The standard treatment for stroke risk patients with non-valvular atrial fibrillation (NVAF) is the use of oral anticoagulants (OACs). However, a substantial number of patients have relative or absolute contraindications to OACs due to concerns of major bleeding risk and other adverse effects while using oral anticoagulation therapy. Recently, occurrences of exclusion of the left atrial appendage (LAA) in patients with contraindication to anticoagulation therapy are widely expanding worldwide, causing major contentious discussions. The LAA is the commonest place of thrombus formation; therefore, the concept of LAA occlusion in reducing stroke and other embolic events in NVAF patients is very important. The current understanding of the available evidence on efficacy and safety of LAA closure (LAAC) with the Watchman device in patients contraindicated to OACs is the major aim of this focused review. After reviewing a significant body of literature, a world experience with no randomized trials, it is suggested that Watchman device implantation is effective and safe in high-risk patients with NVAF contraindicated to OACs therapy.
Patients with aortitis often present with nonspecific constitutional symptoms. Due to the fact that aortitis is associated with inflammatory or infectious courses, patients may manifest fever or fever of unknown origin. Such clinical characteristics of aortitis are unavoidably brought about diagnostic dilemmas and might lead to a series of unnecessary work-ups and maltreatment. Therefore, it is important for the clinical physicians and surgeons to understand aortitis presenting with fever of unknown origin to avoid delayed diagnosis and treatment. In this article, clinical and pathological features of aortitis (giant cell arteritis, Takayasu arteritis and infective aortitis, etc.) with fever of unknown origin are described and the differential diagnosis and management policy are discussed.
Purpose: Surgical resection and reconstruction are considered the most appropriate approaches to treat post-intubation tracheal stenosis (PITS). Bronchoscopic methods can be utilized as palliative therapy in patients who are ineligible for surgical treatment or who develop post-surgical re-stenosis. We investigated treatment outcomes in patients with benign tracheal stenosis.
Methods: A retrospective review was performed in patients who were diagnosed with PITS. Tracheal resection was performed for operable cases, whereas endoscopic interventions were preferred for inoperable cases with a complex or simple stenosis.
Results: In total, 42 patients (23 treated by bronchoscopic methods, 19 treated by surgery) took part in this study. No significant differences were observed in segment length, the proportion of obstructed airways, or vocal cord distance between the two groups. In all, 15 patients in the bronchoscopic treatment group received a stent. Following the intervention, the cure rates in the bronchoscopic and surgical treatment groups were 43.47% and 94.7%, respectively. A multidisciplinary approach resulted in a cure or satisfactory outcome in 90.5% of the patients while failure was noted in 9.5% of the patients.
Conclusion: Bronchoscopic methods are associated with a lower cure rate compared to surgery. A multidisciplinary approach was helpful for treatment planning in patients with PITS.
Purpose: Utilization of donation after circulatory death (DCD) donors has the potential to decrease donor shortage in lung transplantation (LTx). This study reviews the long-term outcome of LTx from DCD donors.
Methods: We included all consecutive DCD (Maastricht Category III) and all donations after brain death (DBD) donor lung transplants at our Center performed between January 2012 and February 2017. Data were analyzed comparing the two groups in regard of survival after LTx as primary outcome.
Results: Median withdrawal to cardiac arrest time was 17 min (interquartile range [IQR]: 11.5–20.5). Median cardiac arrest to cold perfusion was 32 min (IQR: 24.5–36.5). Primary graft dysfunction (PGD) grade 3 at T72 occurred in three recipients. Chronic lung allograft dysfunction (CLAD) led to death in two cases. In DCD group, there was no 90-day mortality. In DCD, group 1- and 3-year survival rates were 100% and 80%. In DBD group, 1- and 3-year survival rates were 85% and 69% (p = 0.4).
Conclusions: Our report confirmed the comparable outcome from DCD donors compared with DBD donors. Utility of DCD donors is a safe option to overcome donor shortage.
Background: The nuclei of most cancer cells in histopathologic preparations differ from normal nuclei and vary individually in size, shape, and chromatin pattern. Although the cytologic characteristics of squamous cell carcinoma (SCC) of the lung have been described, quantification of the cytologic features has not been established.
Methods: Cytologic investigations were performed on bronchial brushings or washings, or fine-needle aspirates. We analyzed the nuclear area (NA) of 50 tumor cells in 32 patients with SCC of the lung and 50 bronchial epithelial cells in 20 patients with no evidence of malignancy including inflammatory lesions.
Results: The NA of tumor cells (102.4 ± 26.2 μm2) was significantly larger than that of bronchial epithelial cells (64.1 ± 16.9 μm2) (P = 0.001). The receiver operating characteristic (ROC) curve analysis showed that an NA cutoff level of 86 μm2 had a sensitivity of 75% and specificity of 88% to detect malignant components.
Conclusion: We conducted quantitative analyses of NA in SCC using cytologic specimen, NA was a useful parameter for evaluation of differential diagnosis between SCC and non-malignancies even in cytologic specimens.
Background: Perventricular and transcatheter device closures are performed for perimembranous ventricular septal defect (pmVSD) to reduce the surgical trauma of conventional surgical repair via median sternotomy. Few comparative studies have been conducted among these three procedures.
Methods: From June 2015 to May 2016, 247 patients with isolated pmVSD who had undergone perventricular or transcatheter device closure or conventional surgical repair were reviewed to compare these three procedures.
Results: The procedure success rate was similar in these three groups. There were a statistically significant difference in operative time, aortic cross-clamping time, duration of cardiopulmonary bypass (CPB), blood transfusion amount, and medical cost in these three groups. Meanwhile, postoperative mechanical ventilation time, duration of intensive care, and length of hospital stay were longer in surgical group than the other two groups. The surgical group required the longest incision. No significant difference was noted in major adverse events. There were different advantages and disadvantages in these three kinds of procedures.
Conclusions: Device closure may be alternative to conventional surgical repair for patients with isolated pmVSD. Perventricular device closure was the preferred procedure because it showed more maneuverable than transcatheter procedure with the same clinical result.
In Behçet’s disease (BD) patients, endovascular repair is a reasonable alternative treatment for aortic aneurysms to avoid postoperative anastomotic pseudoaneurysms. However, there are some complications that may occur after endovascular repair. We herein report the case of a 40-year-old man with active BD developed recurrent aortic pseudoaneurysms at the proximal and distal margins of the stent graft and a femoral puncture site pseudoaneurysm 3 months after endovascular abdominal aortic aneurysm (AAA) repair. The aortic pseudoaneurysms were treated endovascularly, including the use of the chimney technique for the proximal pseudoaneurysm close to the renal arteries and the femoral pseudoaneurysm with surgical excision and reconstruction. Intensive immunosuppressive therapy was initiated immediately after the operation. The patient is in good condition without any complications at 8-month follow-up. This case suggests the utility of the chimney technique and postoperative immediate intensive immunosuppressive therapy in treating recurrent aortic pseudoaneurysms in emergency, active BD patients.
Background: Localized aortic dissection on the left coronary cusp with critical malperfusion of the left main trunk (LMT) is rare and carries a high risk of death.
Case presentation: We report a case of a 48-year-old patient who developed localized aortic dissection of the left coronary cusp complicated by critical malperfusion of the LMT of the coronary artery. After percutaneous coronary intervention (PCI) for the LMT, a Koster–Collins-like direct repair of the localized aortic dissection was carried out by closure of the false channel using BioGlue (CyroLife, Inc., Kennesaw, GA, USA) with the reinforcement of double Teflon felt strips.
Conclusion: The aortic repair using a modified Koster–Collins technique was successful.
Purpose: The surgical management of the patients with traumatic sternal fractures remains controversial. The aim of this study was to evaluate the effectiveness of an early surgical reconstruction of a displaced sternal fracture utilizing longitudinal rigid polymer fixation in the settings of an acute chest trauma.
Methods: To perform the sternal fixation, we utilized a longitudinal rigid plating system. The plate is made of polyether ether ketone (PEEK), an organic thermoplastic polymer.
Results: We used the entire length of the plate on each side of the fracture, secured in multiple places with 6–8 screws. Once the plates have been fully secured we tighten all the screws with a screwdriver. We demonstrated that the method minimizes pain and prevents the development of pulmonary complications.
Conclusion: This technique provides cosmetically acceptable results, minimizing risk of sternal nonunion, and decreases length of hospitalization.