Stefano Congiu

Techniques in Valvular Heart Surgery

Techniques in Valvular Heart Surgery es un texto de 85 paginas escrito por A. Sampath Kumar sobre el tratamiento y las tecnicas quirurgicas de la enfermedad valvular mitral, aortica y tricuspide. El libro empieza con una presentacion del autor y esta distribuido fundamentalmente en cuatro capitulos; cada uno examina una valvula diferente. El primer capitulo desarrolla el tratamiento quirurgico de la enfermedad de la valvula mitral empezando por la comisurotomia cerrada y las tecnicas de abordaje hasta llegar a las tecnicas mas complejas de reparacion y sustitucion con homoinjertos. El segundo capitulo se refiere al tratamiento quirurgico de la enfermedad de la valvula aortica y los criterios de eleccion del sustituto valvular, especificando cuando debe ser mecanico y cuando biologico, cuando utilizar una valvula biologica con soporte y cuando sin soporte. Destacan una serie de apartados de gran interes sobre la reparacion de la valvula aortica y la utilizacion de homoinjertos como sustitutos valvulares, ya que es un debate actual. El tercer capitulo trata las tecnicas de reparacion clasicas de la valvula tricuspide y la sustitucion valvular. El cuarto capitulo describe el tratamiento quirurgico de la valvula pulmonar desde la valvulotomia hasta la sustitucion con homoinjertos. Cabe destacar el enfoque practico que se desarrolla en cada capitulo y apartado. Los capitulos estan redactados de forma directa, simple y con escasa retorica. El enfoque del libro es muy practico y esta apoyado con un buen numero de fotos a color e ilustraciones claras y bien escogidas. La tipografia del manual resulta muy amena a la vista y la lectura. Los dibujos cumplen muy bien el fin didactico de simplificar las fotos, la lectura y el entendimiento de cada tecnica. El manual resulta muy comodo de manejar y hojear, lo que hace atractivo su uso. Cir. Cardiov. 2007;14(2):171

Uniportal thoracoscopic resection of intralobar and extralobar pulmonary sequestration

Pulmonary sequestration (PS) is a rare congenital malformation of the respiratory tract. Two main variants are described, the intralobar and the extralobar PS. Clinical manifestations vary from accidental findings to life threatening complications. Surgical resection is the definitive and indicated treatment of PS. The operation could be performed through an open thoracotomy or video-assisted thoracic surgery approach. We report the management of two patients with diagnosis of extralobar PS in the first case and intralobar PS in the second case. Both patients underwent uniportal video-assisted thoracic surgery resection of PS with success. In our experience, we confirm that uniportal video-assisted thoracic surgery is a safe and feasible approach for extralobar and intralobar PS.

Micro-incision thoracoscopic treatment of primary spontaneous pneumothorax: the “loop” technique

Primary spontaneous pneumothorax has been defined as the disease of the young and healthy. There are multiple possible therapies and in recent years, surgery has evolved towards the use of the uniportal thoracoscopic approach. The objective of our study is to describe and present an innovative approach to access to the thoracic cavity in patients with spontaneous pneumothorax. The surgery was performed using a single access of 20 mm at the level of the 8th intercostal space. For the isolation and suspension of any dystrophic area, we use a loop of non-absorbable braided suture inserted through the IV intercostal space and successive wedge resection using an endoscopic 10 mm mechanical stapler. Using this access, we were able to visualize and dissect the pulmonary ligament and perform complete pleural abrasion. We had no complications. The operative time was 60 min, the chest tube was removed the 2th postoperative day and the patient was discharged the day after. The operation we propose permits the reduction of the dimension of the access to the thoracic cavity. We were able to resect blebs without problems, the recovery was excellent and no complications related to the procedure were reported.

Uniportal video-assisted removal of a right paratracheal pericardial cyst: an unusual location

Cystic lesions of the pericardium are a rare entity. Generally, they are congenital and located in the cardiophrenic angle. The right paratracheal location is unusual and differential diagnosis in particular with bronchogenic cyst is difficult even when using magnetic resonance imaging (MRI). The surgical indication exists in case of symptomatic patients or huge mass with compression of nearby structures. Different surgical approaches have been reported in literature to treat mediastinal cysts. We report a case of uniportal thoracoscopic removal of an unusual located right paratracheal pericardial cyst.

A new image-guided technique for intraoperative localization of lung small solid nodules or ground-glass opacities with a self-expanding tract sealant device: a preliminary experience

OBJECTIVESnThe aim of this study was to evaluate a new self-expanding tract sealant device, designed to prevent pneumothorax after computed tomography (CT)-guided lung biopsy, as an intraoperative marker for small pulmonary nodules or ground-glass opacities during minimally invasive thoracic surgery.nnnMETHODSnThree patients with pulmonary nodules underwent CT-guided biopsies in our radiology department. During the same procedure, using a 19-gauge coaxial needle, a self-expanding tract sealant device was positioned in the lung nodule to be used not only for the prevention of pneumothorax but also as an intraoperative marker. A few days later, conventional thoracoscopic surgery was scheduled. A visual examination was performed. The site of the deployment of the BioSentry device was determined by checking for the proximal end of it beyond the visceral pleura. Thoracoscopic wedge resections using endoscopic staplers were performed to confirm histological characteristics, surgical margins and correct placement of the plug.nnnRESULTSnThree consecutive patients underwent CT-guided placement of this self-expanding tract sealant device (BioSentry) before surgery, without complications. The thoracoscopic resection was performed with success. The plug was easy to visualize with the scope, and all removed nodules had surgical free margins and the plug was correctly positioned in all patients.nnnCONCLUSIONSnThe self-expanding tract sealant device was created for the reduction of pneumothorax and chest tube placement rates after percutaneous lung biopsy. We used it for the first time for intraoperative localization of peripheral small solid nodules or ground-glass opacities with good results.

Transposición de grandes arterias asociado a drenaje venoso anómalo parcial: reparación «uno y medio»

Presentamos el caso de un lactante de 8 meses con una cardiopatia congenita compleja consistente en transposicion de grandes arterias y retorno venoso anomalo parcial de venas pulmonares superior y media derecha a vena cava superior. La clinica consistia en fallo cardiaco congestivo, desnutricion y cianosis importante. El diagnostico se establecio en la intervencion. Se realizo correccion fisiologica de las dos cardiopatias con buen resultado y con resolucion de la sintomatologia.