Kanhua Yin

Sinus of Valsalva aneurysms with concomitant aortic insufficiency: how should the aortic valve be managed?

OBJECTIVES Sinus of Valsalva aneurysms (SVAs) are rare and are often complicated by aortic insufficiency (AI). Treating AI is important for achieving good long-term results in patients with SVA. Here, we have summarized our experience with the surgical management of patients with SVA with concomitant AI. METHODS Patients who were diagnosed with SVA and underwent surgical treatment between January 2008 and May 2016 were included. Clinical characteristics, including age, gender, SVA anatomy and concurrent anomalies, were analysed. The surgical strategies, intraoperative results and early and late outcomes were evaluated. RESULTS A total of 178 patients (age 37.4 ± 13.1 years, 114 men) were identified. Eighty-seven (48.9%) patients had at least 2+ AI preoperatively. Patients with AI had a significant higher incidence of right coronary SVA with concomitant ventricular septal defects (80.5% vs 54.9%, P < 0.001). Concurrent aortic valve surgery was performed in 70 patients with 63 valve replacements and 7 valve repairs. The other 17 patients underwent SVA repair only. The mean follow-up time was 44.4 ± 33.8 months. During the follow-up, no patients who underwent valve replacement experienced perivalvular leakage, whereas 7 patients who underwent aortic valve repair had trivial-to-mild AI and 3 of the 17 patients who underwent SVA repair only presented with moderate AI. CONCLUSIONS Various surgical techniques can be utilized to manage concomitant AI without compromising short-term outcomes. Valve replacement yields good long-term results. According to our experience, valve repair, especially valve-sparing procedures performed by experienced surgeons, could be an acceptable option when managing concomitant AI in young patients.

Clinical features and surgical outcomes of pulmonary artery sarcoma

Objective: Pulmonary artery sarcoma is an exceedingly rare malignancy. There is a lack of consensus regarding its diagnosis and treatment. We reviewed our experience in the surgical management of pulmonary artery sarcoma over an 11‐year period. Methods: From January 2005 to February 2016, 12 patients with pulmonary artery sarcoma (age 51 ± 14 years, 5 male) underwent surgical treatment at our center. Nine patients (75%) exhibited pulmonary trunk involvement on computed tomography angiography. Six patients (50%) were initially misdiagnosed with pulmonary embolism. Results: Ten patients underwent pulmonary endarterectomy, and 3 of these patients required additional unilateral pneumonectomy. The remaining 2 patients underwent exploratory thoracotomy. One patient (8.3%) died in the hospital. The median length of postoperative intensive care unit and hospital stay were 1 day (range, 1‐15 days) and 8 days (range, 5‐21 days), respectively. The median postoperative survival of the total series was 18 months. Patients who received postoperative combined chemo‐ and radiotherapy were associated with improved survival compared with those who had isolated adjuvant therapy or surgery alone (median survival 28 vs 8 months, P = .042). Conclusions: Although pulmonary artery sarcoma has a very poor prognosis, surgical treatment offers a chance for symptom relief and better long‐term outcome. Aggressive postoperative adjuvant treatment may be necessary to improve survival.

Surgical management of traumatic tricuspid insufficiency

This study reviews our experience with traumatic tricuspid insufficiency (TTI) following blunt chest trauma.

Successful management of oesophageal conduit necrosis by a single-stage reconstruction with the pedicled pectoralis major myocutaneous flap

Conduit necrosis is a rare but potentially devastating complication of oesophageal surgery and the subsequent reversal of oesophageal discontinuity can be challenging. An option for both cervical-oesophageal reconstruction and neck wound closure has been limited and less successful. We report a patient with colon conduit necrosis and cervical-oesophageal discontinuity whose cervial oesophagus was successfully reconstructed with a single-stage pedicled pectoralis major myocutaneous flap and neck wound closure.

Pneumopericardium after atrial septal defect closure.

Pneumopericardium after atrial septal defect closure Zhiqi Zhang, Kanhua Yin, Tao Hong and Chunsheng Wang* Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China * Corresponding author. Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai 200032, China. Tel: 86-21-64041990; fax: 86-21-64223006; e-mail: wangchunshengmd@126.com (C. Wang). Received 23 April 2016; received in revised form 18 July 2016; accepted 22 July 2016