Poster Evaluation Admin

IAA account for a small percentage of all peripheral aneurysms. However, the high risk of spontaneous rupture and thromboembolic complications should be considered, especially in symptomatic patients. Surgery is always recommended in such cases. For surgeons, this is a challenge with high morbidity and mortality rates.

A 42-year-old woman presented with a 3-month history of a mass on the right side of the neck and frequent dizziness. The patient had no neurological symptoms and no previous history of trauma, infection, or surgical intervention. The patient was a non-smoker and had a history of hypertension. Physical examination revealed a pulsating mass under the right angle of the mandible with discomfort. CT angiogram showed an aneurysm of the innominate artery. Subsequently, after obtaining consent from the family, surgery was performed. It revealed an aneurysm in the fusiform type innominate artery measuring 3.2 cm and then arterial wrapping from the proximal to the branching of the carotid artery and subclavian artery. Overall, the patient had a smooth recovery postoperatively.

A study reported that atherosclerosis is the cause of more than 60% of IAA. In addition, the incidence of aneurysms caused also by autoimmune disorders, connective tissue, and post-traumatic aneurysms has increased.
Surgical treatment of IAA is necessary if the aneurysm is large and symptomatic or has ruptured. Kieffer et al, 2001. describe indications for surgical treatment for innominate artery aneurysms. They suggest that surgery should be considered in patients with reasonable surgical risk if the aneurysm is saccular or its maximum transverse diameter is more than 3 cm.
Asymptomatic aneurysms are discovered incidentally. However, more giant aneurysms often cause symptoms such as a pulsating mass, dizziness, infection, bruit, bleeding, hoarseness, tracheal obstruction, and cranial nerve deficits.
In this case of a pulsating mass with symptoms of dizziness and hypertension, we decided to perform wrapping to prevent complications.

The goal of treatment is to prevent localised mass, rupture, and neurological deficits due to embolism or thrombosis. Surgical procedures have been the primary treatment method for aneurysms and are almost always successful but come with varying risks.

To present the evacuation management of bullet foreign bodies on the thoracic wall in a peripheral hospital only by chest X-ray examination due to the absence of CT-scan and C-arm modalities

A 17-year-old boy came with a gunshot wound to the left chest. The patient underwent a conventional chest X-ray because the hospital does not have a CT scan and C-arm modalities. The foreign body bullet appeared in the second left intercostal on the chest X-ray. After being marked, bullets were found with chest X-rays on the x-axis +0.5 cm, y-axis -0.5 cm, and z-axis with a depth of -2.5 cm. Then a site marking was made at that point. A bullet was found at the time of the operation, according to the site marking as deep as 2.7 cm just above the second rib. The patient was given analgesic and antibiotic therapy after the evacuation of the bullet and then observed for two days. No complications were found, so the patient was sent home.

Thoracic trauma contributes 20-25% of the mortality rate in cases of death caused by trauma. One of the cases is penetrating trauma due to foreign bodies such as bullets.

CT scan is the primary diagnostic tool because of its ability to provide imaging of various intrathoracic structures. In addition, bullets often migrate before being evacuated, so a portable imaging device (C-arm) is needed to get an accurate location of the bullets. Unfortunately, not all hospitals have these facilities, especially those in peripheral areas.

In the case of a gunshot wound, the distance traveled from the time the projectile leaves the firearm until it hits the target can be described using external ballistics, where the trajectory of the projectile (t) can vary along the direction of its flight path (x) if the nose of the bullet deviates from the vertical axis (y) or horizontal axis (z).

Evacuation of foreign bodies can be done using chest X-rays as a modality. The marker is placed according to the location of the foreign body. Then projections are made on the x, y, and z axes to obtain an accurate location of the foreign body.

A ventricular assist device (VAD) is one of the treatment options for heart failure patients. Therefore, the purpose of this review is to aid in clinical decision-making for VAD selection and exchange.

The search was conducted across several databases until February 25th, 2023. Risk of bias was performed using Cochrane Risk of Bias 2.0 and the Newcastle Ottawa Scale. In order to rank and evaluate pooled odds ratios and mean differences with 95% confidence intervals, we employed conventional and Bayesian network meta-analysis converted to Surface Under the Cumulative Ranking (SUCRA).

A total of 49 studies with 31,105 patients were included in this review. HM3 is the best device exchange choice that causes the lowest risk of mortality [HM3 (99.98) >HM2 (32.43) >HVAD (17.58)], cerebrovascular accidents (CVA) [HM3 (99.99) >HM2 (42.41) >HVAD (7.60)], other neurologic events beside CVA [HM3 (91.45) >HM2 (54.16) >HVAD (4.39)], pump thrombosis [HM3 (100.00) >HM2 (39.20) >HVAD (10.80)], and bleeding [HM3 (97.12) >HM2 (47.60) >HVAD (5.28)]. HM3 is also better than HM2 in hospital admissions [OR: 1.90 (95% CI: 1.15–3.12)]. When complications were present, HM2 or HVAD exchange to HM3 lowered the mortality rate compared to exchanging it to the same device type.

HM3 is the best device for six subgroups of adverse events. Exchange from HVAD or HM2 to HM3 is recommended only if a complication is present.

Endoscopic-CABG provides a promising alternative to conventional surgery for quicker recovery and less trauma. However, commonly used BIMA grafts might not reach distant lesions without tension. Y-grafting is proposed as a solution with uncertain outcomes in Endo-CABG. This study compares BIMA-in situ grafts to Y-grafting efficacy.

A retrospective study from 2018 to 2022 enrolled 603 patients who underwent Y-grafting and 678 patients who received BIMA-in situ grafts. Endo-CABG procedures were performed using three 5mm endoscopic ports in the 2nd, 3rd, and 4th intercostal spaces, with an additional 3cm utility port for surgical access.

Y-grafting showed similar outcomes to BIMA-in situ for target lesion revascularization (12 vs 10; p=0.14), revision at under 48 hours (41 vs 44; p=0.806), one week (6 vs 10; p=0.446), 30-day mortality (16 vs 8; p=0.813), and ventilation time (11.85 vs 10.13 hours; p=0.273). However, Y-grafting had certain drawbacks, including perioperative bleeding (850.2 vs 649.00 ml; p<0.001) and 24-hour postoperative bleeding (693.9 vs 615.6 ml; p=0.021). The Y-graft group also had more atrial fibrillation cases (150 vs 114; p<0.001),longer overall procedure time, in terms of cardiopulmonary bypass (124.3 ± 36.91 vs 95.18 ± 54.30 minutes; p<0.001), and clamping time (68.31 ± 21.94 vs 55.42 ± 18.46 minutes; p<0.001), as well as more required bypasses (3.15 vs 2.45; p<0.001). Y-graft patients also had longer ICU (79.01 vs 65.24 hours; p=0.009) and overall hospital stays (7.63 vs 5.69 days; p=0.023).

Y-grafting emerges as an effective alternative to BIMA-in situ grafts when addressing distant lesions. Despite achieving similar target lesion revascularization as a primary outcome and other measures, it is crucial to acknowledge certain drawbacks. Further studies and long-term follow-up are imperative to establish optimal treatment tailored to each patient.

Despite originally known as a cholesterol-lowering drug, statin has been well studied for other benefits it carries. Its pleiotropic and anti-inflammatory effects were associated with lower mortality after cardiac and non-cardiac surgeries. We aim to investigate the effect of statin administration on patients undergoing isolated on-pump coronary artery bypass grafting

We conducted a comprehensive literature search through PubMed, CENTRAL, and EMBASE for studies comparing statin administration and placebo for patients undergoing isolated on-pump CABG. Studies were screened with our eligibility criteria. Quality of the studies was examined using the Newcastle-Ottawa scale. Statistical analysis was performed using Review Manager 5.4.

Ten studies comprising 5794 patients (2884 received statin) were included. Pooled analysis showed that patients receiving statin had a significantly decreased risk of postoperative mortality (RR 0.59, 95% CI 0.39, 0.88, p=0.009, I2=0%), postoperative atrial fibrillation (RR 0.62, 95% CI 0.49, 0.78, p<0.0001, I2=24%), and postoperative acute kidney injury (RR 0.73, 95% CI 0.63, 0.84, p<0.0001, I2=0%) compared to those not receiving statin. However, there was no difference between both groups regarding the risk of postoperative myocardial infarction (RR 0.79, 95% CI 0.34, 1.82, p=0.58).

Patients receiving statin are associated with lower mortality and morbidity after isolated on-pump coronary artery bypass grafting compared to those not receiving statin. Future studies should be directed towards investigating the benefit of low dose and high dose statin in patients undergoing isolated on-pump CABG.

Needlefish attack can cause critical injuries and fatal complications for patients. Penetrating trauma to the thigh can cause injury to the artery which unnoticed will eventually become a pseudoaneurysm. Injuries by Needlefish causing a superficial femoral artery pseudoaneurysm is a rare case and has never been reported before

A 53 years old male patient with complaint of a throbbing lump on his left thigh since three weeks. Complaints experienced after being impaled by a needlefish while looking for fish in the sea. Complaints of pain when walking. Physical examination found an entrance stab wound in the back of the thigh and a throbbing lump on the left thigh. CT angiography of the lower extremities revealed dilatation focal saccular suggesting a pseudoaneurysm superficial artery femoral sinistra. Furthermore, the patient underwent open repair of the pseudoaneurysm femoral artery sinistra.Identification of the femoral artery then performed Teugel incision. Then open capsule mass and evacuated clot hematom. A fistula was seen in the distal femoral artery with a diameter of 1 cm, then the femoral artery fistula was repaired with a patch of the great saphenous vein. Postoperatively, patient got a good distal arterial pulse and good distal saturation

Needlefish is a fish that lives in the sea. Its nature that jumps to the surface of the sea can injure it causing morbidity and mortality for fishermen when looking for fish. A pseudoaneurysm consists of a blood collection contained by the adventitia or the surrounding soft tissues caused by dissection of all the layers of the arterial wall due to puncture, trauma, or infection. Clinical manifestations of femoral pseudoaneurysms can include a pulsatile mass, femoral bruit, palpable thrill, pain, extremity edema, and/or compressive neuropathy. Pseudoaneurysm should always be treated as an emergency as it can lead to ischemic vascular distal, compression of adjacent vessels and rupture of the lesion. CT angiography is the modality of choice for diagnosis. Open surgical repair was the first treatment option for this case and closure of the A Femoral fistula using a Patch of the Great Saphena vein

Needlefish attacks can be life threatening. Cases of femoral artery pseudoaneurysm by needlefish have never been reported before but these cases should always be treated as an emergency because they can cause morbidity and mortality for patients. Examination and appropriate management can provide great benefits for patients.

Hyperhidrosis is a clinical condition that causes excessive sweating that exceeds physiological needs and can interfere with the patient's daily activities. Video-assisted thoracoscopic sympathectomy (VATS) is considered the most effective treatment for PH for presenting long lasting functional results, being considered the best therapeutic option.

This research is a retrospective study based on medical record data March 2022 – March 2023 at Labuang Baji Hospital. Six cases of severe hyperhidrosis who underwent a bilateral T2-T4 VATS sympathectomy procedure were subsequently conducted through cell phone interviews to assess complications of the procedure, the incidence of Compesatory Hyperhidrosis, length of stay in hospital and assess patient satisfaction after 1 year of undergoing the procedure.

Four of the patients experienced improvement and were very satisfied with undergoing the VATS sympathectomy procedure, one patient was quite satisfied and the other was dissatisfied because the complaint of compensatory hyperhidrosis (CH) experienced was more disturbing to the patient's activities than before surgery. Complications found besides pain are subcutis emphysema, pleural effusion and bleeding. All patients experienced CH which predominated in the chest and back areas.

Bilateral VATS sympathectomy in cases of severe hyperhidrosis is a minimally invasive procedure that can be recommended for the future. This action gives results, a good level of satisfaction and can improve the quality of life of patients after surgery.

Arteriovenous fistula (AVF) is the gold standard vascular access for hemodialysis. Despite its importance, achieving AVF maturation remains challenging. Cilostazol, a phosphodiesterase 3 inhibitor, has been shown to be a promising drug for enhancing AVF maturation. This meta-analysis aimed to investigate the clinical efficacy of cilostazol on AVF maturation.

This study was registered in PROSPERO with the registration number of CRD42023447040. Meta-analysis was performed according to PRISMA guidelines. We conducted a comprehensive systematic literature search in the databases of PubMed, ScienceDirect, Cochrane Library, ProQuest, and Google Scholar to identify studies investigating the clinical efficacy of cilostazol on the maturation of newly created AVF in patients with end-stage renal disease (ESRD) requiring hemodialysis. The intervention groups received perioperative cilostazol therapy, while the control groups did not receive cilostazol. The primary outcome was the maturation rate of AVF, and the secondary outcome was the complication rate of AVF. The quality of included studies was assessed using the Newcastle-Ottawa Scale. Meta-analysis was conducted using Review Manager 5.3.

Five studies involving 549 patients undergoing AVF creation were included in this meta-analysis. The intervention groups comprised 228 patients who received perioperative cilostazol therapy, while the control groups comprised 321 patients who did not receive cilostazol. The pooled analysis showed that patients in the intervention groups had a significantly higher rate of AVF maturation (OR = 2.18, 95% CI: 1.29-3.68, P = 0.003, I2 = 47%) and a lower rate of AVF complications (OR = 0.46, 95% CI: 0.28-0.77, P = 0.003, I2 = 27%) compared to the control groups. The funnel plots were symmetric, indicating no publication bias present.

This meta-analysis provides evidence that cilostazol use is associated with a higher rate of AVF maturation and a lower rate of AVF complications. These findings suggest that patients who are candidates for AVF access may benefit from perioperative cilostazol therapy.

Abdominal aortic aneurysm (AAA) is a segmental dilatation, with the full thickness of the abdominal aorta exceeding the normal vessel diameter by 50%. This disease is commonly experienced by elderly patients, but in the case of young adult patients, its occurrence is rare and the cause is unknown. This report

A 19 year old female came to Emergency Department with abdominal pain, which does not improve even though medication was given to reduce stomach pain. The patient previously complained of intermittent pain in his right hand so he couldn't move it and his body felt weak so it was difficult to walk. The patient has a history of recurrent heartburn and was diagnosed as AAA. General physical examination found a pulsatile mass in the abdomen, swelling of the right wrist and medial malleolus, and decreased palpation of the right popliteal artery. Ultrasound examination found a sacculated abdominal aortic aneurysm measured 5 cm x 4 cm x 4 cm. Cito endovascular repair (EVAR) was performed and found rupture of right common femoral artery, then a femoro-femoral bypass was performed to remove occlusion of punctum distal right common femoral artery.

Ruptured AAA is rare in young patients. It may be caused by congenital connective tissue disorders, vasculitis, umbilical cannulation, and infection. One hypothesis suggests that AAA is the consequence of a developmental defect during embryogenesis that causes a narrowing of a portion of the abdominal aorta. EVAR is the recommended first-line treatment for ruptured AAA with better outcomes. Femoro-femoral bypass was also performed as indication for additional procedures for EVAR and presence of limb ischemia due to occlusion.

Ruptured AAA is rare in young patients and the exact etiology is unknown. Based on the indications, the patient underwent EVAR and femoro-femoral bypass to remove occlusion of distal right femoral artery.

Thoracic endometriosis syndrome (TES) is defined as the presence of endometrial mucosa implantation inside the thoracic cavity in women of child-bearing age. Patients typically present with recurring spontaneous pneumothorax before being diagnosed. The difficulty in diagnosing TES may significantly delay appropriate treatments.

A 38-year-old woman with neither history of pneumothorax nor endometriosis presented with chief complain of right shoulder blade pain followed by shortness of breath on her first day of menstruation. The woman was infertile for 16 years. Chest X-ray showed a bilateral pneumothorax. A computed tomography (CT) of the thorax later confirmed a predominantly right-sided pneumothorax more than half of the chest cavity. A right-sided chest tube was inserted but no significant lung re-expansion was observed within the following week. Right thoracotomy was performed. Pathological finding established the diagnosis of TES with positive CD10 marker, estrogen receptor (ER), and progesterone receptor (PR). The patient was consulted to gynecologist for further treatment.

Endometriosis is often related to infertility. Patient’s history of infertility and failure to achieve complete lung re-expansion after chest tube insertion, enforced us to think about TES, even if it was the first time the patient had pneumothorax during her menstruation. Thoracic surgeons and gynecologists in the context of TES should jointly evaluate patients who are referred for suggestive TES. Current update of TES treatment including surgical resection and GnRH therapy.

TES is often underdiagnosed even after recurring pneumothorax. TES should be suspected earlier in infertile woman of child-bearing age presenting with pneumothorax. Prompt treatment with well-timed surgical resection and GnRH therapy might give the best outcome for the patient to prevent recurrence of pneumothorax.

Percutaneous closure of atrial septal defect (ASD) and patent ductus arteriosus (PDA) with Amplatzer septal/duct occluder (ASO/ADO) is known as an established, safe, and efficient procedure with high successful rate. However, migration and abandoned device still remains a terrified complication requiring immediate intervention. The aim of this case series study

Within two weeks, we received four referrals to our hospital, Dr. Cipto Mangunkusumo National Hospital, Jakarta Indonesia, from different hospitals, that had device migration requiring immediate surgical intervention. Two female children with secundum ASD had ASO device implanted. One embolized to the right ventricle and the other into the right atrium. Also two female children with PDA had device closure. Device embolization occurred into the descending aorta and left pulmonary artery, respectively.

All four devices were successfully evacuated and the defects was closed surgically without any residual, with a low morbidity and no mortality.

The diagnostic approach and consideration whether the case should be given to surgical or transcatheter closure have to be done more careful and accurate. We recommended that occluder devices should be inserted in facilities where cardiac surgical support is attainable.

COVID-19 has resulted in the death of more than 150 thousand patients in Indonesia. Pneumothorax is a complication of COVID-19 that can occur in patients receiving invasive mechanical ventilation. Currently data regarding the survival rate of COVID-19 patients with pneumothorax associated with invasive mechanical ventilation in Indonesia is still limited.

A descriptive survival analysis study enrolled critically ill COVID-19 patients in RSUI who underwent a tracheostomy procedure. Baseline data, including clinical characteristics and laboratory findings before tracheostomy, were recorded. Survival analysis was conducted using the Kaplan-Meier plot.

Fifteen subjects were enrolled in the study: 10 males (66.7%) and 5 females (33.3%). The median age was 54 years. There were 8 subjects with right lung side affected (53.3%), 4 subjects with left lung side affected (26.7%), and 3 subjects with bilateral lungs affected (20%). There were no subjects who survived in the end.

In this study, the survival rate of critically ill COVID-19 patients with pneumothorax related to mechanical invasive ventilation is low. Another study is needed to evaluate the cause of the low survival rate.

The controversial surgery known as tetralogy of Fallot (TOF) repair involves treating several structural abnormalities, including obstruction of the right ventricular outflow tract. Residual lesions after repair often lead to morbidity and mortality. We aim to investigate the impact of annulus preservation techniques in patients undergoing TOF repair.

A comprehensive search of electronic databases was conducted to find studies assessing the outcome of annulus preservation technique used in comparison with TAP technique of TOF repair. The studies covered PubMed, Scopus, Cochrane, and EBSCO as the primary databases for searching. Long-term follow-up information, mortality, pulmonary regurgitation, and reoperation. Using the proper statistical techniques, a meta-analysis was done to combine the findings from the qualified research. The bias in this studies were analyzed with cochrane risk of bias tool.

A total of 19 studies comprising 4725 patients who underwent annulus preservation techniques (48%) and TAP (52%) were included. The choice between valve-sparing repair and transannular repair is contingent upon the z-score, which has been specifically mentioned by some of the studies. Pooled analysis showed that patients undergoing VS procedure had a significantly lower risk of mortality (OR 0.28, 95% CI 0.15, 0.52, p<0.0001, I2=0%), postoperative PR (OR 0.07, 95% CI 0.03, 0.22, p<.00001, I2=84%), PR during follow up (OR 0.11, 95% CI 0.06, 0.21, p<0.0001, I2=49%), and reoperation (OR 0.47, 95% CI 0.24, 0.92, p=0.03, I2=78%) compared to those undergoing TAP procedure. There was no significant difference regarding the risk of preoperative mortality (OR 0.55, 95% CI 0.12, 2.56, p=0.44).

Valve sparing techniques are associated with lower mortality and morbidity when compared to TAP. Future research should focus on developing instruments or guidelines to help choose how and when surgeons can apply the annulus preservation strategy.

Surgical intervention for diaphragmatic eventration (DE) in chronic settings remains challenging. The intervention is required to relocate herniated organs and close the defect, especially in symptomatic patients. In our case, the patient’s DE remained asymptomatic in her childhood and was found late in her life when the symptoms were aggravated.

A 60-year old woman was presented with gradually worsening shortness of breath and epigastric pain radiating to her left shoulder. There is no trauma and other significant past medical history of the patient. She was referred from a district general hospital with thoracic CT scan showing extensive left DE to the lung apex. After diagnostic and preoperative procedures, she underwent conjoin surgery, cholecystectomy by general surgeon for cholelithiasis and thoracotomy by cardiothoracic surgeon for DE repair. The patient then was admitted to ICU in good health and the lung expansion was adequate. During the first postoperative day, she became more hemodynamically compromised with severe hypotension and reduced consciousness. The patient’s abdomen also became more distended, but the drain production was minimal and no leakage was seen on her wound. Aggressive resuscitation and hemodynamic support was taken. Unfortunately, the patient’s condition deteriorated and she passed away on the third day.

The surgical repair for congenital DE in high risk patients has greater risk on developing multi-organ complications. Studies find that such surgical complications may present early in the postoperative period, during hospital stay to months or years later. The severity of the chronic disease is assumed to be linked with the size of the defect and adhesion. One or more possible causes: intraoperative hemorrhage, splenic rupture, organ injury during reduction, severe dense adhesion of abdominal organs due to chronic herniation, increased intra-abdominal pressure and slowed peristalsis after surgery that lead to abdominal compartment syndrome may result in the patient mortality. Previous studies find other serious complications directly related to repair are chylothorax, development of primary infection and peritonitis. Although there have been many studies and technological advances, the safer choice of surgical intervention in high risk patients to close the defect is still limited.

Congenital DE is a complex condition that could be addressed through various surgical interventions. We believe that more studies are required to find the real causative factors of mortality. This could lead to new findings that could minimize risk on surgical complications, especially in chronic and high risk patients.

Left pulmonary artery sling is a rare case in infants. The prevalence of pulmonary artery sling is estimated to occur in one in every 17,000 school-aged children, while no data have been so far published concerning incidence and prevalence of pulmonary sling among infants. The severity of the case depends

A nine-months old patient was referred from Banten because worsening respiratory distress. First symptom of recurrent respiratory tract infections was found when patient was 4 months old and worsening over time. CT scan findings showed possibility of left pulmonary artery (LPA) sling and tracheal compression without any tracheal lesions. Echocardiography study showed no intracardiac lesion. We successfully did LPA transection and re-implantation to main pulmonary artery without cardiopulmonary bypass.

Patient was hemodynamically stable after the procedure and was successfully extubated on 8th day post operative although history of difficulties to wean off from ventilator. There was no major adverse event or complications after re-implantation of the LPA to MPA. Post operative echocardiography showed confluent pulmonary arteries, no ventricular dilatation, no pericardial effusion and good biventricular function

Pulmonary artery sling (PAS) symptoms can appear as worsening respiratory distress but effective treatment requires proper pre-operative workup and surgical intervention. Prognosis after surgical repair without tracheal lesion seems excellent, and follow-up needs to be done routinely to identify the long-term consequences. Early surgical management of symptomatic patients is the

Mediastinal teratoma is a rare germ cell tumor, located in anterior mediastinum and lacking of population-based study. It usually occurs in the age of 20-40 years, accounting for 15% of anterior mediastinal masses in adults and 25% of anterior mediastinal masses in children. It is diagnosed accidentally on chest imaging,

A 21-year old male referred from pulmonologist oncologist presented with complaints dyspnea and chest pain. Physical examination showed no lung sounds in (R) hemithorax and was dull to percussion, ictus cordis shifted 2 fingerbreadths towards left. Chest X-ray showed a large well-defined lesion in (R) hemithorax and chest CT-scan with contrast showed hypodense mass on (R) hemithorax adhering & compressing the lung, diaphragm, pericardium & chest wall, with estimation size of 60 x 20 x 12 cm, lesion displaced the heart. Patient was then treated with complete surgical excision and found a huge cystic tumor with a size of 60 x 20 x 12 cm adhering to all parts of (R) lung, diaphragm and pericardium. Patient was undergoing (R) pneumonectomy due to adhesion. Histologic examination was consistent with mature teratoma. Patient showed no complication after surgery and was discharged uneventfully from hospital after 5 days.

Approximately 95% of benign teratomas arise in the anterior mediastinum. The tumor grows progressively, mostly asymptomatic, if present with dyspnea and substernal chest pain. Cough productive of hair or sebum is pathognomonic sign. The chest radiograph typically reveals a well-circumscribed anterior mediastinal mass that often protrudes into one of the lung fields, tumors are usually large at the time of diagnosis. Complete surgical excision is a treatment of choice of mediastinal teratoma, which can be performed through median sternotomy or thoracotomy or thoracoscopy. Some patients require additional procedures (eg, lobectomy, pericardiectomy) for complete tumor resection.

There is still limited data on mediastinal teratoma. Early referral & treatment show good prognosis. Clinical manifestations, imaging modalities of benign mediastinal teratoma were complicated, but the surgical treatment was effective.

Differentiated thyroid cancer ( DTC ) which includes papillary thyroid carcinoma and follicular thyroid carcinoma, are major of all thyroid cancer (>90%). (1) Papillary thyroid carcinoma ( PTC) is an epithelial malignancy that showing evidence of follicular cell differentiation and a set of distinctive nuclear features. Usually PTC metastasize to

A 49-year-old female patient presented to our department with a unpainful, fixed and firm sternal mass. From the neck CT scan showed that Enhancing solid mass on the left thyroid to intrathoracic and shifted the trachea to the right accompanied by left lymphadenopathy and sternal destruction (AJCC Staging 8 th T3aN1bM1). The operation started by a ressetion of upper third of the sternum enlarged to the internal part of the clavicle and the first two right ribs and continued by reconstruction. Patient extubated earlier, she didn’t has any paradocsical respiration and discharded 4 days after surgery.

Chest wall integrity and stability are the main factors that ensure the protection of intrathoracic organs and an adequate respiratory function. The thoracic surgeon often has to deal with neoplastic, traumatic and malformative diseases affecting the chest wall and requiring the demolition and reconstruction or stabilization of the thoracic cage. Chest wall defects generally result from resection of primary chest wall tumours, locally-invasive malignancies or metastatic lesions. (14) Most surgeons agree that defects >5 cm in diameter or including >4 ribs should be reconstructed due to high risk of lung herniation and respiratory compromise from paradoxical motion of the chest wall, particularly true for anterolateral defects and full thickness resections. (14) (15)

In conclusion, the reconstruction of extensive chest wall defects following thoracic wall resection, could be a challenge. This can be achieved by adhering to the principles of biomimesis, in which anatomy is respected, function is preserved, optimal reconstructive materials are chosen and a multidisciplinary approach to complex reconstruction is undertaken.

Right-sided Infective Endocarditis (IE) is usually rare, with only 5-10% of all IE cases. Ninety percent of right-sided IE involve a tricuspid valve. According to several studies, right-sided IE is strongly associated with intravenous drug use, cardiac implantable device use, and underlying cardiac anomaly.

We presented the case of a 35-year-old female with suspected right-sided infective endocarditis. Echocardiography was performed, revealing dilation of the right ventricle with normal systolic function. Un-coaptation of tricuspid closure was observed, along with severe tricuspid regurgitation. A CT scan indicated a dilated mean pulmonary artery, a thrombus at the distal end of the left pulmonary artery, and involvement of the superior and inferior segments of the left pulmonary artery, as well as the posterior-basal, apical-posterior, superior, and lingual subsegments of the left pulmonary artery. The scan also revealed multiple nodular infiltrative lesions in segments 1, 4, 6, 8, 9, and 10 of the right lung, and segments 1-2, 3, 4, 5, 6, 8, and 10 of the left lung. Ground glass opacity was observed in the superior-medial-inferior segment of the right lung, as well as the superior-inferior segment of the left lung, raising suspicion of pulmonary embolism. Given these

The majority of patients with right-sided IE benefit from antibiotic therapy, with only 20% requiring surgery. The primary objective of surgery is to eliminate the infection and achieve effective hemodynamic correction. Various indications for surgery include the presence of large vegetations, recurrent pulmonary embolism, failure of medical therapy, fever persisting for more than 3 weeks despite antibiotic treatment, right-sided fungal IE, and infected prosthetic valves.

Right-sided IE has excellent survival and good outcomes. Early surgical intervention is recommended before cardiac function deteriorates and before neurological complications occur. The goal of surgical treatment is to radically eradicate the vegetation, minimize the presence of foreign materials in the infected area and implement aggressive antibiotic therapy postoperatively.

Placenta accreta spectrum (PAS) constitutes a collection of anomalies characterized by the atypical attachment of placental trophoblasts to the uterine myometrium. A well-established management approach for this condition involves a classical Cesarean section, succeeded by a total hysterectomy. The primary objective of this study is to evaluate the safety and

In this retrospective investigation was performed at Dr Soetomo Hospital Surabaya Indonesia, spanning from January 4th, 2021, to July 27th, 2023. We have included pregnant women who received a diagnosis of placenta accreta and subsequently underwent Cesarean hysterectomy with the implementation of aortic cross clamping. Our analysis focused on collecting data related to the duration of aortic cross clamping, estimated blood loss (EBL), and various outcomes, encompassing complications associated with distal ischemia, as well as mortality rates.

A total of 55 women (median age of 33 years [IQR 31 to 38]) were included. All participants had previously undergone cesarean sections. The median duration of aortic cross clamping was 75 minutes (IQR 55 to 90), while the median of EBL was 2800 mL (IQR 1500 to 4800). No complications were observed in our study participants and palpable distal pulsation of the dorsum artery was present in all patients.

The application of aortic cross clamping has showcased its efficacy in significantly reducing blood loss during Cesarean hysterectomy for instances of placenta accreta. Previous studies had shown that it is associated with less EBL compared to the endovascular catheter approach. Moreover, this approach has successfully minimized the potential for significant

Pulmonary tuberculomas usually present as a solitary pulmonary nodule. Pulmonary tuberculoma is difficult to differentiate from lung cancer. The treatment should follow the multiple disciplinary team. This systematic review is aimed to summarized the effectiveness of pulmonary tuberculoma treatment, including the response to anti-tuberculosis treatment or surgical resection.

PubMed, Wiley, Cochrane, ProQuest, and ScienceDirect were searched for any design study that showed the cure rate of pulmonary tuberculoma treatment, with surgical resection or the used of anti-tuberculosis treatment. Four studies were identified and analyzed from 288 initial articles. Data were then extracted from the studies and summarized descriptively.

Two hundred eighty-eight articles were screened, and four studies were identified and eventually selected. The cure rate of pulmonary tuberculoma increased in patient with surgical procedure compared with medical treatment (only anti-tuberculosis treatment). Pulmonary tuberculoma respond poorly to anti-tuberculosis treatment and often requires long-term treatment. The treatment of tuberculoma with surgical resection works effectively, with better short- and long-term effects for tuberculoma.

Surgical resection was effective to increase the cure rate of pulmonary tuberculoma. Pulmonary resection in combination with post-operative anti-tuberculosis treatment results in excellent cure rate.

Arrhythmia is one of the most common complications after cardiac surgery. The objectives of this study to determine the prevalence and analyses the risk factors of post-operative arrhythmia in pediatric patients after cardiac surgery for congenital heart defects (CHD) at a single center in Bali, Indonesia over 2 years period

A Cross-sectional study, Among 120 pediatric patients with CHD who underwent cardiac surgery over 2 years period, 92 patients met inclusion criteria in this study. The data was taken from medical records included demographic data, anthropometry, electrocardiography (ECG), surgical procedures, perioperative parameters, electrolyte levels, and management of postoperative arrhythmias. The comparison between the arrhythmia and non-arrhythmia groups will be analyzed using the chi-square test, Mann Whitney test, and independent T-test, depending on the data scale and distribution of each parameter. Data with a p-value <0.05 in the univariate analysis will undergo multivariate testing using linear regression analysis. Results with a p-value less than 0.05 were designated as significant.

Among 92 patients, 14 (15.2%) developed post-operative arrhythmias. Complete Heart Block (CHB) the most common arrhythmia, observed in 5 patients (35.7%), followed by Supraventricular Tachycardia 3 patients (21.4%). There were statistically significant differences between arrhythmia and non-arrhythmia groups for CPB duration (171.23 vs 108.01 min), aortic cross-clamp duration (115.58 vs 73.59 min), ischemia duration (106.33 vs 65.43 min) and potassium level (3.33 vs 3.88 mmol/L) with p < 0.05. Based on multivariate linear regression analysis, CPB time and potassium level were found to be independent risk factor.

Early post-operative arrhythmia observed 15.2% in this study, dominated by Complete Heart Block (CHB). CPB duration, aortic cross-clamping, ischemia time and potassium level were statistically significantly different between arrhythmia and non-arrhythmia groups.

Single coronary ostium and intramural coronary artery variations in patients with transposition of the great arteries has been associated with higher mortality risk after arterial switch operation. In these patients, classic for coronary button implantation may cause kinking or twisting of the coronary artery which can cause coronary insufficiency.

1st patient: 15-months-old girl with transposition of the great arteries-intact ventricular septum (TGA-IVS), who had undergone left ventricle (LV) training with right Blalock-Thomas-Taussig (R-BTT) shunt and pulmonary artery (PA) banding 11 days prior to the arterial switch operation (ASO). 2nd patient: 10-months-old boy with Taussig-Bing anomaly and pulmonary hypertension. Both patients had side-by-side position of ascending aorta and main pulmonary artery, with intraoperative findings showed single ostium and intramural coronary artery. Arterial switch operation with LeCompte maneuver was performed. Aortocoronary flap technique was used for coronary button implantation to the neo-aorta in both patients. After removal of aortic cross clamp, normal sinus rhythm was restored. Postoperative evaluation with electrocardiography showed no ST-segment changes and echocardiography showed no regional wall motion abnormalities. Intensive care unit (ICU) stay after ASO was 21 days and 14 days, and postoperative length of stay was 26 days and 17 days, respectively.

Classic method for coronary button implantation is usually difficult to perform in patients with single coronary ostium and intramural coronary artery variations without compromising the coronary blood flow due to its anatomical aspect. Aortocoronary flap, coronary augmentation with the right subclavian artery, and tube graft reconstruction has been used for coronary button transfer patient with single ostium coronary artery. In this case series, the aortocoronary flap technique was used and showed good postoperative result. The aortocoronary flap technique is preferred because unlike the coronary augmentation with the right subclavian artery technique, this technique doesn’t compromise the circulation to the arm, and unlike the tube graft reconstruction, this technique didn’t form a tunnel/tube, thus less risk for thrombosis.

Aortocoronary flap technique is a safe method for coronary button implantation in patient with single ostium and intramural coronary artery to prevent coronary insufficiency due to twisting and kinking of the coronary artery.

Background: arteriovenous access-related ischemia was a rare complication of hemodialysis access that made the patients really uncomfort and also might be serious problems such as limb loss. Various techniques could have been proposed to solve this, PAI is one of them, which relocates the arterial supply of arteriovenous access to

This is a case report of 43 years old woman with brachiocephalic arteriovenous access-related ischemia. She complained pain of lower arm and hand while she had hemodialysis using brachiocephalic access. After PAI was performed, proximal ligation of the draining vein and relocated the arterial inflow at the brachial artery more proximally using a basilic vein graft. The patient was followed up until 2 months.

Ischaemic symptomps was relieved and the patient was really satisfied. Flow of the dyalisis access still well maintained. No other signs of ischaemia complication was appeared. Intraoperatively, this procedure was not so complicated to performed.

PAI procedure was effective to resolve arteriovenous access related ischaemia. This procedure also maintain arteriovenous access and also the native artery pathway.

Tracheal stenosis due to Penetrating Injury is a relatively rare case. Trauma to the trachea may be penetrating or blunt and acute or subacute. A blow or stab wound to the neck, or crush injuries to the upper chest, may cause acute traumatic disruption of the trachea, but subacute insults

An 11-year-old boys with complaints of shortness of breath since 7 months ago. History of falling from a tree and hitting the neck with a wooden branch On physical examination, stridor and wheezing breath sounds were found in both lung fields. A MSCT Thorax, showed tubular hypodense lesion a size of 7.80 x 0.74 cm at anterior paratracheal region level C5- C7, crossing and constricting the trachea. Patient underwent bronchoscopy followed by surgery for extraction of corpus alienum and repair of trachea with median sternotomy approach and under Cardiopulmonary bypass.

Penetrating tracheal trauma requires urgent surgery for tracheal repair, in this case a median sternotomy approach is performed followed by a two-stage cannulation and tracheal repair is carried out on the bypass to ensure the patient's hemodynamic stability during the operation.

Tracheal stenosis due to penetrating Injury is a stricture of the trachea and is a relatively rare case. Definitive treatment which often involves urgent surgical intervention, has been shown to be beneficial; delays in definitive treatment have been associated with poorer outcomes.

Implantation of cardiac device can lead to various complication, and cardiac perforation is a rare yet can be devastating complication leading to mortality. Immediate asessment and treatment is needed to ensure patient safety and avoid mortality.

A 72 years old female with left sided chest pain especially when taking deep breaths, dyspnea and fatigue. She previously had a complete atrioventricular block and underwent permanent pacemaker (PPM) 4 months prior symptoms. A chest radiograph showed left pleural effusion and PPM lead were seen in place at ventricle. An electrocardiographic examination showed a complete atrioventricular block with no pacemaker impulse, patient underwent temporary pacemaker (TPM) insertion. Echocardiograph findings showed no pericardial effusion. A Thorax CT scan reveal PPM lead was in the left pleural cavity. Patient planned for surgery with left thoracotomy approach, 200mL of blood evacuated and an active-fixation lead protuded 2cm from Right Ventricle (RV). A purse string suture was made, lead was retracted back to RV, suture then thightened. PPM lead was repositioned with good result, TPM then removed. Post procedural was uneventful.

Cardiac perforation caused by implantable cardiac device is rare in practice, symptoms ranging from asymtomatic to life threathening. Cardiac perforation incidence about 0,6% and it can occur acute or chronicly after placement. Treatment strategy depends on lesion morphology and patient hemodinamic either percutaneus or open surgery.

Ventricular perforation due to implantable device is a rare complication and could be life threatening.

Acute Limb Ischemia (ALI) or acute limb ischemia is a condition where there is a sudden decrease in perfusion in the limbs involving thrombus and embolism, which threatens the viability of the extremities. One of the treatment options is a thromboembolectomy. In cases of ischemia with gangrene, amputation can save

We hereby report the case of a 66-year-old woman who suffered from acute limb ischemia with gangrene accompanied by Atrial Fibrillation and Atrial Flutter who underwent thromboembolectomy and above knee amputation at our hospital. CT angiographic evaluation shows total occlusion along a. Left common iliac. The postoperative outcome was smooth and satisfactory.

Thromboembolectomy with Fogarty and amputation with Gigli saw have not been widely reported. It is important to highlight its advantages and disadvantages compared to other means of treating ALI with gangrene accompanied by Atrial Fibrillation and Atrial Flutter.

Thromboembolectomy and above knee amputation for acute limb ischemia with gangrene with atrial fibrillation and atrial flutter is a safe and feasible approach for treating this patient.

Introduction: Varicose veins of lower limb can cause significant decrease of life quality, particularly at later age of the disease. It can be managed by conventional surgery includes stripping and high ligation, but other modalities like endovascular laser ablation (EVLA) are becoming popular. EVLA and conventional surgery are proved to

Methods: A literature search was conducted through databases including PubMed, Science Direct, Nature, Embase, Cochrane Library, and Google Scholar for studies published between 2007 and 2022. Two authors independently examined the full papers of the eligible studies, assessed study quality, and collected the data. Meta-analyses were conducted using the random-effect model and I-square (I2) was used to identify the heterogeneity of studies. Continuous data were presented using mean difference, whereas binary data were presented using Log odds-ratio.

Results: A total of 3029 participants from 26 studies were included (EVLA: 1532, L/S: 1497). Procedural duration was significantly shorter in EVLA group (MD, -30.78; 95% CI, [-42.82, -18.75]; P = 0.00, I2 = 99.82%). EVLA group demonstrated significantly lower blood loss volume (MD, -6.32; 95% CI, [-8.43, -4.21]; P = 0.00, I2 = 98.91%). No difference was found regarding return to work duration between both groups EVLA and conventional surgery (MD, -3.93; 95% CI, [-8.17, 0.30]; P = 0.07, I2 = 97.92%). EVLA group demonstrated higher risk of technical failure (Log OR, -1.02; 95% CI, [-1.98, -0.05]; P = 0.04, I2 = 0.00%). Reduced risk of recurrence rate was observed in EVLA group (Log OR, 0.55; 95% CI, [0.17, 0.94]; P = 0.01, I2 = 45.26%). Reduced risk of complications was identified in EVLA group (Log OR, 0.96; 95% CI, [0.53, 1.39]; P = 0.00, I2 = 38.43%).

EVLA has advantages in lower procedural duration, lower blood loss volume, lower risk of complication and lower risk of recurrence, meanwhile conventional surgery has an advantage in lower risk of technical failure. Although both groups have their own advantage and disadvantage, EVLA is more effective and safe method to treat

There are many complications of COVID-19, including acute limb ischemia (ALI). Due to the rapidly changing clinical course, high amputation and mortality rate, accuracy in diagnosis is needed to ensure immediate treatment. This process is challenging as COVID-19 is a novel and complex disease, and ALI has only been recently

We are reporting a 49 year-old woman with COVID-19 and diabetes mellitus type 2 who reported chest pain on her third day of hospitalization. The patient had been given levofloxacin 1x750mg, oseltamivir 2x75mg, heparin drip 15.000IU/24 hour, dexamethasone 3x10mg and novorapid drip 2IU/hour. Lab results included CRP 107.6 mg/L, D-dimer 1.58mg/L, thrombocyte 168.000cells/uL, HbA1c 10.4%. Her ECG showed ventricular extra-systole, thus was given aspirin 1x80mg, clopidogrel 1x75mg, ISDN 1x5mg, and concor 1x2.5mg. On the next day, the patient reported pain on her left arm. Upon USG doppler we found hyperechoic lesion on the left brachial region with diffuse soft tissue swelling on the axillary region, which indicated possible thrombus on the left brachial vein. Therefore, the patient underwent thrombectomy and fasciotomy, continued with open wound care for 10 days until the patient was fit to be discharged.

Our patient showed elevated CRP and D-dimer at the time of admission, which has been reported to be critical biomarkers in assessing the severity of COVID-19 and predicting complications such as ALI. Therefore, we started administering heparin before the patient showed any symptoms of ALI. However, due to having the risk factor of diabetes mellitus type 2, we could not prevent the occurrence of ALI and performed revascularization immediately after the diagnosis was made. Our prompt approach allowed the patient to survive and saved her limbs from amputation.

ALI is a complication that requires immediate diagnosis to improve the patient's prognosis, thus understanding biomarkers that can predict its occurrence in COVID-19 patients, including CRP and D-dimer, can be useful. This case illustrates the diagnostic and therapeutic approach to ALI as a complication of COVID-19.

Diabetic Foot Ulcer (DFU) frequently results in limb amputation as a life-saving intervention. However, predicting mortality post-amputation in DFU patients remains challenging. This study evaluates the potential of Neutrophil Lymphocyte Ratio (NLR), Platelet Haemoglobin Ratio (PHR), Systemic Immune-inflammation Index (SII), and Platelet Lymphocyte Ratio (PLR) as predictive indicators for mortality

A retrospective analysis of 156 DFU patients who underwent amputation at Ibnu Sina Gresik Regional Public Hospital from January 2018 to July 2022 was performed. Pre-operative inflammatory markers, including NLR, PHR, SII, and PLR, were analyzed with SPSS. The Receiver Operating Characteristic (ROC) curve and Youden index were employed to determine optimal cut-offs.

NLR's optimal cut-off was determined as >7.23, exhibiting a sensitivity of 75% and specificity of 57.8% (AUC=0.622; p=0.043). The PHR cut-off stood at >4.61, with a sensitivity of 67.9% and specificity of 60.2% (AUC=0.629; p=0.033). For SII, the cut-off was identified as >4747.33, with a sensitivity of 46.4% and specificity of 78.1% (AUC=0.648; p=0.015). Notably, PLR did not emerge as a significant predictor for mortality (AUC=0.582; p=0.176). Patients exceeding the NLR threshold had a 4.17-fold increased risk of mortality (95% CI=1.638-10.638; p=0.002). Those surpassing the PHR threshold had a 2.94-fold elevated risk of mortality (95% CI=1.220-7.074; p<0.014). Patients with an SII value higher than the threshold faced a 2.8-fold heightened mortality risk (95% CI=1.181-6.638; p<0.017).

Among the markers studied, NLR, PHR, and SII demonstrated predictive validity for mortality in post-amputated DFU patients. Elevated pre-operative levels of these indices indicate a heightened mortality risk, while PLR was found to be non-significant in predicting mortality.

Deep vein thrombosis (DVT) is a grave medical condition marked by the formation of blood clots within deep veins, typically in the legs or pelvis. DVT can result in severe complications, including pulmonary embolism and chronic venous insufficiency. A range of therapeutic interventions exists for addressing DVT, with the De

A 50-year-old woman diagnosed with DVT associated with cervical cancer was admitted to the hospital due to DVT symptoms. She presented with venous insufficiency in her lower limbs, characterized by swelling, discomfort, and compromised mobility. Her recent cervical cancer diagnosis added complexity to her clinical condition. The patient's preoperative assessment included thorough diagnostic procedures, including venous duplex ultrasonography (DUS) to evaluate the extent of venous insufficiency. A collaborative multidisciplinary team formulated a personalized surgical plan, involving precise incisions, tunnel creation, harvesting the great saphenous vein (GSV), anastomosis, and attentive wound care. The De Palma procedure aimed to restore venous flow and alleviate lower limb swelling. Following the De Palma procedure, the patient's symptoms gradually improved. The postoperative course was characterized by stability. Pitting edema in the lower extremities showed improvement, and circumferential measurements indicated decreased trends. A postoperative DUS demonstrated improved venous blood flow in the extremities.

The De Palma procedure, though less commonly performed for DVT, showcased its efficacy in this case. The technique's ability to restore venous circulation contributed to substantial symptom alleviation and the mitigation of long-term complications associated with extensive DVT.

This case report underscores the value of the De Palma procedure as a viable option for addressing challenging cases of extensive DVT. While its utilization requires careful patient selection and skilled surgical execution, the procedure's potential benefits, as evidenced in this case, highlight its role in improving patient outcomes and

Lower gastrointestinal (GI) bleeding may result from small bowel or colon hemorrhage. The therapeutic options for this conditions are pharmacologic therapy, endoscopic coagulation, transcatheter therapy, and surgery. There are two transcatheter options available for the control of lower GI bleeding: (i) pharmacologic control with use of vasopressin and (ii) embolization.

a 31 years old female with history of mitral valve replacement with mechanical valve had period of uncontrollable hematochezia. Medication with tranexamic acid and vitamin K showed no satisfying result. We performed colonoscopy but showed no active source bleeding nor other causes. Computed tomography showed extravasation and contrast pooling on ileocecal junction originated from ileocolic artery. Embolization of the feeding artery with non-spherical polyvinyl alcohol (nsPVA) was performed. 0,035” guiding catheter and 5 fr diagnostic catheter was inserted through 6 fr sheath via left femoral artery up into superior and inferior mesenteric artery, there was contrast leakage from the branch of ileocecal artery. Microcatheter 2,7 fr was used to engaged to the lesion, nsPVA 355-500 m embolization particle was injected to occlude the lesion. No contrast leak or pooling was found in ileocecal region following the procedure. Hematochezia was stop on the next day, and no sign of peritonitis or

Endovascular embolization for lower GI bleeding is still controversial due to risk of mesenteric infarction following the procedure is greater due to decrease in collateral blood supply of the distal gut. PVA particles (150–500 m) is commonly used for embolotherapy. although embolization shows increasing risk of ischemia, prior study shows embolization particle 150 m or larger can be injected to the proximal artery and produce minimal or no change in the affected guts. Embolization was the definitive and only treatment used in most of patients, which is significant because these patients avoided the morbidity and mortality risks associated with open surgery.

Management of lower GI bleeding with embolization procedure is safe and feasible and showed no signs of guts infarction following the procedure

The choice between CABG and PCI for patients with LMCAD remains a challenging decision for clinicians. Although both procedures have shown efficacy in improving clinical outcomes, it is essential to identify factors that can guide treatment decisions and predict long-term outcomes. This meta-analysis aims to synthesize the findings cohort studies

This study was performed using PubMed and ScienceDirect databases. This search yielded 1,675 studies, of which 4 of cohort studies were included for the final analysis. The keywords that will be used are derived from “SYNTAX Score” AND “PCI” AND “CABG” AND “mortality” AND “MACCE”. Risk of bias assessment for included studies using Newcastle Ottawa Scale. Review-Manager (RevMan) software version 5.4 from the Cochrane Collaboration was used to analyze all data. We used the synthesized HRs with 95% CIs to evaluate the longterm all-cause mortality and late MACCE on LMCAD patients

The 4490 patients aged >18 years were gathered from articles with the publication year has no limitation. All studies published within the last 10 years. All patients were measured syntax score preoperatively and followed up after 5 – 10 years. Pooled analysis showed that the long-term all-cause mortality in high SYNTAX score is significantly higher following PCI than CABG (HR: 1.44; 95% CI: 1.16-1.79; p=0.0010), although no significant difference between low to intermediate SYNTAX score following PCI and CABG. According to Giustino et al, PCI is known to be associated with higher risk for repeat revascularization compared with CABG. Repeat revascularization can increase the risk of mortality. The association between repeat revascularization and mortality is likely repeat revascularization could represent a marker of more extensive coronary artery disease and comorbidity burden. Bundhun et al also reported that mortality to be significantly lower in patients with low SYNTAX score following PCI

This meta-analysis shows that CABG has a lower risk in causing long-term all-cause mortality than PCI in those with high SYNTAX score, but the outcomes of MACCE in any syntax score are not significantly different between CABG and PCI

Acute compartment syndrome is a condition in which increased pressure in the tight fascia space reduces capillary perfusion below the level required for tissue viability. Very few cases of acute compartment syndrome associated with dialysis have been reported. It can lead to severe damage to the tissues of the arm.

A 47-year-old woman with end-stage renal failure presented to the emergency room with swelling and pain in the right upper extremity and has lasted for a day. Three days before admission, the patient underwent right brachiocephalic AV Fistula surgery. Physical Examination showed a blackish bruise at the fossa cubiti, Radial and Ulnar artery was not palpable, but there is Trill at AV fistula. Decreased motoric strength, reduced hand sensation and decreased capillary return in fingers. Oxygen blood saturation of the right fingers could not be read. Diagnosis of acute compartment syndrome was made. The patient was immediately taken to the operating room for decompression surgery. Emergency compartment fasciotomy was performed. After fasciotomy, necrotomy was performed. Furthermore, brachiocephalic AV fistula was ligated. Postoperative evaluation obtained good radial and ulnar artery. Six months after the surgery, the wound was fully healed and no sign of neuromuscular or vascular deficit.

Acute compartment syndrome is still a clinical diagnosis that includes pain on passive stretching, rapid advancement over a short period of time, paraesthesia, pallor, pulselessness and paralysis. One of the most sensitive approach for diagnosing this condition is the use of a two-point discrimination test, in which there is a mismatch between the visible injury and the state of paraesthesia that occurs. Compartment Syndrome can be caused by many pathologies such as reduce the volume in the compartment, increase the compartment content, cause external pressure and/or compression. Vascular access-associated compartment syndrome is reported rarely in hemodialysis patients. Fasciotomy is treatment of choice for the acute compartment syndrome. Rapid intervention is crucial for tissue recovery and rehabilitation. Ischemic tolerance of muscles tissue without irreversible damage is 4-6 hours and skin changes will be seen after 12 hours. Irreversible damage of nerve tissue is after 12 hours.

Compartment syndrome is a possible complication after AV fistula formation that can have disastrous consequences. However, it can be effectively treated if detected and treated early. Prognosis of compartment syndrome after fasciotomy depends on how quickly the condition is diagnosed and treated.

Recently, cancer cells have been found to be damaged by the combination of a light-sensitive medication with visible light or known as photodynamic therapy (PDT). This cancer-alternative treatment may be used as a stand-alone therapy or in conjunction with other therapies. Although it has been somewhat investigated as a therapy

Electronic databases were searched including PubMed, ScienceDirect, Scopus, as well as Google Scholar without any time limit. The studies obtained were then filtered based on the availability of complete manuscripts, written in English. The inclusion criteria in the current review were observational studies involving lung cancer patients, particularly those with centrally located lung carcinoma, who received PDT only. Eventually, all included studies will be assessed for bias according to their respective study designs.

From the 14 included studies, there were 1078 participants who were involved in this study. The majority of studies were conducted in Japan, with the histological results of the studied lesions being dominated by the type of squamous cell carcinoma. The most commonly used photosensitizer is Photoforin (porfimer sodium) at a dose of 2–5 ml/mgBW, followed by NPe6 (talaphorin sodium). Ten studies demonstrated a complete response (CR) in more than 80% of the observed lesions. In more detail, the CR in lesions measuring less than 1.0 cm is almost entirely greater than 93%. Then, 5 of 9 studies presented less than 10% of cases of CR recurring. 

In discussing therapy for central-type lung cancer, PDT can be considered as an alternative with consideration for patients with early stages who cannot be operated on. Currently, there are not many clinical studies that confirm the effectiveness of this therapy, so it is hoped that PDT can be performed on

The most common lung cancer is lung adenocarcinoma. It could be treated depends on the staging of the cancer. We report the pneumonectomy procedure performed in 41 year old female with right lung adenocarcinoma.

The patient was admitted with 1-year history of productive cough with yellowish sputum with no other complains. Patient was referred from prior hospital due to resource limitation. Radiologic examination revealed stage IIIA lung cancer with 5.4cm x 3.9cm x 4. cm irregular nodule (T4) at right inferior lobe along with multiple ipsilateral mediastinal lymphadenopathy (N1). Right inferior lobectomy was decided after multidisciplinary discussion. Intraoperatively, we found multiple nodules in the superior and medial lobe of the right lung, and the tumour encased interlobe fissure and the hilar vessels. Therefore pneumonectomy was decided to perform. Patient recovered and discharged from the hospital 11 days postoperatively.

Our case of lung adenocarcinoma which turned out already spread to other lobes and our decision to do pneumonectomy intraoperatively was challenging, it was the first time our hospital performed a pneumonectomy procedure.

Pneumonectomy was an unexpected decision during the surgery, since intraoperative findings was inconsistent with diagnostic imaging done prior to surgery. PET scan should be done before the surgery to get proper surgical procedure.

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) syndrome is a rare congenital heart disease, affecting between 1 of 30,000 to 300,000 children. It is very lethal with 90% mortality rate in the first year of life.1 Presenting mostly in infancy, ALCAPA is extremely rare in

A 6 year old child that had underwent cardiac surgery 5 years ago presented to us with severe mitral valve regurgitation. During her current surgery, the coronary artery was injured at the attempt to release extensive pericardial adhesion, resulting in very poor contractility that prompted delay of the intended valve repair. Injured coronary vessels were successfully repaired, yet low cardiac output syndrome persisted during perioperative care, necessitating ellaboration of the coronary problem. It was later found that the patient had anomalous left coronary artery from pulmonary artery (ALCAPA) syndrome.

ALCAPA is a remarkable finding in our center, as only five repair procedures have been performed between 2017 and 2022. Patients were mostly aged three or four months when the repair was done, while two patients were operated at age 12 and 23 months. Operative success rate is high, with only one in-hospital mortality.
Ischemic manifestation of ALCAPA, in lack of adequate collateral development, may appear weeks after birth corresponding to a decrease in pulmonary artery (PA) pressure that results in less antegrade coronary flow and eventual reversed flow [1-2]. In our case, prior history suggests that PAPVD, which possibly resulted in pulmonary hypertension, concealed ALCAPA manifestation from infancy up to current presentation. Furthermore, due to extensive epicardial adhesion, we were unable to clearly visualize the coronary anatomy during the 2nd operation.
Deterioration of heart contractility in our case was clearly seen intraoperatively, especially when the cardiopulmonary bypass machine started

This is a rare case of occult ALCAPA finding on a child. After performing coronary repair and mitral repair, the patient was discharged from the hospital without any problem

Pleuropulmonary blastoma (PPB) is a rare primary malignant tumor in the chest that mainly occurs in children <6 years of age. Only 9 cases reported extension of the tumor to the left heart and all of them are 72-old-months younger

An 11-year-old girl presented at an emergency department with 2 months of progressive dyspnea, non-productive cough, pleuritic chest pain, and malnutrition. Her dyspnea was relieved by sitting and bending forward. She grew up with a poor appetite with continuous exposure to secondhand smoke. Decreased left lung sounds and pitting edema were found on physical examination. On CT scan showed a massive pleural effusion with a solid mass in the left lung obstructing the left bronchial tree accompanied by the expansion of the tumor mass into the left pulmonary vein and LA, suspected PPB. A fused mass was found in LA on echocardiogram along with moderate MR, severe MS, and mild pericardial effusion. Median sternotomy approach was performed and tumor mass was easily identified in the left thorax. The heart was temporarily stopped by antegrade cardioplegia to aid the removal of intracardiac tumor followed by pneumonectomy of the left lung. Mitral

PPB is a rare aggressive tumor that has three types. Type III PPB has the least favorable prognosis with 53% of survival rate. The patients often manifest respiratory symptoms initially. Various manifestations can occur in line with the presence of metastases. The treatment consists of aggressive surgery and chemotherapy.

Prompt recognition of the involvement of cardiac chamber and great vessels in type III PPB is needed as it has various presentations and lower survival rate

Buerger’s disease or thromboangiitis obliterans (TAO) is a nonatherosclerotic progressive segmental inflammatory disease affecting the small and medium-sized arteries of extremities, but if the main arteries are affected by the disease than surgical procedure might be the choice of the treatment.

A 49-year-old man smoker presented of a blackened middle finger of his left hand and could not be moved since three months ago, accompanied by a history of pain and numbness.Left palm and the rest of the fingers were paler, peripheral saturation on it was not found and lower than 70% on the others. CT-Angiography showed complete occlusion of the brachial and radial artery. We decided to perform surgical revascularization by using gsv graft.
Harvesting the proximal GSV, Identified left axillary and the pulse was strong,the brachial artery found pulseless and weak flow of the artery.
Tunnelling was performed with clamps from axilla to cubiti, then proximal graft anastomosis was performed end to side on the axillary artery and distal graft end to side to brachial artery. The bypass graft was good with strong pulsation. Monitoring of the patient's finger began to appear red and warm and saturation measured well.

Classically, Buerger's disease affects young male adults with a long history of smoking as in this patient. However, an unusual feature of the disease in this patient is the occlusion of the brachial artery.
The diagnosis is based on the correlation between clinical history, physical examination and arteriography as the main diagnostic test. Systemic autoimmune disease, thrombophilia, diabetes mellitus and proximal embolism should be excluded. Currently, there is no specific treatment for the disease. The main treatment for the patients is to give up smoking. Medical treatment such as antiplatelets, anticoagulants, thrombolytics, vasodilators pentoxifylline, cilostazol, prostaglandins and endothelin-antagonist can be used to treat a patient with this disease. Surgical procedures can be performed in selected cases.

Emergency physicians should keep TAO in mind in patients with pain and discoloration in the extremities because early detection and treatment reduce the symptoms of the patients and prevent amputation. Surgery with the aim of revascularization may be considered in selected patients with severe ischemia and suitable distal target vessels.

One of the injuries that often occurs common in trauma patients is thoracic trauma. Cardiac injuries are the most lethal in thoracic trauma patients, especially penetrating trauma. Penetrating trauma caused by foreign bodies,a grenade fragmentation, inside the heart are rare cases.

a 36-years old male was admitted in emergency room with chest pain for 1 day prior to hospitalization. The chest pain localizing to the left hemithorax. The man injured by fragmentation of grenade explosion during the training of army. From CT-Scan of thorax, the foreign body was visualized at between the pericardium and the left ventricle. The sternotomy exploration was performed. The pericardium was opened, there is a lesion at lateral of left ventricle with a small hole in the pericardium on the apex of heart. Then evacuation was carried out, but was unsuccesfull. Foreign bodies was evacuated by beating Cardiopulmonary Bypass (CPB), but the hemodynamics became unstable, arrythmia (VT/VF). It was decided to do CPB – cross clamp, the foreign body was succesfully removed. Surgical wound closure was performed. The patient was transfered to ICU, the patient was stable. After a few days, patient was discharged with progressive recovery.

Penetrating cardiac injuries are immediate life-threatening situations with a relatively high mortality rate. In most cases they are caused by war or gun-shot injuries. There can be severe complications for these injuries like infections, sepsis, focus ectopic aritmia and migrating foreign bodies that may cause hemopericardium (cardiac tamponade), emboli, lung contusions, hematoma, hemothorax, pneumothorax. Cardiac foreign bodies are rarely seen because most patients with penetrating cardiac injuries die from hemorrhagic shock or cardiac tamponade. Penetrating cardiac injury, caused by intracardiac foreign bodies, presents a big challenge to surgeons for that it is difficult to exactly locate the intracardiac foreign bodies due to the continuous movement of heart and the evacuation may lead the instability of hemodynamic, arrhytmia (VT/VF) and low cardiac output.

We report a case of a penetrating injury into the thorax with the foreign body being lodged into the intramyocardial left ventricle and then managed surgically. Foreign body is high risk of causing infection, sepsis, embolization and cardiac tamponade. Cause of that urgent surgery must be performed.

Doege-Potter Syndrome (DPS) is a rare paraneoplastic syndrome with an incidence of 2.8 per 100,000 population. Tumors associated with DPS can originate from various locations, but the pleural cavity is the most common site. Approximately 50% of patients with respiratory symptoms. A definitive diagnosis of DPS typically requires a biopsy,

The 52-year-old female patient presented with recurring loss of consciousness for over the six months before admission, which consistently improved with D40% administration. The patient was diagnosed with severe hypoglycemia and also reported experiencing right chest pain, cough, shortness of breath, increased comfort while sleeping on the right side, and weight loss. After treatment, further examination revealed a mass in the right lung. A biopsy was performed, and the results indicated non small-cell carcinoma, accompanied by elevated IGF II levels.

Based on clinical symptoms, physical examination, and supporting tests, a diagnosis of Doege-Potter Syndrome (DPS) was established.

The presence of a thoracic mass with recurrent severe hypoglycemia and hypoinsulinemia, it is suspected of a Doege-Potter Syndrome. Performing an intrathoracic mass biopsy to confirm DPS is essential.

Ascending aorta aneurysm is frequent in Thoracic aortic aneurysms, can occur due to many epidemiology. Bentall procedure treats aortic root aneurysms with regurgitation. High risk due to perioperative mortality, even with skilled surgeons. Often combined with other procedures for better outcomes.

A male 54 years old with Endocarditis Infective, Ascending Aortic Aneurysm, Severe Aortic Valve Regurgitation, Severe Mitral Valve Regurgitation, And Coronary Artery Disease. There are no symptoms related to aneurysm, that was found incidentally from examination. Bentall procedure with CABG and MV repair was done successful in this patient. There is bleeding but can managed with tampons and antifibrinolytic. Delay sternal closure in this patient because of the oedema of heart. One day after Bentall procedure, evaluation of bleeding showed there are no major bleeding and active bleeding, and the sternal was closure after that. The patient was extubated, two days after Bentall procedure. After careful and comprehensive treatment, the patient was well and discharged.

The initial hospitalization of the patient stemmed from a fever and resulted in an infective endocarditis diagnosis, with Streptococcus Gordinii identified in blood cultures. Incidentally discovered, the patient also exhibited an aneurysm. Mycotic Aneurysm, an arterial wall dilation due to infection, can arise as an infective endocarditis complication. Diagnosis of mycotic aneurysm involves amalgamating clinical, lab, imaging, and intraoperative data, given the absence of a definitive algorithm. Management mandates prolonged, tailored antibiotic therapy based on culture and sensitivity results, alongside surgical intervention for eradication of infected tissue. Aortic regurgitation and aortic root aneurysms conventionally prompt combined replacement through the Bentall procedure. This surgery has spurred the evolution of alternative root replacement methods, like aortic valve-sparing techniques, offering benefits like anticoagulation avoidance and reduced morbidity. Despite skilled execution, the Bentall procedure remains perilous, carrying substantial perioperative mortality risk. Complications encompass bleeding, coronary ostial detachment, and pseudoaneurysm formation at anastomosis points.

Streptococcus gordonii-caused infective endocarditis is an uncommon case. Alongside aortic valve regurgitation, rare complications like mycotic aneurysms arise—arterial wall dilation due to infection. Incidental discovery through Echocardiography and CT scans is common. Treating aortic regurgitation and aortic root aneurysms involves the high-risk Bentall procedure, replacing both structures simultaneously.

Congenital corrected transposition of the great arteries (cc-TGA) is a complex congenital heart disease characterized by AV–VA discordance with incidence 1/33.000 live born. Classical repair or anatomical repair had been controversial. The aim of this study is to show classical repair was been one of the best choice.

A 13-year-old female patient was admitted to hospital having experienced recurrent lung infections. Patient had been diagnosed congenital heart diseased since 7th month-old. A pletore (increased pulmonal pattern) was seen at thoracic radiographic. Echocardiographic examination showed AV-VA discordance, hypertrophic RA, LA-LV dilatation, moderate MR, severe PS valvular, VSD inlet 1,99 cm, dan position aortic arch at right. Catheterization study showed VSD inlet with severe pulmonary stenosis and calculated McGoon ratio 2,4. VSD closure was successfully done to the patient with PTFE patch. Arteriotomy and commissurotomy were done for PS condition. LV-PA conduits didn’t installed due to limited conduits available. Patient was observed in intensive care unit for two days with stable hemodynamic without complication and extubation was done in first day care in intensive care unit. Patient with classic repair have risk to be right ventricle failure, so patient discharged with medical advice and treatment.

cc-TGA is a complex congenital heart disease. Surgical management strategies in patient with cc-TGA consist of classic (functional) repair dan anatomical repair. Surgical strategies are referred from surgeon preferences, clinical state of patient, and supported facilities. This patient success done classic repair, that are VSD closure, arteriotomy, and commissurotomy with polytetrafluoroethylene (PTFE) patch. Classical repair was chosen due to LV-PA conduit size limitation. Patient was observed only 2 days (short length of stay) in ICU without complication.

Surgical strategies in cc-TGA referred from surgeon preferences, clinical state of patient, and supported facilities. In this case, patient underwent classic repair without complications, short of long of stay in the ICU with stable hemodynamic. Cc-TGA management has become a challenge for paediatric cardiac surgeons to reduce morbidity and mortality.

Tetralogy of Fallot is the most common cyanotic congenital heart disease. Transannular Patch technique in the repair of TOF has a downside of causing Pulmonary Regurgitation. Pulmonary valve creation using pericardium is known as a feasible technique with satisfying result for the management of PR after TAP repair of TOF.

A case series of 4 patients who underwent pulmonary valve creation using pericardium in RSUD Dr. Soetomo Surabaya.

There are 4 cases of Tetralogy of Fallot patients in which each patient has a pulmonary valve abnormality causing severe pulmonary stenosis. All 4 patients underwent surgical total correction with Transannular Patch repair and pulmonary valve creation using pericardium. Transesophageal echocardiography after the procedure shows no pulmonary regurgitation with acceptable pulmonary pressure gradient

Pulmonary valve creation using pericardium is a feasible technique for avoiding pulmonary regurgitation that may be caused by the Transannular patch repair of Tetralogy of Fallot.

Descending necrotizing mediastinitis (DMN) is a life-threatening infection that originates from the ears, nose or throat and spreads inferiorly into the mediastinum via connective-tissue planes. If descending necrotizing mediastinitis is not diagnosed and treated promptly, the mortality rate can reach 50%.

A 26-year-old male admitted to the emergency room with symptoms of swelling and pain in neck and upper chest. The patient said that he had bad oral hygiene and had a toothache 2 weeks earlier. Five days earlier, the patient had neck debridement and drainage performed at the previous hospital. Laboratory results showed leucocytosis (leucocyte 20660 /uL; normal 4000 - 10000 /uL) and Cervical-Thoracic CT-scan indicated neck inflammation and mediastinitis. Acinetobacter baumannii sensitive to cotrimoxazole was found in the patient's pus culture.
The patient was treated with meropenem, metronidazole, vancomycin, and cotrimoxazole. The patient underwent tooth extraction, debridement of abscesses in the neck and chest wall and transcervical mediastinal drainage. Patient consulted a nutritionist due to severe malnutrition and got total parenteral nutrition and albumin transfusion.

Descending necrotizing mediastinitis (DMN) can spread through three potential planes: pretracheal, perivascular, and prevertebral. The patient's CT scan showed hypodense lesions in neck that spread to the superoanterior mediastinum, which suggests that there was spread of infection through the pretracheal planes.
The chest CT-scan indicated superoanterior mediastinitis, it is classified as type I DNM (localized). Transcervical mediastinal drainage is the best treatment option for type I DNM.
Acinetobacter baumannii is one of the major causes of nosocomial infections in critically ill patients. Cotrimoxazole has anti-inflammatory activity, and together with its antimicrobial activity, it makes a good option for the treatment of Acinetobacter baumannii.
Malnutrition can lead to immune dysfunction and increased susceptibility to infectious diseases. Adequate parenteral intakes of energy, macronutrients, and micronutrients are essential to improve immune function to treat DNM.

Descending necrotizing mediastinitis (DMN) is a life-threatening infection that has a high mortality rate. However, with aggressive antibiotic therapy, completely eliminating the source of infection, and treating comorbidities, the patient's outcome can be improved.

Chronic kidney disease hemodialysis patient require permanent dialysis access like arteriovenous fistula (AVF) as soon as the diagnosis is made. In rural area, due to limitation of facility and vascular surgeon, many patients can't have immediate AVF in time. As the result there are many complications develop. This article tries

In this article we report on hemodialysis patients manifesting complication due to AVF. AVF of all this patients were created more than 6 months after the hemodialysis was started due to many reason. While waiting for the AVF, temporary hemodialysis access using short-term double lumen catheter was created. The first patient is 46 year old male. The AVF was created 1 year after the dialysis was started. He then developed complications like central vein stenosis, superior vena cava syndrome, AVF aneurysm and subsequent rupture and permanent loss of the AVF. The second patient is 36 year old female whose AVF was created 7 months after the dialysis was started. She had complication of central vein stenosis and superior vena cava syndrome. The last patient is 38 year old female whose AVF was created 6 months after dialysis. She developed complication of ipslateral central vein stenosis, AVF Aneurysm and bleeding.

Nusa Tenggara Timur has high incidence of chronic kidney disease due to the contamination of the water. All dialysis CKD patients need permanent dialysis access. The presence of AVF often lead to several complications. This complication is aggravated by some condition like prolong use of double lumen catheter in ipslateral subclavian vein, infection, and poor care. Despite or advance understanding of its etiology and recognition about AVF complication, not all guideline and theory can be applied in limited resources area. This complication can lead to devastating effect and cause mortality and morbidity. From this article we want to emphasize at the problem that we face, review and find effective strategy that applicable to reduce the complication that is caused by AVF in limited resources area.

Prevention is always better than cure especially in limited resources area. AVF complication is very devastating and cause severe morbidity and mortality. Even not every theory and guideline can be applied in the limited resources area, at least physician must able to learn and applied their knowledge to prevent or

Germinal cell tumours can present with varying morphologies including benign teratoma and teratodermoid tumour. Teratomas range from benign and well-differentiated cystic lesions to solid and malignant lesions and can contain parts of many tissue types. Cystic teratomas occasionally occur in the mediastinum (7%), retroperitoneum (4%), cervical (3%), and intracranial regions

Here we present a 13-year-old male who presented with shortness of breath, chronic cough, chest pain, incidental weight loss, and history of Tuberculosis treatment who was diagnosed with mature cystic mediastinal teratoma based on thoracic computed tomography (CT) shows a large heterogeneous mass in the anteromedius mediastinum with cystic components, fat, calcification, and necrotic. This mass was approximately 13.6 x 17.7 x10.4 cm in size and histopathological examination of tissue specimens collected using core biopsy. Patient then underwent tumour excision with Clamshell approach. Intraoperative findings showed tumour mass in the right hemithorax with cystic component filled with various tissues. Tumour was found to exert compression towards the mediastinum and causing obstruction of the right lung.

Giant mediastinal tumours in the pediatric population can pose unique threats for resection such as cardiovascular collapse on induction of anaesthesia and injury to surrounding structures. This report highlights the approach of Clamshell thoracotomy which provides the best exposure and enables fastest control of thoracic injuries compared with other incisions. The main challenge in this approach was to control life threatening thoracic bleeding and to prevent bronchovenous air embolism. However, with enough expertise, Clamshell incision is preferred as it allows access to both thoracic cavities and superior mediastinum.

Complete resection of tumour was performed, followed by right lung decortication. Patient was fitted with a thoracic drain on right and left hemithorax with active suction. Clamshell insicion provide a good surgical field and can be safely used in patients with large mediastinal teratomas.

Nearly 90% of congenital heart defect patients in low-to-middle-income countries are unable to receive adequate care, which causes a high demand for pediatric cardiac surgery. Due to this, safety and outcome must be optimized, one of which is through using premedication drugs, where research regarding this topic is still limited.

PubMed and Cochrane databases were searched for full-text journal articles under the topic of premedications in pediatric patients undergoing cardiac surgery. Articles included were published between January 2003 to January 2023. Articles were excluded if it did not describe the outcome of the premedications, did not specify the type of surgery, included adult patients, or was a duplicate from the other database. Selection of articles were conducted by two reviewers and any differences would be discussed after article analysis.

A total of 298 articles were obtained and 10 were selected for analysis. Cefazolin and vancomycin usage provided modest protection in preventing surgical site infections due to methicillin-susceptible staphylococci, with certain dosage caused serum level of each antibiotic maintained to be above the susceptibility cut-offs for susceptible staphylococci. Preoperative methylprednisolone was associated with an improvement in preoperative inflammatory markers, but did not improve markers of inflammation after neonatal cardiac surgery and instead contributed to the incidence of postoperative wound infection or respiratory failure requiring tracheostomy. Intranasal dexmedetomidine was found to give more benefits in terms of separation, sedation, and behavior score with a faster onset of action than oral midazolam and a significant reduction of incidence of perioperative respiratory adverse events. Atropine usage significantly increased the risk of postoperative respiratory acidosis, in which the odds ratio for atropine alone was higher than ketamine alone as the general anesthesia.

Current studies that assessed benefits and harms of premedications on pediatric cardiac surgery were variative. The benefits that would support pediatric cardiac surgery came from antibiotics for certain dose and intranasal dexmedetomidine. Meanwhile, corticosteroids and anticholinergics would give a significant preoperative or postoperative risk that needs to be reconsidered.

Coronary artery bypass graft (CABG) is a major surgical procedure to remove atheromas from the coronary artery through grafted vein or artery. Many studies reported that the harvesting technique is one of the determining factors of a successful procedure. Previous studies have been collected to compare non-touch and conventional harvesting

This article used Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines with database search on PubMed and SagePub from 2013 to 2023. The search was done in July 2023. The recorded results are patency comparison, complications (MACCE), and leg infection post-CABG procedure with both techniques.

This study found 3 relevant articles to compare both techniques. The non-touch method has lower occlusion vein risk than conventional (OR=0,39; 95% CI = 0.22 - 0.68, I2 56%, p<.001). However, it has a higher leg wound infection risk post saphenous magna vein harvesting (OR=2.47; 95% CI = 1.66-3.69, I2 0%, p<.001). Both approaches are significantly indifferent regarding post-operation complications (MACCE).

Patient undergoing CABG with a non-touch approach has lower vein occlusion risk than conventional, hinting at the benefit of maintaining vessel patency post-CABG procedure although possessing a higher infection risk in harvesting location.

A stenosis of a large intrathoracic vein is referred to central venous stenosis frequently injured from intravascular device insertion.The purpose of this study focus on the effectiveness of endovascular therapy in routine hemodialysis patients with central venous stenosis with the goal is establishing endovascular intervention for the treatment of CVS.

To ensure comprehensive retrieval of relevant research we will search the following key databases: PubMed, Cochrane Library, and Proquest through 2013 for peer reviewed articles containing evidence related to endovascular therapy in routine hemodialysis patients with central vein stenosis.

Endovascular intervention is the first-line treatment for CVS because it is less invasive and can both maintain vascular access patency and reduce symptoms. Following management, the symptoms of venous hypertension were alleviated. There were no serious complications or mortality during the procedure. Percutaneous transluminal angioplasty (PTA) has a technical success rate ranging from 70% to 90%. The failure of the method could be attributed mostly to the pathophysiology of the lesion. In some obstruction cases, regardless of the extent of the lesion, passing through the lesion with standard wire is difficult. At one year, the secondary patency rate in the PTA group was (48.6±18.7)% and in the stent group was (83.3±15.2)%.

In the short term, endovascular intervention is a safe and effective approach for treating CVS. To sustain patency over time, enhanced follow-up and recurrent interventions are essential.

Distal insertion arteriovenous fistula (AVF) is advised as primary hemodialysis access. Snuffbox, located on distal wrist, rarely used for AVF insertion due to the prevalence of tiny vessels. In our experience, =0.2 cm on vascular ultrasonography.

AVF placement was planned for five chronic kidney disease patients with an average age of 55.2. All had a history of hypertension, but only three developed diabetes. Each subject passed the Allen's test. The average diameter of the radial artery and cephalic vein in the snuffbox area, measured by ultrasound with a tourniquet was 0.2 and 0.23 cm respectively. The artery had no aneurysms, stenosis, or arteriosclerosis with its average peak systolic velocity was 69.68 cm/s. No thrombosis or stenosis was visible in the vein. The snuffbox AVF (SAVF) creation used end-to-side anastomosis, took an average of 48 minutes without any postoperative problems. Six weeks later, maturation was noted as evidenced by a palpable thrill and an average bruit of >7 cm. However, a follow-up ultrasonography was not performed. The initial patient's results showed that functional patency was maintained for >4 months, demonstrating that SAVF is feasible for hemodialysis access.

SAVFs produced with a vessel diameter of at least 0.2 cm have shown effective maturation. In our investigation, the emergence of bruit and thrill, which were discovered at a minimum distance of 6 cm from the surgical site after six weeks, served as a sign of maturation. Due to limits in follow-up ultrasonography, the rule of six cannot be utilized to evaluate maturation. Diabetes patients are known to experience early AVF failure, however in our 4-month follow-up, every SAVF patient matured and successfully used an AVF for hemodialysis. In obese patients, longer procedures may result from deeper vascular location and a restricted surgical area caused by greater fat layers around the wrist, as vessels in distal locations are often deeper than the more proximal antebrachial or cubital region. Besides, we face limitations in a small number of events and a lack of follow-up to evaluate the patency after a year.

As the hemodialysis access alternative, SAVF is practicable. Prior to surgery, it is essential to measure the vascular using an ultrasound and tourniquet. The SAVF can be implanted in arteries and veins that have a diameter of minimum 0.2 cm, resulting in satisfactory patency and maturation within 6 weeks.

We conducted a systematic review and meta-analysis to analyse the role of trimetazidine therapy on postoperative myocardial preservation in CABG patients by assessing several biochemical markers of myocardial injury, including troponin T (TnT), creatinine kinase-myocardial band (CK-MB), creatine kinase and (CK). The Role of Trimetazidine in Protect the Myocardium on

The research instrument used was RCT test articles regarding trimetazidine therapy on several blood biochemical markers in postoperative CABG patients that have been published and obtained through a systematic and comprehensive search in the PubMed, Cochrane, and Google Scholar databases. We were classified into two group analyses based on sampling time (at least ≤12 or >12 hours after CABG) to analyse trimetazidine therapy on myocardial preservation in postoperative patients. The results of a literature search of a total of 45 potentially relevant articles were identified, of which 5 RCTs were suitable upon application of the inclusion criteria were RCT trials in post-CABG surgery patients treated with Trimetazidine regardless of sample size.

The forest plot evaluating trimetazidine therapy on TnT, CKMB, and CK assessed ≤12 hours postoperatively from several reported data results. TnT (I2 = 96%, SMD = -6.51, 95% CI = -9.75 to -3.27, p < 0.00001); for CKMB (I2 = 95%, SMD = -2.19, 95% CI = -3.15 to -1.23, p < 0.00001); in CK, (I2 = 96%, SMD = -1.35, 95% CI = -3.38 to 0.68, p 12 hours postoperatively. For TnT (I2 = 96%, SMD = -3.91, 95% CI = -5.65 to -2.16, p < 0.00001); for CKMB (I2 = 95%, SMD = -2.68, 95% CI = -4.42 to -0.94, p < 0.00001); in CK, (I2 = 96%, SMD = -3.54, 95% CI = -7.40 to -0.31, p < 0.00001).

Myocardial preservation of CABG by comparing the effects of trimetazidine and placebo by assessing several levels of myocardial damage such as TnT, CK-MB, and CK was significantly lower in CABG patients treated with trimetazidine compared with control CABG patients. In summary, postoperative trimetazidine treatment positively affects myocardial preservation in CABG

Chylothorax remains a rare complication of thoracic trauma and can be as a late onset. It can occurs as the result of laceration, rupture, or obstruction in the thoracic duct or its branches. Incidence in blunt thoracic trauma is said to be 0.2% to 3%, whilst in penetrating trauma, the

A 23-year-old female presented to the emergency room with a penetrating stab wound of the left chest and was hemodynamically stable but the knife still stuck in her chest. Chest X-Ray taken in the emergency room (ER) reveals hemopneumothorax on both sides. We placed a right chest tube with an initial 450cc hemorrhagic production followed by emergency thoracotomy for extraction the corpus alienum of blade. Subsequently, his right chest tube output developed a milky appearance with a total volume of 800 cc over 24 h on POD 3. We do observation with diet but there is no improvement, so surgical treatment thoracic duct ligation was performed. After thoracic duct ligation, the chest tube production became serous and the production was 20 cc over 24 h.

There is often a latent interval of 2 to 10 days before the chylothorax becomes clinically evident because many injured patients receive a restricted diet. Surgery enables a reduction in the period of being hospitalized and prevents complications that may have occurred by chylothorax. Some have favored a more aggressive approach, with immediate thoracotomy and thoracic duct ligation if the leak has not resolved after 2 weeks of observation.

Late onset of chylothorax is a rare complication of penetrating chest trauma that can be managed by surgical if conservative treatment failed.

VATS approach on thoracic surgery has gained its popularity due to its efficacy,
cost-effectiveness, and faster recovery times. VATS lobectomy provides less invasive surgery
compared to conventional thoracotomy

A 66-year-old male presented with left lung tumor. Tumor a size of 3,5 x 3,9 x 4,3 cm was located in the upper lobe of the lung. Symptom presented was unresolved coughing resulted from patient’s long-term illness of chronic obstruction pulmonary disease and past smoking habit. Biopsy examination showed no malignancy presented. Incision was made on the 4th ICS of axillary line. Lobectomy of the left upper lobe via VATS was performed to evacuate the tumor. Intraoperative findings showed solid tumor with no active bleeding from the tumor and fibrin adhesion on the apical side was able to be separated. 10 days after surgery, air leak from the left lung persisted, thus IPC was inserted. IPC was maintained for 8 days and no more air leak presented.

A 66-year-old male presented with left lung tumor. Tumor a size of 3,5 x 3,9 x 4,3 cm was located in the upper lobe of the lung. Symptom presented was unresolved coughing resulted from patient’s long-term illness of chronic obstruction pulmonary disease and past smoking habit. Biopsy examination showed no malignancy presented. Incision was made on the 4th ICS of axillary line. Lobectomy of the left upper lobe via VATS was performed to evacuate the tumor. Intraoperative findings showed solid tumor with no active bleeding from the tumor and fibrin adhesion on the apical side was able to be separated. 10 days after surgery, air alak from the left lung persisted, thus IPC was inserted. IPC was maintained for 8 days and no more air leak presented.

In this patient with left lung tumor, VATS procedure was used to perform lobectomy of the left upper lobe. The surgery was successfully performed with a good outcome.

Trials have shown that coronary artery bypass graft (CABG) is superior to percutaneous coronary intervention (PCI) in patients with multivessel coronary artery disease. Fractional flow reserve (FFR) has become popular in recent years and in this systematic review, we aim to evaluate the outcomes of FFR-guided PCI compared with CABG.

This systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. The electronic databases used to search randomised controlled trials (RCTs) discussing the outcomes of FFR-guided PCI and CABG were PubMed, The Cochrane Library, and EMBASE. We identified studies published in English from 2004 to 2023. Outcomes included major adverse cardiac or cerebrovascular events (MACCE), defined as death from any cause, myocardial infarction, stroke, repeat revascularization, and length of hospital stay. Quality assessment of the included studies was assessed using the Consolidated Standards of Reporting Trials (CONSORT) statement.

A systematic database search reveals 3 relevant studies. These researches found that patients who underwent CABG had a lower rate of major adverse cardiovascular and cerebrovascular events (MACCE) as compared with FFR-guided PCI (31.9% vs 44.5%). The rate of repeat revascularization was lower after CABG as compared with FFR-guided PCI (8.2% vs 24.9%) at <5 years. At 5 years, the rates of MACCE were similar between the 2 treatment strategies. On the other hand, patients who underwent CABG had poorer short-term outcomes such as longer hospital stay and higher incidence of major bleeding, arrhythmia, acute kidney injury and rehospitalization within 30 days compared with FFR-guided PCI.

Our systematic review showed that CABG has a lower rate of MACCE as compared with FFR-guided PCI in patients with multivessel disease. More clinical trials are needed to better define differences of long-term outcomes between CABG and FFR-guided PCI.

Ebstein’s anomaly is a rare congenital disease affecting the cardiac structure involving tricuspid valve leading to right ventricular dysfunction. Patient with Ebstein’s anomaly may have other structural abnormalities. Asymptomatic patient can treated with conservative management while symptomatic patients presenting with severe tricuspid regurgitation, NYHA class III-IV symptoms, overwhelming tachycarrhythmias should

A 13 years old girl presented with EA and ASD underwent a cone procedure with direct ASD closure and PFO creation. While opening the pericardium, the monitor showed VT and the patient was given an internal defibrillation. The sternal closure was delayed due to cardiac edema

Cone procedure is a relatively new surgical approach in EA management and is more preferred because it can be applied to the wide variety anatomical differences in EA. The procedure was done but the patient was hemodinamically unstable so it was decided to delay the sternal closure. The follow up echo showed mild TR with good biventricular function.

Many studies has shown that Cone procedure can improve the right ventricular function and residual mild-moderate TR might completely dissipate after follow ups as shown with our patient. The cone procedure was done successfully with reduced TR and good biventricular function.

This case report describes the management of a 53-year-old male with bilateral bullous emphysema, who presented with chest pain and dyspnea. A combination of open thoracotomy and Video Assisted Thoracoscopic Surgery (VATS) was used to address multiple bullae within the lungs.

Initially, open thoracotomy approach successfully addressed bullae in the right lung. However, VATS was pursued for the left lung, highlighting its suitability for laser bullectomy. Throughout the patient's post-operative course, serial CT scans unveiled the evolution of the right lung’s recovery and the residual bullous formations on the left lung.

This case illustrates the effectiveness of laser bullectomy in treating bullous emphysema without resorting to traditional lobectomy, serving as a multidimensional exploration into the diverse methodologies of laser bullectomy. Both open thoracotomy and VATS have merits, with the former providing better outcomes for its wider visual-field access. The comparative advantages of open thoracotomy and VATS unravel, revealing the former's expansive access for comprehensive bullae eradication and the latter's potential for finesse as surgeon skills advance.

The versatile application of laser bullectomy in bilateral bullous emphysema was demonstrated, indicating the importance of tailored surgical approaches. While open thoracotomy exhibited advantages in comprehensive bullae removal, VATS holds potential as skills advance.

Shock is a life-threatening condition that can occur after CABG and identifying its cause is crucial. The RUSH protocol is a point-of-care ultrasound examination effective at differentiating shock types. This review proposes using RUSH to identify shock causes in CABG patients, potentially improving diagnostic accuracy, treatment, and outcomes.

This literature review was conducted using a systematic search of the PubMed, Scopus, and Cochrane databases. The search strategy included keywords related to the RUSH protocol, shock, and coronary artery bypass surgery (CABG). The quality of the studies was assessed using established criteria, and data were extracted on study design, population, intervention, and outcomes. We put our focus on each point of RUSH protocol to be reviewed on selected publications after our screening through the inclusion and exclusion criteria. The general term was used to obtain a comprehensive number of publications potentially related to each aspect of RUSH protocol in recent literature. The exclusion criteria were any publication without correlation with the use of RUSH protocol. A narrative synthesis was conducted to summarise the findings of the included studies.

The RUSH protocol is a structured point-of-care ultrasound examination that has been shown to be effective in rapidly diagnosing the etiology of shock. A systematic review and meta-analysis found that the diagnostic accuracy of the RUSH exam was high, with a sensitivity of 88% and a specificity of 96%. Studies have also shown that the use of focused bedside ultrasonography in hypotensive patients can improve clinical decision making by emergency physicians and reduce diagnostic uncertainty. The RUSH protocol has been found to be effective in managing shocked patients and diagnosing the type of unknown shock in the emergency department.

The RUSH protocol is a potentially reliable tool for managing shock in post-CABG patients. However, limitations in current evidence suggest the need for further research to evaluate its use in this context.

Dual antiplatelet therapy (DAPT) is commonly used after coronary artery bypass grafting (CABG) to reduce the risk of thrombotic events. There is concern about the risk of major adverse cardiac events (MACE) associated with DAPT use. This meta-analysis aimed to evaluate the incidence of MACE in post-CABG patients receiving DAPT.

A comprehensive literature search was conducted to identify studies comparing the incidence of major adverse cardiac events in post-CABG patients receiving DAPT. The primary outcome was the incidence of major bleeding, while secondary outcomes included the incidence of minor bleeding, myocardial infarction, stroke, and sudden cardiac death. Subgroup analyses were performed to compare the use of ticagrelor versus clopidogrel in both on-pump (ONCAB) and off-pump (OPCAB) CABG groups.

The results showed that the risk of major bleeding following DAPT ingestion did not differ significantly between groups (OR 1.04; 95%CI 0.85 – 1.26). This was also observed in minor bleeding (OR 1.08; 95%CI 0.55 – 2.13). In myocardial infarction and stroke, the analysis did not show a significant outcome. However, DAPT could reduce the risk of sudden cardiac death in OPCAB group (OR 0.54; 95%CI 0.35 – 0.85). In subgroup analysis of the anti-thrombotic group, in the ONCAB group, the use of ticagrelor vs. clopidogrel did not show an increasing risk of major bleeding (OR 1.03; 95%CI 0.68 – 1.56 vs OR 1.06; 95%CI 0.66 – 1.70). The same phenomenon is also observed in the OPCAB group (OR 0.88; 95%CI 0.62 – 1.24 vs OR 1.23; 95%CI 0.58 – 2.59).

This meta-analysis suggests that DAPT use in post-CABG patients does not significantly increase the risk of major or minor bleeding, and may reduce the risk of sudden cardiac death in OPCAB group.

The incidence of cardiac surgery associated acute kidney injury (CSA-AKI) is a devastated condition. The prevalence is around 20% with mortality-rate exceeds 63%. Early intervention is very crucial to lower the mortality-rate. Hereby we present our experience in utilizing prolonged intermittent renal replacement therapy (PIRRT) in managing CSA-AKI.

A 69-year-old man admitted to undergo elective CABG-surgery. His past medical history was remarkable for UAP. CAG study demonstrated left main and two-vessel disease. His EF was 60.5%, with no prior history of DM and CKD. The CABG was performed by anastomosed LIMA to distal segment of the LAD and one graft of GSV was anastomosed to OM. Following the surgery, the patient experienced post-operative atrial fibrillation and stage-three-AKI. His urine production decreased with leg swelling and no shortness of breath. His serum creatinine evaluation reached 3.48-mg/dL and urea 112.9-mg/dL. Our team and nephrologist decided to perform PIRRT with sustained low-efficiency daily dialysis mode (SLEDD). After second dialysis, patient’s condition improved, with increased urine-output production and lowered serum urine-creatinine. After close monitoring for fifteen days, the patient’s serum creatinine was gradually becoming normal. He did not need subsequent routine dialysis following discharge from our hospital.

The occurrence of CSA-AKI in our patient is caused by multiple factors such as ischemic reperfusion injury (IRI) triggered by the use of CPB, which aggravated by blood transfusion and worsened by POAF. The IRI triggers the event of ferroptosis in kidney, an iron-dependent programming of cell death and lipid peroxidation of renal tubular cells. This event was aggravated by the administration of PRC transfusion. This substance contains a myeloid-related-protein which increases the activity and influx of neutrophils against the renal tubular cells. The POAF could worsen the AKI through several mechanisms, such as tubular necrosis due to hemodynamic instability and renal ischemia due to embolism event. Renal replacement therapy become the main treatment strategy in this settings. The PIRRT technique with SLEDD mode was performed due to unstable hemodynamic condition in our patient. Recent study demonstrates reduction in mortality associated with early use of RRT in post-cardiac surgery.

The choice of postoperative management of CSA-AKI must be concordance with the disease’s severity. Alternative technique other than CPB-machine, judicious use of blood products, and prompt management of POAF should be considered. The PIRRT can be chosen as alternative to CRRT with the same outcome for managing AKI following CABG-surgery.

As reported in Riskesdas 2018 prevalence of CKD that needs Hemodialysis (HD) is 19%. AVF and CVC are one the vascular access of choice for HD. Few studies have assessed the association of vascular access type with KDQOL. This study aimed to compare KDQOL in patients undergoing HD by AVF

This was a cross-sectional observational study. All of the data collected in August 2023. The eligible Criteria is All patients who undergoing HD (not Initial HD) who had vascular access using AVF or CVC were eligible to participate in the study, age more than 18 years old, good conciousness. Sociodemographic characteristics were noted, and KDQoL was assessed using the Short Form 36 questionnaire In Bahasa. All the data that collected is analyzed using SPSS.

A total of 66 patients were included in this study, 39 in AVF group and 27 in CVC group. Total Patient of man 38 (57.6%) and woman 28 (42.4%).The mean (standard deviation) age was 53.59 (13.22), and the median (range) duration of HD was 36 months (1 month–132 months). Overall, patients who underwent AVF for vascular access had significantly P=0.007 (P < 0.05) higher KDQOL score than those who underwent CVC(CDL).

This study showed us that patients who had vascular access using AVF showed better Quality of life as compared to CVC(CDL) in patients with HD.

Klippel-Trenaunay syndrome (KTS) is a rare, sporadic congenital disorders characterised by the triad of capillary malformations, unusual varicosities or venous malformations, and bone or soft tissue hypertrophies, typically affecting one extremity.

A 20-year-old male was brought into our hospital with big varicose veins and soft tissue hypertrophy in his left leg. When he had to stand for a prolonged period of time, he complained of leg pain. Based on clinical data and other examinations, we determined the diagnosis of KTS. The saphenofemoral junction and the great saphenous vein (GSV) trunk were not visible during duplex scanning of the veins. A strange sound was found on Doppler examination at the junction between the perforator and the femoral vein. Varicose veins on the posterolateral side of the thigh emptied into the muscular veins through the muscular fascia. Found a dilated femoral vein in the posterior thight accompanied by a perforator vein around it. Total ligation of perforating vein on the lateral and medial side and extirpation of large varicose veins on the thigh, crus and dorsum of the foot were carried out.

Accurate preoperative recording of the venous anatomy and function is necessary for treating chronic venous insufficiency in KTS patients. Duplex scanning is appropriate to make the vascular anatomy clear before surgery. The deep venous system's patency is to be confirmed, and venous incompetence in the deep, superficial, and perforating venous systems in the extremity and pelvis are to be evaluated. The location of the ineffective perforating veins and the locations of the saphenofemoral and sapheno-popliteal junctions can be identified using a duplex scanning examination, which is crucial. In our patient, GSV was absent. Post operative care is also important, which in our case the postoperative course was without complications and patient was discharged on day 2 after the operation.

KTS is a complicated congenital vascular malformation that is uncommon, sporadic, without known cause. Most patients get well without treatment or with elastic compression only. Surgery may be beneficial for patients who have a leg length discrepancy or severe chronic venous insufficiency.

Pseudoaneurysm is one of vascular injury complication in lower extremity that’s rarely been reported, especially occurs in toddler. Should it not treated properly, it can lead to worst condition and even limb ischemic.

a 3-year-old toodler, presented in the Emergency room (OR) of dr.Zainoel Abidin General Hospital (RSUZA) with bleed of his wound in the left limb and persistent active bleeding . The patient was hit by the shattered glass after falling from the window about one month ago before admision. On the physical examination, we found bleeding wound on the medial malleolus region of left limb, a pulsatile mass on the palpation, history of active bleeding was positive. To confirm the diagnose ,we performed CT angiography which showing a sac shaped vascular lesion measuring 2,8 x 2,2 x 2,8 cm of proximal segment of left posterior tibial artery , suggesting a pseudoaneurysm. We perfomed open surgery with excision procedure and a clot was found in medial malleolus region. As a result of open surgery, the left medial malleolus region is red which indicates getting a good blood flow.

Pseudoaneurysm referred to a vascular abnormality that infrequently reported to have an association with penetrating trauma or blunt, and exercises. The case showed a history of trauma before the pseudoaneurysm occurance. The delayed diagnosis of pseudoaneurysm is usually happen because of non-specific clinical manifestation like haematoma, pain, swelling, bleeding . According to symptoms, the patient has experienced swelling, bleeding and pain .The open surgical technique for pseudoaneurysm is a treatment of choice.

Pseudoaneurysm resulting from vascular injury or iatrogenic injury can lead on various serious complications. If pseudoaneurysm is not treated properly, it can even threaten patient’s life.

Surgical site infection (SSI) following adult cardiac surgery remain an inseparable challenge despite advances in its prevention. Understanding preoperative risk factors associated with SSI would help healthcare provider improved patient care and decrease readmission cost. This study aim to analyse associated risk factors on SSI in adult cardiac surgery patients

This was a retrospective study conducted in Jakarta Heart Center (JHC). Data were abstracted on adult (18-64) patients who underwent cardiac surgery procedure between 2020-2023. Potential risk factors for SSI were obtained electronically from JHC medical record, including age, gender, diabetes, hypertension, smoking status, creatinine level, Hb, LVEF, Blood sugar, albumin level, duration of surgery. We employed univariate, bivariate and multivariate to determine association between preoperative risk factors and SSI. Bivariate analysis was done either with Chi Square (categorical data) or Mann Whitney (numerical data). Multivariate analysis was done with binomial logistic regression

108 samples were collected (54 were case and 54 controls). Smoking status (p = 0.010, RR=1.634, 95% CI 1.134-2.355) and diabetes (p=0.048, RR = 1.511, 95% CI 0.976 – 2.341) was reported as statistically significant factor affecting occurrence of SSI. We then employed multivariate analysis with binomial logistic regression. After adjustment of covariate of age, smoking and diabetes emerged as significant preoperative factor for occurrence of SSI with smoking as the leading factor (RR = 3,125, p =0,011) and diabetes followed behind (RR= 2.65, p=0.030).

Current smoking and history of diabetes is significantly associated with development of SSI after adjusting for age with current smoking as the leading factor. More studies are needed to examine establish causal relationship between aforementioned preoperative factor with development of SSI.

80% of dialysis patients in the USA used catheters for hemodialysis access. The incidence of central venous stenosis occurs 25-40% worldwide. Because high prevalence and challenging treatment of central venous stenosis due to the long-term use of a catheter in dialysis patients, we aim to review the use of venoplasty

The patency of central veins is important to adequate dialysis access. A well-established outflow tract clear of any obstruction is essential for an arteriovenous fistula (AVF) to mature and function efficiently. The long-term use of a catheter is associated with increased central vein stenosis incidents. Subclavian catheter placement is a particularly high risk, with the development of subclavian vein stenosis in approximately 25%-50% of patients in various studies. The asymptomatic patients make the diagnosis difficult to determine the actual prevalence. One of the standard treatments for central venous stenosis is central venoplasty. Venoplasty is defined as the inflation of a balloon in the central vein such as the brachiocephalic vein, subclavian vein, or superior vena cava. Venoplasty for central venous disease has high technical success rates, ranging from 70%-90%. Successful venoplasty defines as the successful inflation of the balloon without residual stenosis.

Adwaney et al found patients with a previous catheter used have a higher incidence than patients without a catheter used (RR 2.2, 95% CI 1.6 – 2.9). Cuthbert et al found that a shorter time to the second venoplasty is needed in patients with ipsilateral tunneled dialysis catheters (p= 0,039). Statistically significant differences were found in primary patency rates in those with a history of ipsilateral tunneled dialysis catheters (p = 0,025). Rehman et al reported primary patency rate was 40%, 24%, and 24% at 6, 12, and 24 months. Cumulative patency was 69%, 66%, and 59% at 6, 12, and 24 months. 74 % of patients had a recurrence of symptoms and 60% of patients undergo repeat angioplasty. Calton et al reported five patients performed the antegrade-retrograde technique of venoplasty. 4 patients success in the antegrade technique while 1 patient only be crossed with the retrograde technique. They also

Venoplasty is a gold-standard treatment for patients with central venous stenosis with a high short-term patency rate. Despite its low procedural risk, some patients require re-intervention because of restenosis occurring over the years. Venoplasty requires further research to obtain better long-term patency rates

Following Fontan procedure, patients are at risk of experiencing thromboembolic events due to various factors stemming from the univentricular cardiac system. To mitigate the risk of thromboembolism, patients are typically administered post-operative anticoagulant treatment. However, a consensus regarding the optimal anticoagulant therapy for preventing thromboembolic events in post-Fontan surgery patients has yet to be established.

A literature search was performed across five electronic databases: MEDLINE, EBSCO, ProQuest, Scopus, and the Cochrane Library, to identify relevant studies. The selection of studies for examination was carried out through the removal of duplicate articles, screening of titles and abstracts, and a final selection involving comprehensive review of all the articles screened based on predefined eligibility criteria. A critical appraisal was then performed on the selected studies using the FAITH worksheet for meta-analysis studies.

Following an extensive literature search and meticulous selection, two meta-analysis studies were selected. While the overall validity of both studies is satisfactory, certain aspects of validity criteria were not met in both meta-analyses, notably the absence of an explanation regarding the critical appraisal tools used and the quality of studies included in the meta-analyses. Significantly, both studies showed that the utilization of aspirin or warfarin reduced thromboembolic events in post-Fontan procedure patients when compared to those without anticoagulant therapy (IRR 0.23-0.24 and OR 0.363-0.425; 95% CI; p 0.05).

Administration of both aspirin and warfarin can effectively reduce thromboembolic events in post-Fontan procedure patients. Data from two meta-analysis studies showed no significant difference were identified between aspirin and warfarin with regard to the prevention of thromboembolic events. Thus, aspirin stands as a viable alternative to warfarin for preventing thromboembolic incidents in patients who have undergone Fontan procedure.

Following Fontan procedure, patients are at risk of experiencing thromboembolic events due to various factors stemming from the univentricular cardiac system. To mitigate the risk of thromboembolism, patients are typically administered post-operative anticoagulant treatment. However, a consensus regarding the optimal anticoagulant therapy for preventing thromboembolic events in post-Fontan surgery patients

A literature search was performed across five electronic databases: MEDLINE, EBSCO, ProQuest, Scopus, and the Cochrane Library, to identify relevant studies. The selection of studies for examination was carried out through the removal of duplicate articles, screening of titles and abstracts, and a final selection involving comprehensive review of all the articles screened based on predefined eligibility criteria. A critical appraisal was then performed on the selected studies using the FAITH worksheet for meta-analysis studies.

Following an extensive literature search and meticulous selection, two meta-analysis studies were selected. While the overall validity of both studies is satisfactory, certain aspects of validity criteria were not met in both meta-analyses, notably the absence of an explanation regarding the critical appraisal tools used and the quality of studies included in the meta-analyses. Significantly, both studies showed that the utilization of aspirin or warfarin reduced thromboembolic events in post-Fontan procedure patients when compared to those without anticoagulant therapy (IRR 0.23-0.24 and OR 0.363-0.425; 95% CI; p 0.05).

Administration of both aspirin and warfarin can effectively reduce thromboembolic events in post-Fontan procedure patients. Data from two meta-analysis studies showed no significant difference were identified between aspirin and warfarin with regard to the prevention of thromboembolic events. Thus, aspirin stands as a viable alternative to warfarin for preventing thromboembolic

A rare but acknowledged side effect of peritoneal dialysis is hydrothorax. It is a potentially serious condition that frequently requires cessation of peritoneal dialysis and permanent transition to hemodialysis. Peritoneal dialysate passes via pleuroperitoneal fistulas causing hydrothorax. High glucose concentrations are frequently seen in pleural fluid analyses.

We describe the case of a 47-year-old male on peritoneal for ESRD who developed a hydrothorax nine months after insertion. Patient underwent operation of peritoneal dialysis on October 2022. There was no complain until 9 months. At first the patient notice the production of the peritoneal dialysis were reduced, and later complaint dyspneu. Chest X-ray evaluation shown pleural effusion, and chest tube insertion was done to evacuate the effusion. The patient later referred to RSUD Dr. Soetomo Surabaya, and use catheteter dialysis line for hemodialysis.
The patient was consulted to our department, and we decided to do VATS Diafragmatic Repair. We found fistule on diaphragma with leakage from the fistulation. We did diaphragmatic repair using stapler and reinforced with polyprophylene suture. There is minimum production after the repair, and the chest tube was taken out on the fourth day of post op.

For individuals with end-stage renal failure, peritoneal dialysis is a common modality. Although peritoneal dialysis often successful, there are risks involved. Infection is the most prevalent and significant PD consequence. Intestinal perforation, abdominal wall herniation, catheter site leaks, and catheter blockages are additional frequent consequences.
A rare complication known as hydrothorax is caused by the migration of fluid through pleuroperitoneal fistulas from the peritoneal cavity into the pleural space. The majority of right-sided effusions are caused by these diaphragmatic abnormalities, which are typically congenital and right-sided. According to estimates, hydrothorax happens in 1.6% of patients taking PD. Up to 25% of cases are asymptomatic and most happen within 30 days of the start of PD. When patients on PD present with pleural effusions, hydrothorax should always be taken into consideration.

This case describes a classical presentation of hydrothorax in the context of peritoneal dialysis. Surgical evaluation followed by diaphragmatic repair shown excellent result on this case.

Video-assisted thoracoscopic surgery (VATS) has demonstrated its efficacy and improved clinical outcomes as an option for early-stage non-small cell lung cancer. The development of robotic-assisted thoracoscopic surgery (RATS) has become the newest alternative to VATS. This study aims to compare VATS and RATS in terms of clinical outcomes.

This Systematic Review research used the PRISMA method. A literature search relevant to this research was conducted on Pubmed and Cochrane databases. Out of a total of 122 search results, 8 studies were found that were relevant to the research criteria. Data retrieved from the literature in the form of study design, time period, total size, and outcomes collected in the form of intraoperative parameters (operation duration, transfusion rate), length of stay, intraoperative and postoperative complications, mortality in hospital or 30 days postoperatively and chest drain duration. Meta-analyses of clinical outcomes were performed. In the forest plots depicting outcomes, each comparison is grouped by overall effect and heterogeneity. We computed Mean Difference and Odds Ratio (ORs) with 95% Confidence Intervals using inverse variance for continuous and discrete data. Heterogeneity is present if X2 P 50%.

RATS is proven to be an alternative with superior results compared to VATS on the Mortality in 30 days parameter (OR 0.59, 95% CI = 0.40, 0.86, I2 : 0%; p<0.006) and transfusion rate (OR = 0.50; 95% CI: 0.27 - 0.92, I2: 6%; p = 0.34). There was no significant difference between the RATS vs VATS procedure in terms of duration of surgery (OR = 0.50; 95%CI: 0.27 - 0.92), and intraoperative complications (OR 1.98, 95%CI: 0.12 - 32.44) and postoperative complications (OR 1.05, 95%CI: 0.93 - 1.19). The parameters of length of stay and chest drain duration in most of the studies show that VATS requires longer treatment time and thoracic drainage time than RATS.

RATS can be an alternative to minimally invasive surgery in early-stage lung cancer with a lower risk of death and transfusion requirements than VATS, but there is no difference in duration of surgery, as well as intraoperative and postoperative complications.

Norwood is a first palliative procedure for Hypoplastic Left Heart Syndrome (HLHS). The pulmonary circulation has been supplied via modified Blalock Taussig (BT) shunt. Recently, there is a modification that substitutes a conduit between right ventricle and pulmonary arteries (RV-PA). Whether BT shunt or RV-PA conduit will result better outcomes

Systematic research was performed on electronic databases (PubMed, ScienceDirect and Scholar). The search was aimed to the studies reporting comparative outcomes of patients undergoing Norwood with BT shunt compared with RV-PA conduit. The primary outcomes of this study were short-term post procedural including short-term mortality, interstage mortality, ICU length of stay, length of hospitalization, cardio-pulmonary bypass (CPB) time, deep hypothermic circulatory arrest (DHCA) time, and ventilatory support time. Secondary outcomes was late hemodynamic status during catheterization before undergoing stage II hemi-fontan palliation, including pulmonary:systemic blood flow ratio (Qp/Qs), aortic saturation (Ao SpO2), aortic oxygen pressure (Ao PO2), aortic diastolic pressure (Ao DP), right ventricle end diastolic pressure (RVEDP), nakata index, and shunt related stenosis. Data were collected using the Mantel-Haenszel fixed effects model with relative risk (RR) and mean difference (MD) as the effect size with 95% confidence intervals (CI). All analyzes were performed using Review Manager 5.4.1.

Total of 13 studies with 905 patients were included to our study. The results in our study showed RV-PA conduit significantly associated with lower short-term mortality (RR0.62;95%CI 0.45,0.85;P=0.001,I2=0%), lower interstage mortality (RR0.18;95%CI0.05,0.64;P=0.008,I2=0%), lower ICU length of stay (MD-3,29; 95%CI -5.02,-1.56; P=0.0002, I2=88%), lower hospitalization (MD -2.62; 95%CI -5.13,-0.11; P=0.04, I2=40%), lower DHCA time (MD -8.58; 95%CI -9.32, -7.83; P<0.00001, I2=87%), and higher CPB time (MD 17.81; 95%CI 15.88, 19.74; P<0.00001,I2=94%) compared to BT-shunt. Meanwhile, ventilatory support time was not statistically significant different between two groups. On late hemodynamic status, RV-PA group was significantly associated with lower Qp:Qs (MD -0.17; 95%CI -0.24, -0.10; P<0.00001,I2=85%), higher Ao DP (MD5.22;95%CI 2.56-7.87;P=0.0001,I2=0%), lower Ao SpO2 (MD -5.05; 95%CI -6.43, -3.68; P<0.00001, I2=62%), higher nakata index (MD43.01; 5%CI 34.84,51.18; P<0.00001, I2=68%), and higher shunt stenosis (RR3.21;95%CI 1.94,5.32; P<0.00001; I2=95%) compared to BT group.The RVEDP and Ao PO2 were not statistically significant different between two groups.

Norwood procedure with RV-PA conduit were considered to have better outcomes in mortality and late hemodynamic status compared to BT shunt for stage II hemi-Fontan palliation. However, the higher incidence of shunt stenosis in RV-PA should also be considered.

Hemothorax is defined as an accumulation of blood 1-3 whereas pneumothorax is defined as the presence of air between the visceral and the parietal pleura4 which can be caused by thoracic trauma. This case report presents possible thoracic trauma from traditional body massage, which is a common practice in Indonesia.

A 31-year-old male referred due to dyspnea and cough two days prior. Three days before admission. the patient went to traditional whole-body massage and heard crackling sound on his back while receiving the massage. There is no history of trauma, fever, weight loss, nor prolonged cough. Thoracocentesis and chest tube insertion was performed and connected to water-sealed drainage (WSD).

Five hours after chest tube insertion with bloody production of 800 cc, patient developed shortness of breath with blood pressure levels of 80/60 mmHg and Hemoglobin (Hb) of 6.6 from 10.3 g/dL. Fluid resuscitation and emergent transfusion of packed red cell administrated before evaluating with chest x-ray. Chest X-ray showed massive left hydropneumothorax accompanied by right tracheal deviation. After exclusion of COVID-19, emergent thoracotomy exploration performed. In thoracotomy, ruptured bullae at left apical superior lobe was found and resected. The source of the bleeding was stopped and the hematoma was evacuated.

Hemopneumothorax can be caused by traumatic, spontaneous, or iatrogenic.1-3 The spontaneous hemopneumothorax mostly caused by rupture of previously existing bullae.5 The formation of bullae may be from emphysematous disease or other mechanisms, such as the mechanical compression and repetitive friction by ribs.5, 6 Meanwhile, traditional massage is common practice in Indonesia which is very thick with culture7, but, without any medical expertise background. High pressure and compression to dangerous area can cause problems, such as myalgia, nerve entrapment, or bone fracture. In this case, the force of massage in thorax area cause rupture of thin and weak-integrity bullae, causing hemopneumothorax.
In massive hemopneumothorax, patient’s hemodynamic can deteriorate rapidly due to blood loss. Therefore, management of massive hemothorax includes early diagnosis along with adequate resuscitation. In hemodynamically unstable patient, surgical approach is recommended to explore bleeding. As in this case, the ruptured bullae are resected and repaired to secure the bleeding.

Traditional massage is uncommon cause of hemopneumothorax due to rupture of bullae, which cause a life-threatening consequence. The early diagnosis and treatment are essential for increasing the survival chances of these patients.

Cardiac rhabdomyoma is one of the most common cardiac tumor in children and frequently associated with tuberous sclerosis complex (TSC). In Indonesia, TSC is exceedingly rare. The aim of this study is to discusses a case with clinical manifestation of TSC involving multiple cardiac rhabdomyomas finding and to evaluate the

A case of 1-month old boy came to the ER with cyanosis and periodic apnea. The patient was prematurely born from preeclamptic mother. Any seizure episodes was not reported. There was no family history of any genetic disease. Echocardiography findings were multiple solid masses located in left and right ventricle vary in size (1.3 cm x 6.9 cm), moderate PDA and Persistent Foramen Ovale. Any regurgitation was not reported. Head CT scan showed multiple nodule calcification. Tuberous sclerosis diagnosis was made clinically according to the TSC guidelines.

Tuberous sclerosis complex is one of the rare genetic disorders, specifically mutation in TSC1 or TSC2. The incidence falls between 1 in 6000 and 1 in 10,000 live births, as this can be challenging for practitioners in diagnosing this disease. Generally, cardiac rhabdomyoma can be resolved on its own. However, in this symptomatic patient, it is imperative to decide the proper treatment in this case, either by medical or surgical management. Eventually, it was decided that the patient was treated with everolimus, an mTOR inhibitor. After a month, the echocardiography showed a substantial reduce in size. Hence, no surgical intervention for the management of the cardiac tumor.

Despite its tumor size and symptoms, mTor inhibitor alone has successfully able to reduce size of the cardiac tumors. This can also shorten hospital stay, lower morbidity rate and lessens the need for surgery.

Isolated tricuspid valve surgery after previous cardiac surgery is considered a high risk procedure. Median sternotomy is a conventional procedure with high morbidity and mortality. Recently, redo surgery with minimally invasive for tricuspid (MIT) either via right mini-thoracotomy or thoracoscopic have developed. However,the choices of surgical approach are still controversial.

Systematic search was performed on PubMed and ScienceDirect. The search was aimed to studies comparative outcomes of MIT compared with median sternotomy in redo tricuspid valve surgery. Subgroup analysis also done between mini-thoracotomy and thoracoscopic compared to median sternotomy. Outcomes of this study were cardiopulmonary bypass (CPB) time, operation time, ICU and hospital length of stay, total chest drainage, postoperative complications, re-exploration, short-term mortality, and long-term mortality. Data were collected using Mantel-Haenszel fixed effects model with relative risk (RR) and mean difference (MD) as the effect size with 95% confidence intervals (CI). Statistical heterogeneity between groups was measured using the Higgins I2 statistic. All analyzes were performed using Review Manager 5.4.1.

Total of 8 studies with 629 patients were included in this study. CPB time was higher in
MIT group (MD 18.81;95%CI 16.05,21.58;P<0.00001;I2=92%), but lower in mini-thoracotomy subgroup (MD -15.83;95%CI -23.80, -7.86;P<0.0001;I2=18%). Operation time (MD -36.04; 95%CI -47.41,-24.67;P<0.00001;I2=66%), hospitalization (MD -2.64;95%CI -3.77,-1.51;P<0.00001;I2=78%) and ICU length of stay (MD -0.37;95%CI -0.45,-0.29;P<0.00001;I2=69%) were significantly lower in MIT group. The need of re-exploration due to bleeding was significantly lower in MIT group (RR 0.42; 95%CI 0.21,0.87;P=0.02, I2=0%), similar significance was also found in thoracoscopic subgroup (RR 0.26; 95%CI 0.07, 0.97;P=0.05,I2=0%) but not significant in mini-thoracotomy subgroup. Post-operative complication and short-term mortality significantly lower in MIT group [(RR 0.66; 95%CI 0.51,0.85;P=0.001,I2=38%), (RR 0.47; 95%CI 0.28,0.79;P=0.005, I2=0%) respectively] and also in mini-thoracotomy subgroup [(RR 0.62; 95%CI 0.44, 0.86;P=0.005,I2=46%), (RR 0.46; 95%CI 0.24, 0.91;P=0.02,I2=8%) but not in thoracoscopic subgroup. In long-term mortality, both groups did not show significant differences.

Minimally invasive surgery, especially right mini-thoracotomy procedure for tricuspid valve redo surgery shows better outcomes in short-term mortality and morbidity. However, in long-term mortality, minimally invasive surgery didn’t show its superiority over conventional sternotomy. Therefore, further research is still needed to determine which gives better long-term outcomes.

Obstructive shock is a condition caused by obstruction of the great vessels or the heart itself. The symptoms are nonspecific and mostly due to extracardiac causes. Early recognition and immediate management are crucial to prevent unwanted outcomes. We presented a case of tuberculosis infection with rare and life-threatening complication.

A 56-Year-Old Male diagnosed with Cardiogenic Shock with ADHF was referred to the ER with hypotensive, tachycardia, and tachypnea. Increased jugular vein pressure, decreased breath sound, dull sound percussion on the left lung, and distant heart sound were found. 12-leads Electrocardiography showed low voltage, and Chest X-ray revealed massive pleural effusion on the left lung. Bedside Trans-thoracic Echocardiography reveals a left pleural effusion with pressure on the left atrium and left ventricle with low cardiac output and minimal pericardial effusion. Chest Tube placement is done immediately and reveals hemothorax, then symptoms become relieved. A Blood test showed leukocytosis and mild anemia. The sputum test was negative for tuberculosis infection, but from the CT scan result, we suspected tuberculosis infection. Anti-Tuberculosis Drug was added to the treatment and the patient showed more improvement and was discharged after 5 days of hospitalization.

Obstructive shock is one of the rarest types of shock, this condition can be a result of multiple etiologies involving the heart, lungs, major systemic vessels, or pleural cavities. In significant volumes, hemothorax may result in increased intrathoracic pressure, leading to obstructive shock. Immediate causal treatment is needed in this type of shock, such as thoracic or pericardial drainage. Spontaneous Hemothorax is a rare condition that can be associated with many diseases, but it is still uncommon in any of them. Massive hemothorax is an infrequent and life-threatening condition. Spontaneous pneumothorax, pulmonary emboli, tuberculosis, neoplasms, hematological abnormalities, connective tissue disorders, exostoses, and drug-induced are various pathological conditions that may trigger intrathoracic hemorrhage. Tuberculosis is a chronic infection that is a leading cause of death worldwide. This condition can cause abnormal vascularization connecting the pleura and chest wall, which then cause aneurysm that result in intrathoracic hemorrhage if ruptured.

Early recognition and immediate causal treatment are the keys to managing this rare and life-threatening condition. Proper history-taking and physical examination are important. Imaging can help to confirm the type of shock. The underlying cause also needed to be diagnosed and treated properly.

Extracardiac Fontan operation is currently the preferred method of choice for patients with single ventricle physiology. Avoiding cardiopulmonary bypass during this procedure carries potential benefits. We present a case report of extracardiac off-pump Fontan in a 6-year-old girl with univentricular heart. To the best of our knowledge, this is the

We present a case of 6 years old girl with tricuspid atresia, ventricular septal defect, and pulmonary stenosis who previously underwent central shunt in 2017 and bidirectional cavopulmonary (Glenn) shunt in 2019. We successfully did extracardiac conduit Fontan operation without cardiopulmonary bypass.

The extracardiac off-pump Fontan operation is associated with favorable outcomes. In this patient, the duration of intubation is 16 hours, relatively short. An adverse event in this patient is chylothorax, and prolong duration of chest tube drainage. We believe that the borderline PA pressure and significant discrepancy between diameter of IVC dan conduit are the main factors that contributed to the development of chylothorax

Performing extracardiac off-pump Fontan operation is reported to result in better outcomes. Although the technique may be challenging, however we recommend to attempt the technique whenever possible to eliminate the adverse effects.

Cardioplegia is one of the myocardial protection in cardiac surgery. Very few studies have examined the differences between the Plegiocard® and modified del Nido solutions in pediatric cardiac surgery. Therefore, we wanted to analize the renal and cardiac outcomes in both groups.

All data were analyzed from this retrospective study starting from 2021 to 2022 in Ciptomangunkusomo National Hospital. Renal outcome (Ureum and Creatinine serum levels) and Left Ventricular Ejection Fraction were compared in both groups