performed via VATS (N=17;70.8%), via thoracotomy (N=5;20.8%) and via RATS (N=2;8.3%). 23 (95.8%) were R0 resections. Postoperatively: 19 (79.2%) were stage IA; 3 (12.5%) IB; ,1 (4.2%) IIB, and 1 (4.2%) IIIA. 3 (12.5%) had upstaging. 2 (8.3%) patients underwent adjuvant chemotherapy, 1 (4.2%) had completion lobectomy. 2 (8.3%) experienced recurrence. DFS was 100% at 3, 6, and 12 months, and at 3 and 5 years, was 88.9% and 66.7% respectively. OS was 100% at 3, 6, and 12 months and 95% at 3 and 5 years. Median follow up time was 29 months (IQR: 18 - 44).</p><p><strong>Conclusion: </strong>This study reinforces the idea that segmental resections should be considered a viable option for patients with early-stage lung cancer. Although this analysis has some limitations, such as a limited number of preoperative histological diagnoses and postoperative upstaging, our results demonstrate promising OS and DFS, in accordance with recent literature.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"31 3","pages":"33-38"},"PeriodicalIF":0.0,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017974","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":"Advancing Vascular Surgery: The Role Of Artificial Intelligence And Machine Learning In Managing Carotid Stenosis.","authors":"Ana Daniela Pias, Juliana Pereira-Macedo, Ana Marreiros, Nuno António, João Rocha-Neves","doi":"10.48729/pjctvs.411","DOIUrl":"10.48729/pjctvs.411","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiovascular diseases affect 17.7 million people annually, worldwide. Carotid degenerative disease, commonly described as atherosclerotic plaque accumulation, significantly contributes to this, posing a risk for cerebrovascular events and ischemic strokes. With carotid stenosis (CS) being a primary concern, accurate diagnosis, clinical staging, and timely surgical interventions, such as carotid endarterectomy (CEA), are crucial. This review explores the impact of Artificial Intelligence (AI) and Machine Learning (ML) in improving diagnosis, risk stratification, and management of CS.</p><p><strong>Methods: </strong>A comprehensive literature review was conducted using PubMed and SCOPUS, focusing on AI and ML applications in diagnosing and managing extracranial CS. English language publications from the past two decades were reviewed, including cross-referenced scientific articles.</p><p><strong>Results: </strong>Recent advancements in AI-enhanced imaging techniques, particularly in deep learning, have significantly improved diagnostic accuracy in identifying carotid plaque vulnerability and symptomatic plaques. Integration of clinical risk factors with AI systems has further enhanced precision. Additionally, ML models have shown promising results in identifying culprit arteries in patients with previous cerebrovascular events. These advancements hold immense potential for improving CS diagnosis and classification, leading to better patient management.</p><p><strong>Conclusion: </strong>Integrating AI and ML into vascular surgery, particularly in managing CS, marks a transformative advancement. These technologies have significantly improved diagnostic accuracy and risk assessment, paving the way for more personalized and safer patient care. Despite clinical validation and data privacy challenges, AI and ML have immense potential for enhancing clinical decision-making in vascular surgery, marking a pivotal phase in the field's evolution.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"31 3","pages":"55-64"},"PeriodicalIF":0.0,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017958","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 Future of Aortic Surgery.","authors":"Florian S Schoenhoff","doi":"10.48729/pjctvs.495","DOIUrl":"https://doi.org/10.48729/pjctvs.495","url":null,"abstract":"","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"31 3","pages":"11-14"},"PeriodicalIF":0.0,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017982","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":"Editorial: change in the editorial board.","authors":"Marina Dias Neto","doi":"10.48729/pjctvs.472","DOIUrl":"https://doi.org/10.48729/pjctvs.472","url":null,"abstract":"","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"31 2","pages":"9"},"PeriodicalIF":0.0,"publicationDate":"2024-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141545635","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":"Hypovolemic Shock And The Need For Invasive Mechanical Ventilation On A Patient With Congenital Heart Disease.","authors":"Marisa Simoes, Sergio Gaião","doi":"10.48729/pjctvs.414","DOIUrl":"10.48729/pjctvs.414","url":null,"abstract":"<p><p>Techniques of venoarterial-extracorporeal membrane oxygenation (VA-ECMO) have improved over the decades, with numerous applications.1 Those with reversible low cardiac output benefit most from this support.1 Case of 21-year-old male, history of congenital heart disease (severe right ventricle hypoplasia and pulmonary artery stenosis with extracardiac cavo-pulmonary shunt (Fontan surgery), and atrial septal defect). Brought to the Emergency Department due to a Mallory-Weiss syndrome, upper-endoscopy \"laceration at esophagogastric junction (EGJ) with active bleeding\", clips were applied. However, worsening shock, repeated melenas and hematemesis, hemoglobin drop, lactate 2.8mmol/L, and needing noradrenaline (1.21mcg/kg/min). Due to active blood loss and worsening shock, the patient was intubated to maintain airway protection. Repeated upper-endoscopy \"voluminous live red clot at EGJ, 4-clips and active bleeding of mucosa between, injection of polidocanol\". Despite the implemented strategy, high risk of rebleeding remained. Following invasive mechanical ventilation (IMV), sustained hypotension having to increase noradrenaline (1.52mcg/kg/min) and lactate (5.8mmol/l), despite fluid resuscitation. Echocardiogram evidenced severe ventricular dysfunction, and fixed inferior vena cava (IVC) of 20mm. The heart defect combined with positive intrathoracic pressure, contributed to the worsened shock, as Fontan circulation is dependent on low vascular resistance to maintain output2. Needing VA-ECMO and admitted to ICU, volemia optimization, adjusting ventilation to lower intrathoracic pressure and started on milrinone and sildenafil. Another upper-endoscopy showed laceration at EGJ, with placement of clips. Echocardiogram revealed \"Normal left ventricle. Hypoplastic right ventricle. Mild mitral regurgitation; aortic VTi 19cm. IVC 22mm. RV/RA gradient 70mmHg. Interatrial bidirectional shunt\". Favorable evolution permitted extubation, suspension of milrinone and sildenafil, followed by decannulation. With rescue ECMO, congenital heart disease are salvageable despite sudden decompensation3. This case, positive intrathoracic pressure impairs the Fontan circulation, dependent on preload and higher central venous pressure to maintain cardiac output, as the ventricle is unable to compensate increased demands2, and worsening shock.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"31 2","pages":"47-49"},"PeriodicalIF":0.0,"publicationDate":"2024-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141545637","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":"Endoscopic Vein Harvesting - How Do We Do It?","authors":"Paulo Veiga Oliveira, Márcio Madeira, Inês Alves, Sara Ranchordás, José Pedro Neves","doi":"10.48729/pjctvs.425","DOIUrl":"https://doi.org/10.48729/pjctvs.425","url":null,"abstract":"<p><p>The saphenous vein graft (SVG) remains the most used conduit as a second graft in Coronary Artery Bypass Grafting (CABG).1 Traditionally, surgeons harvest SVG with an open approach, making a long incision along the medial part of the leg or thigh. This procedure can potentially result in important complications, such as delayed wound healing, postoperative pain and infection.2 Thus, less invasive techniques for vessel harvesting have grown in popularity. Endoscopic vein harvesting (EVH) is a minimally invasive harvesting procedure, which only requires a short incision, leading to less wound complications and a faster return to normal daily activities. This article intends to describe how we do EVH technique in our centre, from the preparation of the patient to the postoperative period and share some tips and tricks from our experience.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"31 2","pages":"11-16"},"PeriodicalIF":0.0,"publicationDate":"2024-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141545636","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":"Vascular Surgery Procedures Performed By Residents. A Narrative Review On The Impact In 30-Day Outcomes.","authors":"Tiago Ribeiro, Rita Soares Ferreira, Rita Bento, Fábio Pais, Joana Cardoso, Helena Fidalgo, Adriana Figueiredo, Maria Emília Ferreira","doi":"10.48729/pjctvs.410","DOIUrl":"https://doi.org/10.48729/pjctvs.410","url":null,"abstract":"<p><strong>Introduction: </strong>Worldwide, there is an increase in scrutiny after surgical treatment of a vast array of pathologies. Doing so, a large body of evidence clearly supports centralisation, such as teaching hospitals, where a larger caseload enables optimal outcomes. These institutions have a strong presence of surgical residents seeking training in both technical and non-technical skills. Inevitably, as part of training, they will be involved in the surgical treatment of those patients, even as the primary operator. We sought to investigate the impact of trainee performed procedures in outcomes of common vascular procedures of different technical complexity.</p><p><strong>Methods: </strong>A non-systematic MEDLINE and Scopus databases review on the outcomes of resident performed common vascular procedures was performed.</p><p><strong>Results: </strong>Specific evidence in many procedures (venous disease, aortic aneurysms, peripheral artery disease) is lacking. After carotid endarterectomy (CEA), resident performed procedures seem to have similar cranial nerve palsy and stroke when compared to expert surgeons. Generally, resident-performed primary radiocephalic and elbow arteriovenous fistula (AVF) presents similar primary and secondary patency. As with CEA, AVF procedures performed by residents took longer. On aortic aneurysms, although no specific comparison has been performed, resident involvement (irrespective of surgeon or assistant) in these procedures does not seem associated with increased adverse events.</p><p><strong>Conclusion: </strong>In most vascular surgery procedures, little is known about resident performance and their impact on outcomes. Notwithstanding, resident-performed CEA and primary AVF seem free of major compromise to patients. Further research is warranted to clarify this topic.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"31 2","pages":"41-45"},"PeriodicalIF":0.0,"publicationDate":"2024-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141545666","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":"Cardiac Perforation Caused By Pectus Excavatum Metal Bar Stabilizer: A Case Report.","authors":"Alexandre De Oliveira, Marco Antonio P Oliveira, Rafael Ribeiro Barcelos, Diego Arley Gomes da Silva, Miguel Lia Tedde","doi":"10.48729/pjctvs.454","DOIUrl":"10.48729/pjctvs.454","url":null,"abstract":"<p><p>This paper reports the case of a female patient who underwent minimally invasive repair of pectus excavatum (MIRPE) in another service that evolved with bar rotation and cardiac perforation caused by the left stabilizer. The unique and frightening aspect of the case is that despite having the stabilizer inside the ventricle, the patient was oligosymptomatic: occasional chest pain and respiratory discomfort. Preoperative imaging showed rotation of the bar with stabilizers within the thoracic cavity. During surgery, intense ossification was observed around the prosthesis and it was noted that the left stabilizer had perforated the patient's left ventricle. Cardiac repair required a Clamshell incision and cardiopulmonary bypass. This case reinforces the validity of late radiological follow-up after MIRPE in an attempt to avoid this type of event, and the need to reevaluate the use of stabilizers perpendicular to the bar since they are not safe to prevent rotation of these implants.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"31 2","pages":"59-61"},"PeriodicalIF":0.0,"publicationDate":"2024-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141545634","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":"Pleural Solitary Tumors - Long-Term Prognosis Related To Surgery And Clinicopathological Criteria.","authors":"Vânia Almeida, Luis Veloso, Sara Cunha, Lina Carvalho","doi":"10.48729/pjctvs.336","DOIUrl":"10.48729/pjctvs.336","url":null,"abstract":"<p><strong>Introduction: </strong>Pleural solitary fibrous tumors (SFTs) are indolent mesenchymal neoplasias, generally with good prognosis, for which complete surgical resection is the gold standard. However, local recurrences and distant metastases are reported at variable rates. Risk-assessing criteria and models determining recurrence and metastatic risk have been proposed, and can impact on patient follow-up strategies.</p><p><strong>Methods: </strong>We conducted an observational study comprising a 12 years period to characterize a cohort of 20 surgically resected thoracic SFTs, and to retrospectively assess the prognostic value of England's histology criteria and Demicco's 4-tier model.</p><p><strong>Results: </strong>All tumors were pleural-based, 12 patients were women, and the mean age at diagnosis was 62.8 years. The median duration of follow-up was ten years, and at the end of the follow-up, all patients were alive, and no distant metastases were reported. Three cases (15%) had local recurrence at the median time of 89.3 months/7.4 years. The only case with an incomplete surgical resection relapsed. Collectively, tumors with worst prognostic features, specifically a positive margin or tumors with malignant histology or non-low-risk features, according to England's and Demicco's models, respectively, were associated with recurrence.</p><p><strong>Conclusion: </strong>These results confirm the importance of complete surgical resection of SFTs, and show that risk stratification criteria and models can predict important surgical outcomes such as recurrence. Moreover, they support a risk-based follow-up schedule, as patients with higher relapse risk can benefit from close follow-up.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"31 2","pages":"17-22"},"PeriodicalIF":0.0,"publicationDate":"2024-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141545662","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}