Transaxillary Approach for Surgical Repair of Simple Congenital Cardiac Lesions: Pitfalls, and Complications

Background: In the treatment of simple congenital cardiac lesions, percutaneous and cosmetic surgical approaches have steadily gained prominence. Surgically, right vertical axillary approach is sparsely used despite superior cosmesis and less pain and blood product usage. Knowledge of potential pitfalls could lead to its more widespread acceptance. Methods: We retrospectively analyzed perioperative outcomes of 104 consecutive patients who underwent surgery by this technique between mid-2016 and December 2019, including ostium secundum (67), sinus venosus (34), coronary sinus (1), and ostium primum (1) atrial septal defects and hemianomalous pulmonary venous connection (1). Perioperative variables, surgical times, complications, and follow-up data were analyzed. Results: Patient weight ranged from 6.8 to 41 kg. Incision length ranged from 4 to 6 cm. There was no mortality. All cannulation was central. Difficulty in cannulation (inferior vena cava) was seen in two patients. Morbidity included pneumothorax in 2 (1.9%) patients and subcutaneous emphysema necessitating prolonged intercostal drain retention in 20 (19.2%) patients. Surgical time increased linearly (r = 0.567; P < .001) with increasing patient weight but cardiopulmonary bypass (CPB) time remained unaffected. No chest deformities or paresthesia were noted on follow-up. Scar size decreased in some patients. Conclusions: Right vertical axillary approach can be safely employed to treat simple congenital cardiac lesions with adequate awareness of potential pitfalls. Increasing patient weight increases the surgical time but does not affect CPB times. Incidence of pneumothorax and subcutaneous emphysema is similar to other thoracotomy approaches. It is cosmetically superior.

Download Full-text

Cementless Primary Total Hip Arthroplasty with a Trabecular Titanium Implant: Results at Short-to-Medium-Term Follow-Up

The Journal of Hip Surgery ◽

10.1055/s-0039-1678745 ◽

2019 ◽

Vol 03 (01) ◽

pp. 048-052

Author(s):

Andrea Bertagnon ◽

Luca Celotti ◽

Fabio D'Angelo ◽

Steven Harwin ◽

Ettore Vulcano ◽

...

Keyword(s):

Blood Loss ◽

Harris Hip Score ◽

Acetabular Cup ◽

Medium Term ◽

Surgical Time ◽

Total Hip ◽

Heterotopic Ossifications ◽

Patient Weight ◽

Highly Porous

AbstractOver the last two decades, cementless hip prostheses gained increasing popularity. Highly porous, trabecular coatings and their promising bone-friendly properties also came to a wider diffusion. As a consequence, this study was aimed to evaluate clinical and radiographic results at short-to-medium term of cementless prosthetic implants with trabecular titanium cup and titanium femoral metaphyseal stem highly porous coatings. From September 2012 to June 2015 213, cementless total hip arthroplasties were performed in 200 patients. All patients received a cementless Accolade II stem and Tritanium cup with UHMWPE Trident X3 Bearing Technology polyethylene liner. All surgeries were performed using a tissue-sparing modified posterolateral approach. All patients underwent prophylaxis for heterotopic ossifications. For every patient, the following data were collected: age, gender, height, weight, body mass index, blood loss, preoperative and postoperative hemoglobin, surgical time, and complications. Harris Hip Score was obtained for every patient. Radiographic measurements were performed using a freeware software (TraumaCAD 2.0). The computed parameters were inclination and anteversion of acetabular cup and presence of heterotopic ossification. The mean follow-up was 37.7 months from surgery. Data were analyzed by SPSS software v 24.0. The postoperative average Harris Hip Score was 87.4 points (range, 40.5–95.7) and 91 patients scored excellent results, with more than 90 points (52.4%). Heterotopic ossifications were seen in 12 patients (6.9%) and correlated to patient weight, surgical timing, and hemoglobin values. There were three cases of dislocation (1.7%) that significantly correlated with cup inclination (R 2 = 17.9; p = 0.018). One cup underwent early revision because of undersizing of the component and subsequent lack of integration, thus leading to an overall survivorship of 99.4%. In conclusion, excellent medium-term functional outcome, patient satisfaction, and low complications rate were observed for the studied implant. A higher incidence of heterotopic ossifications was significantly correlated to patient weight, surgical time, blood loss, and transfusions. Also, inclination of the acetabular cup proved to be correlated to hip dislocation.

Download Full-text

Transaxillary Surgical Ligation of Patent Ductus Arteriosus in Paediatric Group of Patient

Cardiovascular Journal ◽

10.3329/cardio.v11i2.40410 ◽

2019 ◽

Vol 11 (2) ◽

pp. 114-117

Author(s):

Md Zahidul Islam ◽

Kazi Abul Hasan ◽

Khondokar Shamim Shahriar Ziban Rushel ◽

Shahriar Moinuddin ◽

Saiful Islam Siraji ◽

...

Keyword(s):

Patent Ductus Arteriosus ◽

Ductus Arteriosus ◽

Patient Discharge ◽

Transaxillary Approach ◽

Surgical Ligation ◽

Axillary Approach ◽

Superficial Wound ◽

Age Range ◽

Patent Ductus

Background: Patent ductus arteriosus is a frequent congenital anomaly with left to right shunt. The aim of this study is to assess 3 years’ experience of transaxillary approach in surgical ligation of patent ductus arteriosus. Methods: In three years from July 2015 to September 2017, 46 patients underwent in surgical ligation of patent ductus arteriosus through transaxillary approach. All patients had undergone elective operation. Intra operative and post-operative data were analyzed and follow up after 1 month and 3 years. Results: There were 18 male (39%) and 28 female (61%). Their age range was from 5 months to 10 years months (mean 39.2±24.7 months) and body weight ranges from 4.5 kg to 32 kg (mean 16.05±6.63 kg).There was no mortality or residual patency. Morbidity includes superficial wound infection and chylothorax. All patient discharge on 3rd-5th postoperative day except those who developed chylothorax was discharged after 8 days. Conclusion: Trans axillary approach for closure of PDA has moved from an alternative incision to a standard posterolateral incision in our experience. It is less traumatic and more cosmetic. Cardiovasc. j. 2019; 11(2): 114-117

Download Full-text

Evaluation of Thoracoscopic Pericardial Window Size and Execution Time in Dogs: Comparison of Two Surgical Approaches

Animals ◽

10.3390/ani11051438 ◽

2021 ◽

Vol 11 (5) ◽

pp. 1438

Author(s):

Francesco Macrì ◽

Vito Angileri ◽

Claudia Giannetto ◽

Lorenzo Scaletta ◽

Piero Miele ◽

...

Keyword(s):

Pericardial Effusion ◽

Surgical Technique ◽

Cardiac Tamponade ◽

Execution Time ◽

Clinical Signs ◽

Window Size ◽

Surgical Approaches ◽

Surgical Time ◽

Pericardial Window

Pericardial effusion presents clinicians with a challenge when diagnosing the underlying cause and performing a prognosis. Different techniques have been suggested for canine thoracoscopic pericardiectomy with the creation of variable pericardial window size. The aim of this study was to statistically compare the surgical time and achieved window size of the paraxiphoid transdiaphragmatic and monolateral intercostal approaches. The paraxifoid and monolateral intercostal approaches showed a mean surgical time of 55 ± 20.08 (SD) minutes and 13.94 ± 4.61 (SD) minutes, and a mean pericardial window diameter of 4.23 ± 0.80 (SD) cm and 3.31 ± 0.43 (SD) cm, respectively. A significant correlation was observed between the dogs’ bodyweight and window size (r = 0.48; p = 0.04) for both surgical approaches, and between the dogs’ bodyweight and surgical time (r = 0.72; p = 0.0016) for monolateral intercostal approach. All treated dogs showed no clinical signs of recurrent cardiac tamponade during the follow-up. Our results provided useful information to help surgeons make the definitive choice of the surgical technique to treat the pericardial effusion.

Download Full-text

Perioperative outcomes associated with thoracolumbar 3-column osteotomies for adult spinal deformity patients with rheumatoid arthritis

Journal of Neurosurgery Spine ◽

10.3171/2018.11.spine18927 ◽

2019 ◽

Vol 30 (6) ◽

pp. 822-832

Author(s):

Cecilia L. Dalle Ore ◽

Christopher P. Ames ◽

Vedat Deviren ◽

Darryl Lau

Keyword(s):

Rheumatoid Arthritis ◽

Spinal Deformity ◽

Perioperative Complications ◽

Adult Spinal Deformity ◽

Vena Cava ◽

Deformity Correction ◽

Perioperative Outcomes ◽

Medical Complications ◽

Filter Placement ◽

Estimated Blood Loss

OBJECTIVESpinal deformity causing spinal imbalance is directly correlated to pain and disability. Prior studies suggest adult spinal deformity (ASD) patients with rheumatoid arthritis (RA) have more complex deformities and are at higher risk for complications. In this study the authors compared outcomes of ASD patients with RA following thoracolumbar 3-column osteotomies to outcomes of a matched control cohort.METHODSAll patients with RA who underwent 3-column osteotomy for thoracolumbar deformity correction performed by the senior author from 2006 to 2016 were identified retrospectively. A cohort of patients without RA who underwent 3-column osteotomies for deformity correction was matched based on multiple clinical factors. Data regarding demographics and surgical approach, along with endpoints including perioperative outcomes, reoperations, and incidence of proximal junctional kyphosis (PJK) were reviewed. Univariate analyses were used to compare patients with RA to matched controls.RESULTSEighteen ASD patients with RA were identified, and a matched cohort of 217 patients was generated. With regard to patients with RA, 11.1% were male and the mean age was 68.1 years. Vertebral column resection (VCR) was performed in 22.2% and pedicle subtraction osteotomy (PSO) in 77.8% of patients. Mean case length was 324.4 minutes and estimated blood loss (EBL) was 2053.6 ml. Complications were observed in 38.9% of patients with RA and 29.0% of patients without RA (p = 0.380), with a trend toward increased medical complications (38.9% vs 21.2%, p = 0.084). Patients with RA had a significantly higher incidence of deep vein thrombosis (DVT)/pulmonary embolism (PE) (11.1% vs 1.8%, p = 0.017) and wound infections (16.7% vs 5.1%, p = 0.046). PJK occurred in 16.7% of patients with RA, and 33.3% of RA patients underwent reoperation. Incidence rates of PJK and reoperation in matched controls were 12.9% and 25.3%, respectively (p = 0.373, p = 0.458). At follow-up, mean sagittal vertical axis (SVA) was 6.1 cm in patients with RA and 4.5 cm in matched controls (p = 0.206).CONCLUSIONSFindings from this study suggest that RA patients experience a higher incidence of medical complications, specifically DVT/PE. Preoperative lower-extremity ultrasounds, inferior vena cava (IVC) filter placement, and/or early initiation of DVT prophylaxis in RA patients may be indicated. Perioperative complications, morbidity, and long-term outcomes are otherwise similar to non-RA patients.

Download Full-text

Partial Anomalous Pulmonary Venous Connection: Forty-Six Years of Follow-Up

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135120960482 ◽

2021 ◽

Vol 12 (1) ◽

pp. 70-75

Author(s):

Anne Kathrine M. Nielsen ◽

Vibeke E. Hjortdal

Keyword(s):

Superior Vena Cava ◽

Superior Vena ◽

Sinus Node ◽

Vena Cava ◽

Node Disease ◽

Sinus Node Disease ◽

Patch Technique ◽

Anomalous Pulmonary Venous Connection

Background: Surgical repair of partial anomalous pulmonary venous connection (PAPVC) may disturb the electrical conduction in the atria. This study documents long-term outcomes, including the late occurrence of atrial tachyarrhythmia and bradyarrhythmia. Methods: This retrospective study covers all PAPVC operations at Aarhus University Hospital between 1970 and 2010. Outcome measures were arrhythmias, sinus node disease, pacemaker implantation, pathway stenosis (pulmonary vein(s), intra-atrial pathway, and/or superior vena cava), and mortality. Data were collected from databases, surgical protocols, and hospital records until May 2018. Results: A total of 83 patients were included with a postoperative follow-up period up to 46 years. Average age at follow-up was 43 ± 21 years. During follow-up, new-onset atrial fibrillation or atrial flutter appeared in four patients (5%). Sinus node disease was present in nine patients (11%). A permanent pacemaker was implanted in seven patients (8%) at an average of 12.7 years after surgery. Pulmonary venous and/or superior vena cava obstruction was seen in five patients (6%). Stenosis was most prevalent in the two-patch technique, and arrhythmia was most prevalent in the single-patch technique. Sixty-seven (81%) of 83 patients had neither bradyarrhythmias nor tachyarrhythmias or pacemaker need. Conclusions: This study contributes important long-term data concerning the course of patients who have undergone repair of PAPVC. It confirms that PAPVC can be operated with low postoperative morbidity. However, late-onset stenosis, bradyarrhythmias and tachyarrhythmias, and need for pacemaker call for continued follow-up.

Download Full-text

Percutaneous vertebroplasty versus kyphoplasty for the treatment of neurologically intact osteoporotic Kümmell’s disease

BMC Surgery ◽

10.1186/s12893-021-01057-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shou-qian Dai ◽

Rong-qing Qin ◽

Xiu Shi ◽

Hui-lin Yang

Keyword(s):

Blood Loss ◽

Bone Cement ◽

Percutaneous Vertebroplasty ◽

Cement Leakage ◽

Intraoperative Blood Loss ◽

Surgical Time ◽

Significant Difference ◽

Neurologically Intact ◽

Operation Cost

Abstract Background Percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) have been widely used to treat neurologically intact osteoporotic Kümmell’s disease (KD), but it is still unclear which treatment is more advantageous. Our study aimed to compare and investigate the safety and clinical efficacy of PVP and PKP in the treatment of KD. Methods The relevant data that 64 patients of neurologically intact osteoporotic KD receiving PVP (30 patients) or PKP (34 patients) were analyzed. Surgical time, operation costs, intraoperative blood loss, volume of bone cement injection, and fluoroscopy times were compared. Occurrence of cement leakage, transient fever and re-fracture were recorded. Universal indicators of visual analogue scale (VAS) and Oswestry disability index (ODI) were evaluated separately before surgery and at 1 day, 6 months, 1 year, 2 years and the final follow-up after operation. The height of anterior edge of the affected vertebra and the Cobb’s angle were assessed by imaging. Results All patients were followed up for at least 24 months. The volume of bone cement injection, intraoperative blood loss, occurrence of bone cement leakage, transient fever and re-fracture between two groups showed no significant difference. The surgical time, the operation cost and fluoroscopy times of the PKP group was significantly higher than that of the PVP group. The post-operative VAS, ODI scores, the height of the anterior edge of the injured vertebrae and kyphosis deformity were significantly improved in both groups compared with the pre-operation. The improvement of vertebral height and kyphosis deformity in PKP group was significantly better than that in the PVP group at every same time point during the follow-up periods, but the VAS and ODI scores between the two groups showed no significant difference. Conclusion PVP and PKP can both significantly alleviate the pain of patients with KD and obtain good clinical efficacy and safety. By contrast, PKP can achieve better imaging height and kyphosis correction, while PVP has the advantages of shorter operation time, less radiation volume and operation cost.

Download Full-text

Multiple pericardial hematomas: a case report and mini-review in multimodality imaging

BMC Medical Imaging ◽

10.1186/s12880-021-00617-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Aninka Saboe ◽

Ferdy Sanjaya ◽

Raden Erwin Affandi Soeriadi ◽

Euis Maryani ◽

Nuraini Yasmin Kusumawardhani ◽

...

Keyword(s):

Cardiac Surgery ◽

Cardiac Imaging ◽

Single Photon ◽

Multimodality Imaging ◽

Photon Emission ◽

Vena Cava ◽

Intracardiac Thrombus ◽

Surgical Closure ◽

The Right

Abstract Background Pericardial hematoma is blood accumulation in the pericardial space. Although rare, it could arise in various conditions, such as after cardiac surgery. Clinical diagnosis of pericardial hematoma is implausible; thus, cardiac imaging plays a pivotal role in identifying this condition. We presented a case of multiple pericardial hematomas, which was found as an incidental finding in post-cardiac surgery evaluation. We highlighted the diagnostic challenge and the key features of multi-modality cardiac imaging in pericardial hematoma evaluation. Case presentation An asymptomatic, 35-years old male, who underwent surgical closure of secundum atrial septal defect (ASD) one month ago, came for routine transthoracic echocardiography evaluation. An intrapericardiac hematoma was visualized at the right ventricle (RV) 's free wall side. Another mass with an indistinct border was visualized near the right atrium (RA). This mass was suspected as pericardial hematoma differential diagnosed with intracardiac thrombus. Cardiac computed tomography (CT) scan showed both masses have an attenuation of 30–40 HU; however, the mass's border at the RA side was still not clearly delineated. Mild superior vena cava (SVC) compression and multiple mediastinal lymphadenopathies were also detected. These findings are not typical for pericardial hematomas nor intracardiac thrombus; hence another additional differential diagnosis of pericardial neoplasm was considered. We pursued further cardiac imaging modalities because the patient refused to undergo an open biopsy. Single-photon emission computer tomography (SPECT)/CT with Technetium-99 m (Tc-99 m) macro-aggregated albumin (MAA) and Sestamibi showed filling defect without increased radioactivity, thus exclude the intracardiac thrombus. Cardiac magnetic resonance imaging (MRI) reveals intrapericardial masses with low intensity of T1 signal and heterogeneously high intensity on T2 signal weighted imaged and no evidence of gadolinium enhancement, which concluded the diagnosis as subacute pericardial hematomas. During follow-up, the patient remains asymptomatic, and after six months, the pericardial hematomas were resolved. Conclusion Pericardial hematoma should be considered as a cause of pericardial masses after cardiac surgery. When imaging findings are atypical, further multi-modality cardiac imaging must be pursued to establish the diagnosis. Careful and meticulous follow-up should be considered for an asymptomatic patient with stable hemodynamic.

Download Full-text

The role of MDCT in the assessment of cardiac and extra-cardiac vascular defects among Egyptian children with tetralogy of Fallot and its surgical implementation

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00426-z ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Ahmed Elshimy ◽

Rasha Tolba Khattab ◽

Hend Galal Eldeen Mohamed Ali Hassan

Keyword(s):

Tetralogy Of Fallot ◽

Heart Diseases ◽

Preoperative Evaluation ◽

Vena Cava ◽

Predictive Values ◽

Surgical Interventions ◽

Vascular Abnormalities ◽

Egyptian Children ◽

Cardiac Lesions ◽

Cyanotic Congenital Heart Diseases

Abstract Background Tetralogy of Fallot (TOF) is considered the most common form of cyanotic congenital heart diseases (CHD), accounting for about 10% of cases. It includes four main cardiac defects, in addition to various extra-cardiac anomalies. Aim This study aimed to evaluate cardiac and extra-cardiac vascular defects associated with TOF among Egyptian children, regarding frequency and types with assessment of multi-slice or multi-detector computed tomography (MDCT) role in their diagnosis. Definitely, full detection of these vascular anomalies has utmost importance when evaluating such patients particularly before surgical intervention. Methods This study included 60 pediatric patients diagnosed as TOF, who underwent MDCT examination in our institute during period of 6 months from (March to September 2020), to confirm their trans-thoracic echocardiography (TTE) findings and detect other vascular abnormalities which cannot be precisely detected with TTE before their surgical interventions. Results The incidence of different extra-cardiac vascular defects diagnosed by MDCT among our patients was 85% which was significantly higher than that detected by TTE (55%). Moreover, MDCT was superior to TTE assessment as regards its diagnostic accuracy (96.6% vs. 80%), sensitivity (98% vs. 76.9%), and specificity (88.9% vs. 85.7%), in addition to both positive and negative predictive values. The most common anomalies detected were affecting the pulmonary artery (80%), followed by aorto-pulmonary vessels (45%), then aortic artery (40%), coronary arteries (20%), and lastly vena cava connection (6.7%). Patients’ demographic characteristics and clinical presentations were also presented. Conclusion This study confirmed that many extra-cardiac vascular defects are commonly associating cardiac lesions in TOF and emphasizing the great value of MDCT in their diagnosis. Certainly, proper detection of these anomalies will help decision-making during preoperative evaluation, corrective interventions, and further management of these cases.

Download Full-text

Evolution of Surgical Approaches in the Treatment of Petroclival Meningiomas: A Retrospective Review

Operative Neurosurgery ◽

10.1227/01.neu.0000303218.61230.39 ◽

2007 ◽

Vol 61 (suppl_5) ◽

pp. ONS202-ONS211 ◽

Cited By ~ 36

Author(s):

Nicholas C. Bambakidis ◽

U. Kumar Kakarla ◽

Louis J. Kim ◽

Peter Nakaji ◽

Randall W. Porter ◽

...

Keyword(s):

Survival Rates ◽

Progression Free Survival ◽

Surgical Approaches ◽

Single Institution ◽

Short Term ◽

Total Resection ◽

Free Survival ◽

Petroclival Meningioma ◽

Petroclival Meningiomas

Abstract Objective: We examined the surgical approaches used at a single institution to treat petroclival meningioma and evaluated changes in method utilization over time. Methods: Craniotomies performed to treat petroclival meningioma between September of 1994 and July of 2005 were examined retrospectively. We reviewed 46 patients (mean follow-up, 3.6 yr). Techniques included combined petrosal or transcochlear approaches (15% of patients), retrosigmoid craniotomies with or without some degree of petrosectomy (59% of patients), orbitozygomatic craniotomies (7% of patients), and combined orbitozygomatic-retrosigmoid approaches (19% of patients). In 18 patients, the tumor extended supratentorially. Overall, the rate of gross total resection was 43%. Seven patients demonstrated progression over a mean of 5.9 years. No patients died. At 36 months, the progression-free survival rate for patients treated without petrosal approaches was 96%. Of 14 patients treated with stereotactic radiosurgery, none developed progression. Conclusion: Over the study period, a diminishing proportion of patients with petroclival meningioma were treated using petrosal approaches. Utilization of the orbitozygomatic and retrosigmoid approaches alone or in combination provided a viable alternative to petrosal approaches for treatment of petroclival meningioma. Regardless of approach, progression-free survival rates were excellent over short-term follow-up period.

Download Full-text