Project description:Tracheal sleeve pneumonectomy for lung cancer is an old technique, and it is reserved for exceptional cases with tracheal carina involvement. Intra-operative airways management of this operation is incredibly complex, involving thoracic surgeons, anaesthesiologists and pulmonologists. We report a case of a 38-year-old male with no clinical history, referred to our department for an adenoid-cystic carcinoma involving distal trachea, carina and main right bronchus. Tracheal sleeve pneumonectomy was performed using extra-corporeal membrane oxygenation (ECMO). A veno-venous ECMO circuit was established through a heparin-coated percutaneous cannula in the right femoral vein and a heparin-coated percutaneous cannula in the internal right jugular vein by ultrasound assistance. No major complications occurred, and the patient was discharged after 30-day bronchoscopic control, showing the absence of fistula and negativity of the methylene blue test. ECMO-assisted surgery ensures adequate respiratory support, haemodynamic stability, lower risk of bleeding complications with a clean operating field and better brain and myocardial oxygenation.
Project description:Left sleeve pneumonectomy is a rarer intervention compared with right sleeve pneumonectomy. It is a challenging surgical therapeutic strategy even when performed through open thoracotomy. Here, we report a case of uniportal video-assisted thoracoscopic surgery (VATS) left sleeve pneumonectomy in a patient with non-small cell lung cancer. The tumor, located at the opening of left upper lobe bronchus, submucosally invaded the orifice of lower lobe extending upward to 4 to 5 cartilage rings of the left main bronchus and to the level of the carina. Left sleeve pneumonectomy and airway reconstruction was performed through video-assisted thoracoscopic completely with an incision of 4 cm. The total operative time was 220 minutes and the estimated intraoperative blood loss was 300 mL. Chylothorax occurred after surgery, which was well handled, and no other severe complication was observed. Three months after the surgery, the follow-up bronchoscopy revealed good healing of the anastomosis. No signal of tumor recurrence was observed by follow-up examination 1 year after the surgery. To our knowledge, this is the first reported uniportal VATS left sleeve pneumonectomy in the world. It was indicated that uniportal VATS might be a feasible approach for left sleeve pneumonectomy, with less surgical trauma compared with other approaches.
Project description:We report a case of infective endocarditis with a septal abscess that was complicated with abnormal blood flow from the left ventricle to the right atrium (Gerbode defect) along with abnormal blood flow from the aorta to the right atrium (atrial-aortic fistula). This is the first reported case of successful correction of both defects by a percutaneous approach.
Project description:Oesophageal rupture after pneumonectomy is very rare. Management remains a significant challenge. This current case report describes a patient that underwent right pneumonectomy for right central squamous cell carcinoma. On the third day after the operation, food residues were observed in the thoracic tube. Considering oesophageal rupture, surgery was performed. Intraoperative oesophageal rupture was observed and intermittent suture was performed. Unfortunately, an oesophageal pleural fistula developed. Anti-infection treatment, chest drainage, thoracic irrigation, nutrition support and stent implantation were used after the operation. The patient recovered smoothly and had no discomfort when eating. Oesophageal rupture after pneumonectomy is extremely rare and treatment is very difficult. In our opinion, surgical repair is the key to the treatment of oesophageal rupture. Once an oesophageal pleural fistula occurs, enhanced nutrition, adequate irrigation and drainage and stent implantation are critical factors.
Project description:Highlights•Aorto-right ventricular fistula is a rare diagnosis and is on the spectrum of aortic periannular rupture.•Multimodality imaging is crucial in identifying aortic periannular rupture, defining its course, and for preprocedural planning.•We describe a case of aorto-right ventricular fistula, which was successfully treated using an Amplazter vascular plug intravenous device (St. Jude Medical) and is to our knowledge the first reported case of using a plugging device for this type of disorder.