Content from the Journal of the American Neurological Surgeons.
Donald D. Chang, MD PhD Department of General Surgery, Henry Ford Hospital, Detroit, Michigan. Correspondence: dchang1@hfhs.org “Before our able discussant embarks On his salient and probing remarks I happen to have a rhyme Not that I’m buying time COVID you were never welcomed here You’ve taken so much we hold dear But we’re resilient and…
The cephalic vein is suitable for central venous access and pacemaker and defibrillator implantation. Furthermore, with a success rate of approximately 80 percent, the cephalic vein cut-down method is associated with a lower probability of complications than the subclavian puncture. A surgeon’s ability to recognize and identify the anatomical variations of the cephalic vein will reduce the occurrence of iatrogenic complications when surgery is performed in…
This video demonstrates a valve-sparing root replacement with a reimplantation technique in a fifty-two-year-old female with a dilated root aneurysm and a bicuspid aortic valve with mild aortic valve regurgitation. The procedure was done via median sternotomy. To start, routine cannulation for cardiopulmonary bypass was performed. Then, a left ventricular vent was inserted through the right superior pulmonary vein, cross-clamping was performed, and…
Mitral valve replacement using the top-hat technique can be an option in patients with small mitral annulus or patients with patient-prosthesis mismatch. This technique can provide adequate left ventricle in-flow without a need to perform radial incisions to the mitral annulus, intraoperative balloon dilation of the mitral annulus, or aorto-mitral curtain reconstruction. The Patient A nineteen-year-old, 62kg…
Intraoperative aortoscopy during arch resection and stabilization of the “downstream aorta” with the frozen elephant trunk (FET) procedure using hybrid stent devices (Thoraflex in this video) is a new emerging adjunct diagnostic modality. Intraoperative direct visualization of the distal aortic bed prior to and after deployment of the hybrid stent device during the period of deep hypothermic circulatory arrest is necessary to confirm proper deployment and inspect…
The patient in this case is a sixty-eight-year-old male with a background of bowel adenocarcinoma (pT3aN1a) resected in 2019. Follow-up surveillance demonstrated two suspicious, enlarging non-fluorodeoxyglucose lesions in the right lung, one affecting the lateral basal (S9) and posterior basal (S10) of the right lower lobe, and the other within the right middle lobe abutting the horizontal fissure. The patient’s past medical history included a benign…
A thirty-year-old male was admitted for decompensated heart failure. He had a history of a hole in the heart during childhood. The echocardiography on admission showed left ventricular function, an ejection fraction of 60%, a ruptured right coronary sinus of Valsalva aneurysm into the right ventricle, and severe mitral regurgitation due to the prolapse of the…
Cervico-mediastinal tumors are commonly situated in the anterior mediastinum. However, 10 to 15 percent of them may be located in the posterior mediastinum. This video presents an unusual case of a complicated cervico-mediastinal extension of a goiter to the posterior mediastinum causing severe lower tracheal compression. A fifty-two-year-old female presented to us with asthmalike symptoms and dyspnea that progressed to stridor and orthopnea. Her chest X-ray showed upper mediastinal widening, and a CT scan of the neck and…
Invasive infective endocarditis (IE) with abscess formation involving the intervalvular fibrous body (IFB) between the aortic and mitral valves or aorto-mitral curtain (AMC) can make surgical repair and reconstruction a particularly complex and high-risk surgical procedure. Tirone David initially described the reestablishment of the “neo-aortomitral curtain” continuity through the use of bovine pericardial or Dacron fabric patchesthat can range from a ”Hemi-Commando procedure,” which allows for sparing…
This article details the step-by-step procedure for a robot-assisted left upper lobectomy and mediastinal lymphadenectomy in a sixty-two-year-old male. Background The patient had a past medical history of significant tobacco use of ten to fifteen packs a year, and coronary artery disease complicated by STEMI, status post drug-eluting stent x3 with preserved ejection fraction, and…
This video demonstrates Dr. James Tweddell’s surgical strategy in a two-month-old male with diagnosis of aortic atresia, hypoplastic aortic arch, coarctation, large perimembranous VSD, mildly hypoplastic mitral valve, normal biventricular size, and bilateral SVC (left SVC to CS). There was also an intraoperative finding of an aberrant right subclavian artery originating from the descending thoracic aorta with retroesophageal course. To begin, the patient was palliated in the neonatal period…
The patient was an eighty-two-year-old man with severe ostial LAD stenosis, paroxysmal atrial fibrillation, and paravalvular leak in a two-year-old TAVR valve. The operation was performed via median sternotomy, followed by the harvesting the left internal mammary in a pedicle fashion. The pericardium was opened and suspended. Then, heparin was given. After reaching an ACT of above 480, cardiopulmonary bypass (CPB) was initiated via central aortic and venous cannulation. A…
A segmentectomy is indicated in selected patients with non-small-cell lung cancer with peripheral nodules measuring greater than 2 cm and a less than 50 percent ground-glass appearance on computed tomography (CT) (1). This video features the case of an eighty-year-old asymptomatic man with a history of symptomatic epilepsy who underwent CT for an unrelated condition.…
Global Variation in Training Accreditation Cardiac surgery training is subject to vast global variation in pathways and scope as reflected by differences in terminology (i.e., cardiac surgery, cardiovascular surgery, and cardiothoracic surgery). In many countries, cardiac surgical training follows after general surgery.(1,2) In Canada, the United Kingdom, Germany, and Brazil, for example, trainees enter integrated…
This video presents a twenty-two-year-old male born with congenital aortic stenosis secondary to a bicuspid aortic valve who had two previous sternotomies. He received an initial open aortic valvotomy at three weeks old.This was followed by Ross procedure with ascending aorta replacement when he reached fifteen. He developed severe right ventricular outflow tract obstruction secondary…
Disclosure: The author of this video is a consultant and proctor for Atricure—the company that makes the Epi-Sense catheter used in this procedure. This video focuses on the convergent hybrid ablation procedure, which recently received FDA approval for the treatment of longstanding persistent atrial fibrillation (AF). It covers the rationale for the procedure, the surgical…
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