Portuguese journal of cardiac thoracic and vascular surgery最新文献

{"title":"Coronary Stent Infection: An Unusual Complication After Percutaneous Coronary Intervention.","authors":"Souhayla Souaf Khalafi, Gustavo Andrés Valencia Páez, Angel Luis Fernández González","doi":"10.48729/pjctvs.372","DOIUrl":"10.48729/pjctvs.372","url":null,"abstract":"<p><p>Coronary artery stent infection (CSI) is one of the rarest complications associated with the percutaneous coronary intervention (PCI), usually requiring surgical intervention. Reaching and confirming the diagnosis remains the most challenging aspect of this complication. We describe a case of drug-eluting stents (DES) infection after several repeated procedures of primary angioplasty and stent implantation in the context of myocardial infarction. In the current era of growth of coronary stent implantation, it's important for clinicians to consider and to prevent such potentially fatal events. The diagnosis process remains difficult and requires the association of multiple clinical, biological and imaging parameters. Although medical treatment may be the only possible approach in some cases, we present a clinical case where surgical treatment was successful.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"30 3","pages":"71-75"},"PeriodicalIF":0.0,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140159673","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":"Immunotherapy in Non-small Cell Lung Cancer: a Review.","authors":"Telma Sequeira, M Teresa Almodovar","doi":"10.48729/pjctvs.371","DOIUrl":"10.48729/pjctvs.371","url":null,"abstract":"<p><p>Immunotherapy has revolutionized the field of oncology by utilizing the body's immune system to target and eliminate cancer cells. In non-small cell lung cancer (NSCLC), immunotherapeutic agents such as immune checkpoint inhibitors (ICIs) have shown promising results. ICIs target receptors like PD-1, PD-L1, and CTLA-4 to enhance the immune response against tumors. However, resistance mechanisms to immunotherapy are not fully understood, and ongoing research aims to overcome these challenges. In the early-stage setting, neoadjuvant and adjuvant trials are investigating the efficacy of ICIs in combination with chemotherapy, with interesting results. Additionally, in the metastatic landscape of NSCLC the therapeutic options multiplied in recent years. The use of immunotherapy in NSCLC holds great promise, and future studies may provide more effective therapies and biomarkers for personalized treatment approaches.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"30 3","pages":"55-65"},"PeriodicalIF":0.0,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140159674","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":"Uterine Leiomyomatosis With Intracardiac Extension: One-Stage Surgical Approach.","authors":"Pablo Del Canto Peruyera, Manuel Javier Vallina-Victorero Vázquez","doi":"10.48729/pjctvs.344","DOIUrl":"10.48729/pjctvs.344","url":null,"abstract":"<p><p>Intravenous leiomyomatosis is a rare benign vascular tumor. Intracardiac extension is infrequently but can lead into a threating-life situation. We report a 41-year-old woman who has undergone previous hysterectomy due to uterine myomatosis and now presents with a pelvic mass contacting the venous system through the right internal iliac vein and extending up to the right pulmonary artery. Surgical resection of the pelvic mass and intravenous tumor removal was successfully performed in a single-stage approach with cardiopulmonary bypass. Patient recovered satisfactorily, being asymptomatic at hospital discharge time. One-stage surgical approach needs a multidisciplinary surgical team and needs a longer operative time than two-stage approach. However it can be a safety treatment option for patients with good general condition. Furthermore cardiopulmonary bypass guarantees a safe procedure, avoiding renal and hepatic ischemia and potential embolizations into pulmonary circulation during mass or ilio cava venous sector manipulation.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"30 3","pages":"77-80"},"PeriodicalIF":0.0,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140159684","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":"Renal Doppler Ultrasound - a Late Diagnosis of Aortic Coarctation.","authors":"Ana Luísa Pinto, Alexandra Mesquita, João Pedro Vieira, Diogo Garrido, Sofia Dutra","doi":"10.48729/pjctvs.350","DOIUrl":"10.48729/pjctvs.350","url":null,"abstract":"<p><p>Aortic coarctation is characterized by a segmental narrowing of the aortic lumen, usually diagnosed and treated in the neonatal period or early childhood, but can remain undiagnosed until adulthood. It manifests as a broad spectrum of signs and symptoms, ranging from mild to severe, of which arterial hypertension is one of the most common. In this article, the authors describe the clinical case of a 9-year-old child under investigation in the Pediatric Department for secondary causes of arterial hypertension. A renal Doppler ultrasound study revealed the presence of bilateral parvus et tardus waveform morphology in renal and intrarenal arteries and the proximal abdominal aorta. These findings were suspicious for diagnosing aortic coarctation, which thoracic CTangio confirmed.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"30 3","pages":"89-91"},"PeriodicalIF":0.0,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140159681","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 Impact Of Active Chest Tube Clearance Technology On Surgical Outcomes After Cardiac Surgery: An Updated Systematic Review And Meta-Analysis.","authors":"Basil Ahmad, Vithusha Yogathasan, Eric Meng, William Khoury, Ali Alakhtar, Angel-Luis Fernandez, Mohammad El-Diasty","doi":"10.48729/pjctvs.379","DOIUrl":"10.48729/pjctvs.379","url":null,"abstract":"<p><strong>Objective: </strong>Active chest tube clearance technology (ACT) systems were introduced to improve the patency of chest tubes and to reduce the potential complications associated with inadequate mediastinal blood drainage after cardiac surgical procedures. The purpose of this study is to assess the impact of ACT on the incidence of chest tube clogging, retained blood syndromes (RBS), re-exploration for bleeding, and the incidence of postoperative atrial fibrillation (POAF) after cardiac surgical procedures.</p><p><strong>Methods: </strong>A database search was conducted using Medline, Embase, Cochrane Library, and Web of Science. Only articles comparing the use of ACT to conventional chest tube drainage after cardiac surgery were screened. Included articles were restricted to adult patients and English language only.</p><p><strong>Results: </strong>Nine of the 841 articles screened were included in this review. Two studies were randomized controlled trials (RCT) and seven were observational studies. Pooled estimates showed RBS, surgical re-exploration rates, and POAF were significantly less common in the ACT group.</p><p><strong>Conclusion: </strong>Our meta-analysis suggests that the use of ACT may be beneficial in reducing the incidence of postoperative complications associated with inadequate drainage of mediastinal blood after cardiac surgery. However, more robust evidence is required to endorse these findings and support the routing use of ACT in clinical practice.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"30 3","pages":"43-53"},"PeriodicalIF":0.0,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140159683","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":"Infective Endocarditis: A Prospective Registry Of Surgical Lesions.","authors":"Sara Ranchordás, Márcio Madeira, Paulo Oliveira, Marta Marques, Miguel Abecasis, Maria João Andrade, Miguel Sousa Uva, José Pedro Neves","doi":"10.48729/pjctvs.365","DOIUrl":"10.48729/pjctvs.365","url":null,"abstract":"<p><strong>Introduction: </strong>Infective endocarditis morbidity and mortality remains high. Surgery is performed in about half of endocarditis cases, being the ideal setting to evaluate endocarditis lesions. The aim of this study was to register and describe endocarditis lesions found during surgery; find predictors of morbidity and mortality and correlate lesions found in echocardiogram vs. surgery.</p><p><strong>Materials and methods: </strong>One hundred consecutive patients with endocarditis lesions seen during surgery were included between June 2014 and August 2018. Pathological lesions were coded prospectively using a coding form published by Pettersson et al. Other data were collected retrospectively.</p><p><strong>Results: </strong>Prosthetic endocarditis accounted for 23% of cases. Embolic events had occurred in 41% of cases, mainly to the brain (22%). The most frequent lesions found in echocardiogram were vegetations (77%). Vegetations and valve integrity anomalies were the main lesions described during surgery (70% and 71% respectively). Invasion was present in 39% of patients. In-hospital mortality was 9%. In univariable analysis, predictors of early mortality included chronic kidney disease (P= .005), prosthetic valve endocarditis (P <.001), EuroSCORE II (P <.001) and valve integrity anomalies (P=.016). Predictors of embolic events included aortic valve vegetations seen during surgery (P= .026). Sensitivity and specificity of echocardiogram findings for identification of vegetations were 84% and 40%, for valve integrity anomalies 42% and 97% and for invasion 54% and 95%, respectively.</p><p><strong>Conclusions: </strong>Diversity of lesions found in endocarditis precludes obtaining significant predictors of morbidity or mortality with small numbers of patients. Echocardiogram lacks sensitivity for valve integrity anomalies and invasion but is highly specific.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"30 3","pages":"21-30"},"PeriodicalIF":0.0,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140159675","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":"Maintaining Vascular Access Response in a Severely COVID-19 Hit Country.","authors":"João Diogo Castro, Paulo Almeida, Clemente Sousa, Paulo Teles, Norton De Matos","doi":"10.48729/pjctvs.349","DOIUrl":"10.48729/pjctvs.349","url":null,"abstract":"<p><strong>Introduction: </strong>The COVID-19 pandemic has caused an unprecedented disruption in healthcare systems worldwide, and Portugal was no exception. We analyze the impact of the COVID-19 pandemic in activity of our Vascular Access Center (Grupo Estudos Vasculares - GEV).</p><p><strong>Material and methods: </strong>This is a retrospective study, during March 2019 and February 2021. An analysis of surgical and appointments records in 2,495 patients from 25 hemodialysis centers followed by GEV was performed. Patients were divided into two periods: non-pandemic (NPP) (March 2019 to February 2020) and pandemic periods (PP) (March 2020 to February 2021). The number of surgeries and appointments were analyzed per month and per week. The number of thrombosis were analyzed in both periods. Normality was tested by the Shapiro-Wilk test and by the Lilliefors (Kolmogorov-Smirnov) test. Comparisons were made by the t-test (paired samples) when normality was not rejected and by the Wilcoxon test otherwise. All the variables (normal or otherwise) were described by the usual descriptive measures such as the mean, median and quartiles. No categorical data were collected. To avoid COVID-19 infection a set of measures were created: Sars-cov-2 PCR test for every patient, individual protection equipment for staff, rotating teams and schedules, and only one patient allowed in the circuit to the intervention room. A descriptive statistical analysis was performed with SPSS version28. The statistical significance was confirmed for p-value < 0.05.</p><p><strong>Results: </strong>A total of 1756 surgeries and 800 appointments were made in both PP and NPP. Comparing the periods, we performed 914 (52%) interventions in the NPP and 842 (48%) in PP, 423 (53%) consultations in NPP and 377 (47%) at PP. Comparing the NPP and PP by months we observed more appointments in the NPP (p=0.004). However, the difference in the number of surgeries did not reach statistical significance (p=0.533). There were more thrombosis during the summer and fall in the NPP and PP. A total of 138 in NPP and 131 in PP thrombosis were observed in the 2 years period. There was no record of COVID-19 infections between all GEV staff (n=25).</p><p><strong>Conclusion: </strong>Due to timed and tight set of measures taken in the pandemic lockdown by GEV, a similar clinical and surgical activity regarding hemodialysis patients was obtained in both periods (PP and NPP). The hypothesis that the PP could diminish vascular access assessment/intervention or more thrombosis could occur was not verified at our institution. The set of measures established to deal with the COVID-19 pandemic was also effective to prevent infection in staff members.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"30 3","pages":"37-41"},"PeriodicalIF":0.0,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140159678","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":"João Cid dos Santos seen by his disciples and colleagues.","authors":"Luís Mendes Pedro","doi":"10.48729/pjctvs.397","DOIUrl":"10.48729/pjctvs.397","url":null,"abstract":"","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"30 3","pages":"13-19"},"PeriodicalIF":0.0,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140159677","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":"Minimally Invasive Concomitant Aortic And Mitral Valve Surgery - Initial Experience Of A Single Centre.","authors":"Daniel Martins,&nbsp;João Lopes Cardoso,&nbsp;Sara Costa,&nbsp;João Pedro Monteiro,&nbsp;Fátima Neves","doi":"10.48729/pjctvs.359","DOIUrl":"https://doi.org/10.48729/pjctvs.359","url":null,"abstract":"<p><strong>Introduction: </strong>Valve surgery through a median sternotomy has been the standard approach, but in the past decade various minimally invasive procedures have gained increasing traction among physicians and patients.</p><p><strong>Materials and methods: </strong>We present a series of three patients submitted to minimally invasive combined aortic and mitral valve surgery, performed through right lateral thoracotomy.</p><p><strong>Results: </strong>We report no postoperative complication or mortality. Mean length of stay was 5 days, with a self-reported pain score 2/5 (mild/annoying pain).</p><p><strong>Conclusions: </strong>We report our initial experience, describing surgical technique and postoperative results, showing this technique to be safe, reproductible and comparable to conventional surgery.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"30 2","pages":"15-18"},"PeriodicalIF":0.0,"publicationDate":"2023-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9862754","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":"Primary Cutaneous Adenoid Cystic Carcinoma Of The Chest Wall With Axillary Lymph Node Metastases And Its Management: A Case Report.","authors":"Klein Dantis,&nbsp;Radhakrishna Ramchandani,&nbsp;Shamendra Anand Sahu,&nbsp;Vandita Yogendra Singh,&nbsp;Subhajit Dasgupta","doi":"10.48729/pjctvs.293","DOIUrl":"https://doi.org/10.48729/pjctvs.293","url":null,"abstract":"<p><p>Primary cutaneous adenoid cystic carcinoma (PCACC) is a rare form of adenoid cystic carcinoma (ACC) arising commonly from the salivary gland. Less often they originate outside the head and neck region, with the scalp being the commonest cutaneous site in 40% of the cases. The presentation on the chest wall is rare, with no reports to date on axillary lymph node metastases. Here we report a case of a 65-year-old female with previously operated PCACC of the chest wall at a different center, showing uptake on positron emission tomography imaging at the site of surgical scar that w as inconclusive on needle biopsy metastasized to the axillary lymph node confirmed by needle biopsy managed with wide local excision, axillary lymph node dissection, and chest wall reconstruction with keystone island flap. The postoperative outcome was uneventful with no recurrence or axillary complications at one year's follow-up. She was advised to receive adjuvant radiotherapy; however, she refused. To conclude, though PCACC is rare, they can have an aggressive presentation, and a multidisciplinary approach is necessary for a better outcome.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"30 2","pages":"51-54"},"PeriodicalIF":0.0,"publicationDate":"2023-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9797633","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}