Lateral Thoracotomy Research Articles

Lateral atrial septal defect closure with induced ventricular fibrillation versus cardioplegic arrest.

We present our single-centre results of paediatric patients who underwent surgical atrial septal defect II closure via lateral thoracotomy. Retrospective analysis. Patients were divided into a cardiac arrest group and a cardiac fibrillation group. All procedures were performed via right midaxillary thoracotomy through a single incision without side ports. All 37 consecutive patients between March 2019 and August 2022 (median age 3 years; percentile 25th: 2; 75th: 5 years) in both groups were free of mortality and postoperative morbidity such as haemodynamically relevant residual shunt or malignant arrhythmias. Cardiopulmonary bypass time was significantly shorter in the fibrillation group (mean: 34.7 min vs 52.6 min, P = 0.01), and all patients were weaned off the ventilator immediately postoperatively. Length of the intensive care unit stay was not different between the 2 groups. Postoperative hospital stay was significantly longer in patients with cardiac arrest (mean: 5.6 days vs 4.9 days, P = 0.04). Postoperative laboratory parameters did not differ between the 2 groups. All patients were discharged with normal left ventricular function and normalized cardiac enzymes. Minimally invasive closure of an atrial septal defect during atrial fibrillation is a safe procedure with results comparable to those of an induced cardiac arrest procedure.

Efficacy of epidural anesthesia in minimally invasive cardiac surgery

Introduction: The most commonly performed minimally invasive cardiac surgery (MICS) is lateral minithoracotomy, which requires one of the most painful incisions. Adequate postoperative pain management is essential for cardiac surgery to prevent perioperative complications. Thoracic epidural analgesia (TEA) is the gold standard for thoracotomy; however, it is still controversial because of the risk of epidural hematoma following systematic heparinization. The objective of our study was to investigate the safety and efficacy of TEA following MICS. Methods: The clinical data of patients aged over 18 years who underwent elective MICS and received epidural analgesia along with general anesthesia between January 2014 and March 2019 were reviewed. Data were collected, including patient demographics, operative data, postoperative pain, postoperative course, and complications. Chronic pain was evaluated 6 months after discharge, and we defined it as a NRS score ≧3. Postoperative complications included epidural-related complications. Results: Seventy patients were included in the analysis. The mean NRS score was below 2. We collected chronic pain data from 52 patients and found that 11 patients had chronic pain. TEA-related complications were not observed. Conclusion: The current observational study revealed that TEA following lateral thoracotomy was effective for acute pain as well as chronic pain without causing any severe epidural-related complications. Protocols to prevent potential devastating complications, including epidural hematoma, should follow the American Society of Regional Anesthesia and Pain Medicine recommendation. If the rules are strictly followed, TEA can be a safe and effective pain management method for patients who undergo MICS.

Feasibility of lung lobectomy through a transdiaphragmatic approach in dogs.

Different pulmonary pathologies may require a partial or total lung lobectomy as treatment. This study compared two techniques for performing a caudal pulmonary lobectomy: a traditional lateral thoracotomy (LT) and a novel transdiaphragmatic (TD) approach. TD and LT approaches were performed on each of 18 canine cadavers. The operator and order of intervention were randomised at the beginning of the study. To compare both techniques, surgical time, percentage of area of lobe removed, incision length and iatrogenic damage were recorded. The mean length of surgery for the TD approach (1155±232.8 seconds) was non-inferior to the LT approach (1126.8±180.6 seconds) (p=0.6131). The mean percentage of the area of caudal lobe that was successfully removed during the TD approach was 25.83±8.95% (range 10.55‒40.72%) of the lobe surface, while 100% of the caudal lobe was removed during the LT approach. There was no statistical difference in iatrogenic damage between the procedures. This is a non-inferiority ex vivo study carried out by three different surgeons, and no leak test was performed after lobectomies. Partial caudal lung lobectomy can be performed in dogs by the TD approach without greater iatrogenic damage or longer surgical duration than the traditional LT approach.

Modernization of Cardiac Advanced Life Support: Role and Value of Cardiothoracic Anesthesiologist Intensivist in Post–Cardiac Surgery Arrest Resuscitation

Cardiac arrest in the post-operative cardiac surgery patient requires a unique set of management skills that deviates from traditional cardiopulmonary resuscitation and Advanced Cardiovascular Life Support (ACLS). Cardiac Advanced Life Support (CALS) was first proposed in 2005 to address these intricacies. The hallmark of CALS is early chest reopening and internal cardiac massage within five minutes of the cardiac arrest in patients unresponsive to basic life support. Since the introduction of CALS, the landscape of cardiac surgery has continued to evolve.Cardiac intensivists encounter more patients who undergo cardiac surgical procedures performed via minimally invasive techniques such as lateral thoracotomy or mini sternotomy, in which an initial bedside sternotomy for cardiac massage is not applicable. Given the heterogeneous nature of the patient population in the cardiothoracic intensive care unit (CTICU), personnel must expeditiously identify the most appropriate rescue strategy. As such, we have proposed a modified CALS approach to (1) adapt to a newer generation of cardiac surgery patients and (2) incorporate advanced resuscitative techniques. These include rescue-focused cardiac ultrasound to aid in the early identification of underlying pathology and guide resuscitation and early institution of extracorporeal cardiopulmonary resuscitation (ECPR) instead of chest re-opening. While these therapies are not immediately available in all cardiac surgery centers, we hope this creates a framework to revise guidelines to include these recommendations to improve outcomes and how cardiac anesthesiologist intensivists' evolving role can aid resuscitation.

Incidence and impact of involuntary rib fracture after intercostal spreading for thoracotomy.

Thoracotomy with rib spreading still remains the preferred approach for complex surgery. Rib fracture is considered a frequent involuntary event during this approach, but its real incidence has not been adequately investigated yet. In this study, we evaluated the incidence of rib fracture after thoracotomy, the possible risk factors and the relationship with post-operative pain and complications. We retrospectively analyzed the medical records of single-institution patients submitted to lateral thoracotomy from January 2016 to June 2023. Exclusion criteria were traumatic etiology and a medical history of osteoporosis. The presence of rib fracture was retrieved by surgical reports or post-operative chest X-ray. Basal and evoked pain after surgery was assessed by Visual Analogue Scale. The considered 30-day post-operative complications were atelectasis, need of endoscopic broncho-aspiration, pneumonia and pleural effusion. A total of 367 consecutive patients underwent thoracotomy in the study period. The median age was 68 (interquartile range 60-75) years. Rib fracture was detected in 179/367 (48.8%) patients. Incidence did not significantly vary throughout years (p = 0.98). The risk of developing post-thoracotomy rib fractures was significantly associated with age greater than the median value (p = 0.003). The presence of rib fracture was related to significantly more elevated evoked pain at 48h after surgery (p = 0.039) and a higher incidence of complications (32/179 vs 20/188; p = 0.047). Our study demonstrated that rib fracture occurs in almost half of the thoracotomies. Older patients are more likely to develop this event, which significantly correlates to increased evoked post-operative pain and higher rate of post-operative complications.

Subclavian arterial rupture due to blunt trauma injury: A case report.

Subclavian arterial injury due to blunt trauma is rare but can have devastating outcomes. Massive hemorrhage or limb ischemia might develop depending on the extent of damage, and open repair might be necessary to salvage the limb. However, life-saving treatments should be prioritized in critically unstable patients. A 21-year-old male patient who was transferred to our trauma center following a motorcycle accident. Abdominal and chest computed tomography (CT) revealed right renal injury and massive hemothorax with several rib fractures in the right chest. Right renal injury with multiple extravasations and right 8th intercostal arterial injury were detected during angiography. Emergent exploration with lateral thoracotomy was performed to manage right hemothorax. Pulsating bleeding from the thoracic roof observed in the operative field suggested a subclavian arterial injury. The unstable vital signs did not recover despite massive transfusion, and his right arm had already stiffened. Therefore, endovascular approach was adopted and the second portion of the right subclavian artery was embolized using microcoils and thrombin. Postoperative intensive care unit management performed to resuscitate patient from multiorgan failure included continuous renal replacement therapy (CRRT). After confirming the demarcation lines, transhumeral amputation of the right arm was performed on admission day 12. The patient recovered from multiorgan failure for more than 3 weeks after the accident; however, the patient survived. Limb salvage, albeit critical for quality of life, is not possible in some cases where life-saving measures require its sacrifice. In these cases, quick decision-making by the surgeon is paramount for patient survival. As illustrated in this case, endovascular approaches should be considered less invasive measures to save the patient's life.

Complete transection of the bilateral main bronchus in a 5-year-old patient: a case report

BackgroundTracheobronchial injuries caused by blunt chest trauma are rare in children, and such injuries usually involve multiple organs. Most cases involve respiratory failure on the way to the hospital, and the mortality rate is high. Herein, we describe the case of a 5-year-old patient who fell from an electric vehicle, causing complete rupture of the bilateral main bronchus.Case presentationWe treated a 5-year-old patient with complete bilateral main bronchus rupture. Chest computed tomography (CT) failed to detect bronchial rupture. Continuous closed thoracic drainage resulted in a large amount of bubble overflow. Tracheal rupture was suspected. Fibreoptic bronchoscopy revealed complete rupture of the right main bronchus and rupture of the left main bronchus. Emergency tracheoplasty was performed under cardiopulmonary bypass (CPB). During the operation, we found that the bilateral main bronchi were completely ruptured. Postoperative recovery was smooth. The traditional surgical method for treating these injuries is lateral thoracotomy. However, a median sternotomy provides a better opportunity for selective repair. Extracorporeal circulation-assisted surgery is required for patients with unstable breathing.ConclusionComplete fractures of the bilateral main bronchi are rare. Bronchial rupture should be suspected in the presence of expansion defect-dropped lungs and massive air leakage despite tube thoracostomy in haemopneumothorax developing after thoracic trauma. Extracorporeal circulation-assisted tracheoplasty is a relatively safe option for children whose respiratory system is difficult to maintain, thus ensuring oxygenation ventilation and a clear surgical field.

A 20–YEAR FOLLOW–UP OF SUCCESSFUL SURGICAL MANAGEMENT OF DOUBLE–OUTLET RIGHT VENTRICLE WITH PULMONARY STENOSIS: A CASE REPORT

Abstract A 25–year–old man, suffering from worsening exertional dyspnea for 4 months, was referred to our Cardiology Unit. The patient was previously diagnosed with a late diagnosis of double outlet right ventricle (DORV), as well as pulmonary stenosis, VSD, and right–sided aortic arch for which he underwent a first surgical procedure around the age of 2 involving an intersternal anastomosis through a left lateral thoracotomy approach. A second intervention took place 2 years later for a radical correction of the anomaly through a median sternotomy. The patient had sporadic follow–up since then. A baseline ECG was performed, showing evidence of sinus rhythm, normal AV with a bifid P wave in lead II, slight RAD, incomplete RBBB, and asymmetric negative T waves from V1 to V3 and in aVL, and biphasic T waves in V4–V5. We performed an echocardiogram which showed: a dilated RA, a normal–sized LA, an apparently intact interatrial septum without evident shunts; a normal sized LV; EF 60%; a moderately dilated, hypertrophic and hypertrabeculated RV; FAC 33%; normal aortic flow; a minimal MR; a massive residual pulmonary insufficiency; a moderate TR; a dilatated pulmonary trunk; a normal–sized and collapsible IVC upon inspiration; PAPs of 70 mmHg; no pericardial effusion. A maximal exercise stress test appeared to be normal throughout. However, due to the severe pulmonary hypertension he was referred to our PH centre. While these patients are commonly affected by residual early or late left ventricular outflow tract obstruction, fortunately our patient was not. DORV is a relatively common congenital heart defect characterized by an abnormal connection between the ventricles and arteries, in which both the aorta and the pulmonary trunk are connected completely or predominantly to the right ventricle. The anatomical spectrum of this anomaly is quite large, and it can be associated with the presence of a VSD that often extends towards one or both of the arterial valves, allowing the flow of blood from the left ventricle to the aorta. An accurate diagnosis through echocardiography or CMR is essential in order to guide the surgical repair and the appropriate therapeutic approach for individuals affected by this anomaly. A successful surgical correction of DORV is essential, but it is important to be aware of the potential complications of post–operative PH (especially in patients with preoperative PH), which necessitates close surveillance and appropriate therapeutic management.

A Case Report on Anesthesia Management of a Giant Thymoma Excision with a Lateral Thoracotomy Approach

A Case Report on Anesthesia Management of a Giant Thymoma Excision with a Lateral Thoracotomy Approach

15-Year Analysis of Surgical Approaches and Outcomes for Coarctation in 132 Neonates and Infants.

A variety of surgical approaches exist to treat aortic coarctation in neonates and infants. Our institutional approach is designed to match the surgical approach to the individual anatomy of the patient. The objective of this study is to evaluate operative characteristics and outcomes of all neonates and infants who underwent surgical repair of coarctation of the aorta or hypoplastic aortic arch at University of Florida from 2006 to 2021, inclusive, either in isolation or with concomitant repair of atrial septal defect (ASD) and/or ventricular septal defect (VSD). A retrospective review was performed of 132 patients aged 0-1 year who underwent surgical repair of aortic coarctation or hypoplastic aortic arch between 2006 and 2021, inclusive, either in isolation or with concomitant repair of ASD and/or VSD. Patients were divided into two groups based on the surgical approach: Group 1=Median Sternotomy and Group 2=Left Lateral Thoracotomy. Continuous variables are presented as median (minimum-maximum); categorical variables are presented as N (%). The most common operative technique in Group 1 was end-to-side reconstruction with ligation of the aortic isthmus. The most common operative technique in Group 2 was extended end-to-end repair. Operative Mortality was one patient (1/132 = 0.76%). Transcatheter intervention for recurrent coarctation was performed in seven patients (7/132 = 5.3%). Surgical re-intervention for recurrent coarctation was performed in three patients (3/132 = 2.3%). From these data, one can conclude that a strategy of matching the surgical approach to the anatomy of neonates and infants who underwent surgical repair of aortic coarctation or hypoplastic aortic arch, either in isolation or with concomitant repair of ASD and/or VSD, is associated with less than 1% Operative Mortality and less than 3% recurrent coarctation requiring reoperation.

Thirteen Years of Impactful, Minimally Invasive Coronary Surgery: Short- and Long-Term Results for Single and Multi-Vessel Disease

Objectives: Minimally invasive coronary surgery (MICS) via lateral thoracotomy is a less invasive alternative to the traditional median full sternotomy approach for coronary surgery. This study investigates its effectiveness for short- and long-term revascularization in cases of single and multi-vessel diseases. Methods: A thorough examination was performed on the databases of two cardiac surgery programs, focusing on patients who underwent minimally invasive coronary bypass grafting procedures between 2010 and 2023. The study involved patients who underwent either minimally invasive direct coronary artery bypass grafting (MIDCAB) for the revascularization of left anterior descending (LAD) artery stenosis or minimally invasive multi-vessel coronary artery bypass grafting (MICSCABG). Our assessment criteria included in-hospital mortality, long-term mortality, and freedom from reoperations due to failed aortocoronary bypass grafts post-surgery. Additionally, we evaluated significant in-hospital complications as secondary endpoints. Results: A total of 315 consecutive patients were identified between 2010 and 2023 (MIDCAB 271 vs. MICSCABG 44). Conversion to median sternotomy (MS) occurred in eight patients (2.5%). The 30-day all-cause mortality was 1.3% (n = 4). Postoperative AF was the most common complication postoperatively (n = 26, 8.5%). Five patients were reoperated for bleeding (1.6%), and myocardial infarction (MI) happened in four patients (1.3%). The mean follow-up time was six years (±4 years). All-cause mortality was 10.3% (n = 30), with only five (1.7%) patients having a confirmed cardiac cause. The reoperation rate due to graft failure or the progression of aortocoronary disease was 1.4% (n = 4). Conclusions: Despite the complexity of the MICS approach, the results of our study support the safety and effectiveness of this procedure with low rates of mortality, morbidity, and conversion for both single and multi-vessel bypass surgeries. These results underscore further the necessity to implement such programs to benefit patients.

Video assisted thorascopic assisted correction of left partial anomalous pulmonary venous connection: one case report

IntroductionThe left partial anomalous pulmonary vein connection is a rare congenital heart disease, especially with intact atrial septum. Now we reported a case of the left superior pulmonary vein drainage to left innominate vein through a vertical vein, and corrected with video assisted thoracoscopy.Case presentationA-59-years old man diagnosed left anomalous partial pulmonary vein connection with presentation of short breathiness and palpation, and diagnosed with computer tomography pulmonary angiography. The operation was carried out under video assisted thoracoscopy with one manipulation incision and one observational incision, the vertical vein was dissected and anastomosis with left atrial appendage. The patients recovered smoothly and postoperative CTPA showed anastomosis ostium was unobstructed.ConclusionThe left lateral thoracotomy and video assisted thoracoscopic surgery is a feasible for correction of left PAPVC with intact interatrial septum without using CPB.

A rare complication of rupture of a mediastinal Teratoma into the bronchus: A case report

Background: Germ cell tumours (GCT) are tumours arising from primordial germ cells. Gonadal and extragonadal GCT are infrequent in childhood occurring at a rate of 2.4 cases per million children accounting for 2-3 % of paediatric malignancies with most common subtype being a matured Teratoma. Case presentation: We present a case of a 10-year-old female child who presented to the emergency department of a tertiary care centre with complaints of cough with massive expectoration of blood of approximately 200 ml in quantity which on imaging revealed a left anterior mediastinal mass which was managed by left lateral thoracotomy with a non-anatomical left sided pulmonary lobectomy which on histopathology was diagnosed to be a case of mature teratoma. Conclusion: This case report describes a unique presentation of extra-gonadal mediastinal teratoma which presented as a rare complication with rupture into the left bronchus. It emphasizes caution and a high clinical suspicion is required in managing cases of varied presentations of teratomas.

Erysipelothrix rhusiopathiae: An Emerging Organism Causing Pleural Effusion in an Immunocompetent Child

Aims: Erysipelothrix rhusiopathiae is a Gram-positive bacillus attributed to zoonotic infections primarily. In humans they usually cause localized cutaneous infections namely erysipeloid, occasionally becomes diffuse and may lead to septicemia and endocarditis in opportunistic immunocompromised individuals. The growing and evolving disease spectrum of this organism in human beings is a potential future threat. This case report addresses a common disease manifestation with this unusual organism which is needs to be highlighted.
 Presentation of Case: Herein we report a case of 1year 9month old immunocompetent male child belonging to a shepherd family who presented with long standing left sided pleural effusion. Pleural fluid culture yielded Erysipelothrix rhusiopathiae. Despite a culture sensitive antibiotic therapy a sequelae of residual effusion with subpleural collapse and fibrous septations developed, hence left lateral thoracotomy along with decortication surgery was performed.
 Discussion: This case report highlights the drug sensitivity and resistance pattern in detail and also points out the prognosis and possible sequelae of the disease which in turn can increase treatment awareness regarding the organism.
 Conclusion: Erysipelothrix rhusiopathiae is an unusual organism which was found in our patient causing pleural effusion is a very unlikely coalition and needs a separate mention as this emerging microbe can be a cause of concern due to its novelty and scarce medical evidence.

Regional Arch Measurements Differ Between Imaging Modalities in Infants With Aortic Coarctation

BackgroundAortic arch measurements provide a framework for surgical decision-making in neonatal aortic coarctation, specifically in the determination of approach for arch repair by lateral thoracotomy vs median sternotomy. The purpose of this study was to evaluate our experience with transthoracic echocardiography (TTE) and computed tomography angiography (CTA) in the preoperative evaluation of infants with aortic coarctation, specifically comparing arch dimensions as a function of imaging modality. MethodsImaging data were reviewed for all infants undergoing surgical repair of aortic coarctation at our institution from 2012 to 2022. Infants with both TTE and CTA evaluations were included. Aortic measurements were compared at predefined anatomic regions including ascending aorta, proximal arch, distal arch, and isthmus. ResultsDuring the study period, 372 infants underwent surgical coarctation repair; 72 (19.4%) infants had TTE and CTA arch evaluations preoperatively. Significant discrepancies between imaging modalities were defined by poor correlation coefficients and absolute measurement differences and were most prominent in the proximal aortic arch (R2 = 0.23 [−4.4 to 3.2 mm]) and isthmus regions (R2 = 0.11 [−4.2 to 1.7 mm]). Improved correlation was demonstrated in the ascending aorta (R2 = 0.63) and distal aortic arch (R2 = 0.54). ConclusionsSignificant variability exists between TTE- and CTA-derived aortic measurements in infants with coarctation, with proximal arch measurements demonstrating the poorest correlation. This anatomic location represents a commonly used arch region for the determination of approach for repair of neonatal aortic coarctation. Thus, these findings have important implications for current preoperative surgical decision-making paradigms and future prospective study to minimize the risk of residual or recurrent arch obstruction.

Peri-anaesthetic complications in dogs undergoing lateral thoracotomy or median sternotomy: a retrospective study at a single University teaching hospital

Peri-anaesthetic complications in dogs undergoing lateral thoracotomy or median sternotomy: a retrospective study at a single University teaching hospital

A108Using a high-fidelity part-task model as a replacement for animal models to enhance emergency medicine thoracotomy training

A local course has been delivered since 2018 to provide training in rare, time-critical, life-saving procedures that emergency medicine trainees may need to perform, including emergency lateral thoracotomy. Previously pig thoraxes have been used to provide thoracotomy training in this course. In 2022 a part-task model was purchased for thoracotomy training to replace this. We compare the use of this to animal models in our provision of simulation teaching of this skill. Animal models are useful due to availability, low cost, and provision of hands-on experience for learners. However, there are associated ethical, religious, psychological limitations with using animals for educational purposes. They may less accurately represent human anatomy and pathology. Their timely acquisition can pose a challenge with defrosting requirements and variable condition which can impact on the quality of training. There are infection risks due to fluid leakage, associated unpleasant odour and animal products require incineration for disposal. The high-fidelity part-task mannequin can anatomically and physiologically replicate the thoracotomy experience to provide realistic simulation training. The mannequin is equipped with realistic external human features and internal organ anatomy, including a beating heat and blood, to provide an immersive training experience. It is reusable with repair, which could be cost-effective long term and more environmentally-friendly. This model enables thoracotomy skill practice in a safe, controlled environment without infection risk. Another advantage is the ability to provide standardized training, better allowing for objective evaluation of performance which can be challenging with animal models. This model ( The immersive lateral thoracotomy model we are using, which is fully repairable to be used multiple times for authentic learner experience There are disadvantages to use of this model for the department, but the overall learning experience and sustainability is felt to be superior to animal models for training in emergency thoracotomy. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Does lateral approach preserve the right ventricular function after HeartMate 3 insertion?

Lateral thoracotomy (LT) approach may preserve the right ventricular (RV) function after left ventricular assist device (LVAD) implantation. This study evaluated the short- and long-term RV function using echocardiography after LVAD implantation via LT or median sternotomy (sternotomy). The patients who underwent HeartMate 3 implantation were retrospectively reviewed. The RV function was assessed before and 1 month and 1 year after LVAD implantation. The primary and secondary outcomes were all-cause mortality and a composite of death or readmission due to RV failure, respectively. Of the 195 patients, 55 (28%) underwent LT and 140 (72%) underwent sternotomy. There were no significant differences in the preoperative RV geometry or function. One month after the LVAD implantation, the LT group had a smaller RV end-diastolic dimension [42 (29-48) vs 47 (42-52) mm; P = 0.003] and RV end-diastolic area [25 (21-28) vs 29 (24-36) cm2; P < 0.001] and a greater RV fractional area change [30 (25-34)% vs 28 (23-31)%; P = 0.04] and peak systolic tissue velocity [8 (7-9) vs 7 (6-8) cm/s; P = 0.01]. Twenty-four patients died and 46 met the composite end point. Kaplan-Meier curve analysis did not reveal significant differences between LT and sternotomy in the 2-year survival (93% vs 83%; log-rank test, P = 0.28) and adverse event rate (76% vs 71%; log-rank test, P = 0.65). LT approach yielded a better-preserved RV function at 1 month; however, there were no significant differences in the 2-year survival and adverse event rates.

Surgical treatment strategy of pulmonary artery sling: a series of 110 cases

Objective: To examine the effect of surgical treatment in children with pulmonary artery sling and the surgical treatment strategy. Methods: Relevant data of 110 children with pulmonary artery sling admitted to the Department of Cardiac Surgery, Children's Hospital Affiliated to Shandong University from February 2017 to July 2022 were retrospectively analyzed. There were 55 males and 55 females, aging (M(IQR)) 9.0 (10.6) months (range: 1 to 96 months). The weight was 7.8 (3.5) kg (range: 2.5 to 25.0 kg). Of the 110 patients, 108 had different degrees of tracheal stenosis and 2 had normal trachea. Left pulmonary artery transplantation and tracheoplasty were performed in 78 patients. Left pulmonary artery transplantation was performed in 30 patients (11 in our hospital and 19 in other hospitals) due to the lack of an early tracheoplasty technique, in which 24 patients needed stage Ⅱ tracheoplasty due to obvious respiratory symptoms and limited activity endurance, and 6 cases did not intervene. Two children with normal trachea only underwent left pulmonary artery transplantation. Results: Among the 78 children who underwent surgery in the same period, 70 cases recovered smoothly after surgery, of whom respiratory symptoms were significantly reduced or disappeared during the 1 to 65 months follow-up, with similar activity endurance to normal children of the same age. Eight cases died, including 4 cases of postoperative multi-drug resistant bacteria infection, died from tracheal anastomotic opening or septic shock, 1 cases with severe congenital heart disease died from postoperative low cardiac output syndrome difficult to correct, 1 case died from blood pressure could not be maintained due to the compressed left pulmonary artery after transplantation, 2 cases of postoperative digestive system diseases (adhesive intestinal obstruction, gastrointestinal bleeding, etc.). The 24 patients in the staging group were followed for 1 to 84 months. All patients needed stage Ⅱ tracheoplasty due to respiratory symptoms and decreased endurance to activity. Eight cases of the non-intervention tracheal group were successfully separated from the ventilator, cured and discharged in a short period of time. Conclusions: Most children with pulmonary artery sling have tracheal stenosis. Children with low degree of tracheal stenosis and inconspicuous respiratory symptoms can only undergo left pulmonary artery transplantation by lateral thoracotomy. For patients combined with severe tracheal stenosis or obvious respiratory symptoms, a simultaneous left pulmonary artery transplantat and tracheoplasty is recommended.

Clinical features of patients with cancer of thoracic esophagus and results of their surgical treatment

Esophageal cancer takes one of the first places in the structure of morbidity and mortality among malignant diseases. The development of anesthesiology and thoracic resuscitation provided the evolution of the surgical method. Resections of the esophagus with locally-disseminated and complicated forms of cancer have become possible. But even today, the long-term results of surgical treatment don’t satisfy clinicians. Often this is due to the dissemination of the tumor process in most patients at the time of treatment. For this purpose, an analysis of clinical material was carried out, including 89 patients with cancer of thoracic part of esophagus, who underwent reconstructive surgeries (extirpation of the thoracic part of esophagus with simultaneous retromediastinal plasty by stomach tube) in the surgical unit of Republican Clinical Hospital (RCH), n.a. academic M.A.Mir-Gasimov, Baku city. Interventions on the esophagus were performed either of two approaches – upper median laparotomy and left-sided cervicotomy (76 patients – 85,4%) or from three-with the addition of a right sided lateral thoracotomy in the fifth intercostal space (13 patients – 14,6%). There were no deaths due to surgical complications. The fundamental possibility and reasonableness of performing expanded radical interventions has been detected, taking into account the technical resectability of the tumor, which is especially important in working with a group of patients with “late” esophageal cancer criteria, such as the age of the patient, the size of the primary tumors, its local dissemination are not a contraindication to radical surgery.