Oblique Fissure Research Articles

Indigenous Cadaveric Variations in Lung Fissures and Lobes

Introduction: Lung fissures are responsible for uniform expansion. These fissures may be complete, incomplete or absent causing lobar variation. A detailed knowledge of variations of classical and accessory fissures is necessary for proper pulmonary radiological interpretation. Patients benefit from accurate assessment of integrity of pulmonary fissures during cardiothoracic surgery as surgeons can perform segmental lung resections and lobectomies safely to have an uncomplicated perioperative outcome. So, the cadaveric study was done to note the morphological variation of the fissures of lung in Pakistan cadaveric population and compare it with the previous study.
 Aims & Objectives: To determine the frequency of variations in fissures and lobes of the lungs on cadaveric Pakistani population.
 Place and duration of study: Anatomy Departments of KEMU and AIMC, Lahore. Duration of study was from 2020 to 2022
 Material & Methods: An observational cross-sectional study was conducted on 160 cadaveric lung specimens from AIMC and KEMU Anatomy Departments. They were preserved in 10% formalin and were studied for morphological details of their lung lobes and fissures. Data was collected and graded using Craig and Walker classification. Data was analysed using SPSS 22 version. p value ? 0.05 was taken as significant
 Results: Out of 160, 77% of the left lung and 75% of the right lungs were normal. Among the variations, horizontal fissure had shown to be more variable as compared to oblique fissure .18% of the right-side specimens were shown to have incomplete horizontal fissures and in 4% of the specimen, they were totally absent. 15% of the left side specimen had incomplete oblique fissures whereas only 2% of the right-side specimen had incomplete oblique fissures. Accessory fissures were more common in the left side specimens as compared to the right-side specimens.
 Conclusion: Morphological variations do occur in normal population, and they must be kept in mind during radiological and surgical interventions.

A study of morphological variations of fissures and lobes of formalin fixed cadaveric lungs

Background: Variation of morphology of lung fissures and lobes affects the interpretation of results of radiological examination as well as line of action in cardiothoracic surgical procedures. A research was done to find out the incidence of variations of fissures and lobes in embalmed cadaveric lungs.
 Materials and methods: This is a cross sectional study. All the formalin fixed lung specimens present in dissection halls and museums of the Anatomy Departments were observed for any abnormal fissures that are adding accessory lobes to lungs. Data was entered and analyzed by using SPSS 22.0. Descriptive analysis was applied by using frequencies and percentages for qualitative variables.
 Results: Total 80 formalin-fixed specimens of lungs were examined and a total of 29 (36.25%) (%) were found to have incomplete fissures. It was observed that 14 (17.5 %) out of 80 lungs had incomplete oblique fissures, and out of these 6 (17.65%) were found in right lungs and 08 (19.05%) were present in left lungs, whereas 15 (39.47%) right lungs showed incomplete horizontal fissure. Among 80 lungs, 6 (7.5%) presented unusual accessory fissures and lobes, whereas 5 (14.7%) showed absent horizontal fissure reducing the number of lobes to two in right lung specimen.
 Conclusion: There is a prevalent incidence of incomplete horizontal fissure that must be kept in mind when investigating and treating any lung pathology.

Loculated Pneumothorax in COVID-19 Patient – A Case Report

Aim: Loculated pneumothorax and multilocular cystic lung lesions are rare complications of acute respiratory distress syndrome in patients with COVID-19 infection. In this case report we wanted to emphasize that not only mechanically ventilated patients are at increased risk of pneumothorax and cystic lung lesions. Those lesions can also be found in non-ventilated patients. Case report: We present a case report of a 52-year-old man who was hospitalized because of COVID-19 pneumonia. MSCT pulmonary angiography revealed ground glass opacities, multilocular cystic lesions and loculated pneumothorax. On followup computerized tomography examination in an outpatient hospital two months later, there was a significant regression of the lung parenchymal ground glass opacities, as well as the regression of the cystic lesions with residual fluid-filled lesion in the oblique interlobar fissure. Conclusion: Only few case reports have been published on this specific lung pathology in COVID-19 disease. Increased incidence of complications such as pneumothorax in COVID-19 pneumonia is common, but physicians should also be aware of the possibility of other lung pathologies such as loculated pneumothorax and multilocular cystic lesions which can present not only in mechanically ventilated patients.

Prevalence of anatomical variations in children with congenital lung malformations investigated by video recordings of thoracoscopic lobectomy

Background: Sufficient knowledge of anatomy including normal patterns and aberrant variations is crucial in thoracoscopic lobectomy for congenital lung malformations (CLMs). This study aimed to investigate the prevalence of anatomical variations and their correlations with surgical outcome. Methods: Video-recordings of thoracoscopic lobectomy performed for CLMs between 2009 and 2021 were reviewed. The incidences of surgically relevant variations, including abnormal branches of pulmonary arteries and veins, aberrant systemic arteries, and incomplete fissures (as classified by Craig) were assessed in comparison with the previously published reports. Moreover, multiple univariate analyses were performed to seek correlations between surgical finding and prolonged operative times and postoperative drainage. Results: Fifty-six lobectomies were reviewed. Variations of pulmonary arteries were more commonly seen in the left lung (29.6%) compared to right (10.7%). The prevalence of atypical pulmonary venous branches was similar between the right (13.8%) and left (18.5%). The right upper oblique fissure was frequently associated with Grade 2 incomplete fissure (44.8%). Grade 3 incomplete fissure was rare (3.4%) in the right lower oblique fissure but relatively common (14.3 – 18.5%) in other locations. Grade 4 incomplete fissure was limited to the right horizontal fissure (1.7%). Multiple univariate analyses demonstrated a significant correlation between any degree of incomplete fissure and prolonged operative time (p < 0.05), whereas no factor was identified to affect need for postoperative drainage. Conclusions: The incidence of anatomical variations in CLM patients was similar to that reported in adults. Review of intra-operative video footage was useful to closely evaluate and understand anatomical variations.

The Corrosion Behavior of WEDM Machined Stainless Steels in a Pyrolysis Environment

Pyrolysis represents one of the most convenient technologies for the chemical transformation of waste. The exposure to corrosion products and high temperatures does, however, require chemically resistant construction materials. This study was carried out to analyze the corrosion behavior of 1.4571 (AISI 316Ti) and 1.4305 (AISI 303) stainless steels machined with wire electric discharge machining (WEDM) in a pyrolysis environment. Different machining parameters were used for both materials tested to examine the influence of WEDM machining. The total testing time in the pyrolysis environment was 28 days, with the testing chamber being refilled 12 times. The surface topography was analyzed following the WEDM, cleaning, and corrosion test. The surface morphology and cross-section analyses were carried out using electron microscopy at all three stages of the process. An analysis of the chemical composition of the surfaces was carried out as well as of the pyrolysis environment to which the samples were exposed. It was established that the organic acids found in the pyrolysis chamber did not degrade the tested stainless steels to a meaningful degree. Minor fissures, that is, fine precipitated carbides, were observed on the surface of both the steel types and in their subsurface layer, as well as a significant presence of carbon. This presence was directly connected to the impurities found on the surface after the removal from the test furnace that were probably of a protective or passivation nature.

A pulmonary nodule mislocated in "dorsal" segment due to tri-lobed left lung.

The left lung has two lobes and one fissure, while the right lung has three lobes and two fissures. Accessory fissures are usually found in imaging examinations and autopsies; however, finding an actual accessory lobe is rare. In a lung nodule resection surgery, a 68-year-old male patient was found with three lobes and two fissures in his left lung. The lung nodule was misdiagnosed as being located in the lower lobe because the accessory fissure was misregarded as the oblique fissure. The lung nodule was found in the upper lobe, and this anatomical variation changed the surgical plan. The pathology of the lung nodule was granulomatous inflammation with caseous necrosis with the positive antacid stain. The patient was eventually diagnosed with tuberculosis. Cases involving the lung accessory fissure and lung accessory lobe variants were reviewed. In 10 autopsy and dissection studies, the incidence of accessory fissure in the left lung was 13.5% (79/587, ranging from 2.7% to 50.0%), and in the right lung, it was 7.3% (42/575, ranging from 3.1% to 30.4%). The incidence of accessory lobes in the left lung was 2.0% (11/547, ranging from 0.0% to 7.4%), and in the right lung was 2.6% (14/539, ranging from 0.0% to 17.4%). The incidence of accessory fissures in bilateral lungs identified by chest x-ray or computed tomography ranged from 7.3% to 32.0%. Three surgical case reports inferred accessory lobes, including a left upper lobectomy, left lung transplantation, and an open thoracotomy. This is the first clinical case report that shows that lung accessory lobe caused the mislocation of a lung nodule. Therefore, radiologists and surgeons should be aware of the possibility of an accessory lobe in the lung.

Anatomical study of pulmonary fissures

The lungs have three main fissures: in the right lung, the oblique and horizontal fissure, and in the left lung the oblique fissure. These can be complete, incomplete or absent. “Classical anatomy” textbooks frequently describe pulmonary fissures as complete, although knowledge of their variations is important both for thoracic surgery and to understand the spread of disease. The objective of this study is to assess the frequency and extension of the main pulmonary fissures, as well as to determine the frequency and location of accessory fissures in cadaveric material. An observational descriptive study was carried out and consisted of the dissection of 86 ex-situ lungs (43 right and 43 left lungs) of adult corpses from both sexes previously fixed in formaldehyde solution. The presence of complete, incomplete or absent main fissures and the presence of accessory fissures were assessed. For incomplete fissures, the integrity percentage of the fissure was calculated. In both lungs, incomplete fissures predominated; the oblique fissure of the right lung with a percentage of 65%, the horizontal fissure of 79% and the oblique fissure of the left lung of 58%. Regarding accessory fissures, the overall prevalence was 6%. The anatomy of pulmonary fissures is highly variable. In our study, incomplete fissures predominated in both lungs. There are differences between the studies regarding the prevalence of the completeness of the fissures because, actually, the literature is not concluding.

Theme: Hepatobiliary system

Theme: Hepatobiliary system

Method for Preparing Hollow Cylindrical Specimens of Natural Granite Residual Soil

Abstract As an effective method of studying soil anisotropy, hollow cylinder torsional shear (HCTS) tests have been performed extensively on sedimentary soil, thereby establishing the anisotropic behavior of sand and clay. However, little is known about the anisotropic behavior of granite residual soil (GRS) formed by weathering, partly because hollow cylindrical specimens of natural GRS have yet to be prepared successfully, hence the lack of HCTS tests performed on GRS. The unique geotechnical properties of GRS, including high intact strength, susceptibility to disturbance, and the minor fissures in soil, pose great challenges when trying to prepare natural specimens. This paper proposes a new method to address this issue, which involves preparing a solid cylindrical specimen, drilling an initial inner cavity and then enlarging it, and finely trimming the specimen to its ultimate dimensions. Two methods are proposed for enlarging the inner cavity, both of which work well. The reliability of the proposed method is confirmed through specimen quality as indicated by the limited void ratio change due to reconsolidation, test repeatability, and comparison of the results of HCTS tests with those of triaxial tests. The HCTS tests reveal the shear strength anisotropy of natural GRS. Although specified for residual soil derived from granite, the proposed method could also be used for other weathered materials.

Morphometric Study of Fissures of Lung with its Clinical Implications

Background: Complete or incomplete fissures divide the lung into lobes. Fissures can also be absent in the lung. Quantitative assessment of the completeness of fissures can be helpful for surgeons and radiologists during invasive procedures related to the lung. Hence, the present study was undertaken to record the extent of completeness of fissures, contour of the fissural surface of lobes, and accessory fissures. Methodology: The present study was done on 78 (right-40 and left-38) formalin-fixed random lung specimens obtained from adult cadavers. Results: Majority of oblique oblique fissures were incomplete (left-60.5% and right-60%). The absence of fissures was mainly seen in horizontal fissures (25%). Quantitative assessment for the degree of pulmonary fissure completeness showed that G0 and G3 were found more in the right oblique fissure (ROF) and horizontal fissure, G1 and G2 more in the left and ROF, respectively. Fissural surface of lower lobe was concave in the upper part and convex in the lower part, whereas fissural surface of middle lobe was convex in the majority of cases. Accessory fissures were found in 21.8%. Azygos fissure was present in two right lungs. A strong correlation was found between the depth of oblique fissure and the thickness of left lung. Conclusion: High frequency of incomplete fissures was found. Accessory fissures were commonly observed in the right lung. A wide range of variations in the completeness of fissures was noticed between the present and previous studies. Hence, surgeons and radiologists should be alert of these variations for surgical planning and interpretation of radiological images.

RIB FRACTURE AS A RARE AND UNDER-REPORTED ETIOLOGY OF PLEURAL SPACE INFECTION: CASE REPORT AND REVIEW OF LITERATURE

RIB FRACTURE AS A RARE AND UNDER-REPORTED ETIOLOGY OF PLEURAL SPACE INFECTION: CASE REPORT AND REVIEW OF LITERATURE

Morphological variations of human pulmonary fissures: an anatomical cadaveric study in Sri Lanka

The aim of this study was to identify morphological and morphometric variations of pulmonary fissures. A sample of 50 adult formalin fixed Sri Lankan cadaveric lungs (24 left and 26 right lungs) were observed with the help of magnifying glass and length measurements of the lung fissures were taken using a measuring tape. Complete oblique fissure was seen in 16 (66.67%) left lungs and 11 (42.3%) right lungs. Incomplete oblique fissure was seen in 8 (33.33%) left lungs and 15 (57.69%) right lungs. There was complete absent of horizontal fissure in 4 (15.38%) right lungs whereas rest of the 22 right lungs indicated incomplete horizontal fissure (84.61%). The mean lengths of the left oblique fissure, right oblique fissure and horizontal fissure were 26.88±5.88cm, 27.31±6.04 cm and 8.31±3.61 cm, respectively. Incomplete fissure was the most common variant of the fissures in the analyzed sample. There was a high prevalence of incomplete horizontal fissure of right lung followed by incomplete right and left oblique fissures. Absence of oblique fissure was not found in either left or right lungs. The mean length of right oblique fissure was slightly greater than the mean length of left oblique fissure. The knowledge lung fissures, indeed help clinicians and radiologists to identify alterations of the disease distribution and to reduce the misinterpretation of radiological modalities as well as to arrive at an accurate diagnosis with plan of management of a patient.

Causes and management of intraoperative complications in robot-assisted anatomical pulmonary resection for lung cancer.

BackgroundTo perform safe robot-assisted anatomical lung resections, the details of intraoperative complications need to be shared among thoracic surgeons. However, only limited data are available.MethodsThis retrospective, single-institutional study evaluated 134 patients who underwent robot-assisted anatomical lung resection. We examined the causes, management, and outcomes of all intraoperative complications.ResultsOf the 134 eligible patients, 118 (88%) underwent lobectomy and 16 (12%) underwent segmentectomy. Intraoperative complications occurred in 17 (12.7%) patients. These complications included pulmonary artery (PA) injuries in seven patients, pulmonary vein (PV) injuries in three, azygos vein (AV) injury in one, superior vena cava (SVC) injury in one, bronchial injuries in three, and lung injuries in four. Most PA injuries were at a distal side and controlled by pressure, fibrin sealant, or stapling of the proximal side. In the three PV injuries, right upper PV was sandwiched by robotic instruments, V6 was punctured by the tip of the Maryland bipolar forceps, and the distal side of V2t was injured during tunneling of a minor interlobar fissure. These were controlled the same way as the PA injuries. The AV injury occurred during hilar lymph node (LN) dissection and was controlled by suturing. The SVC injury was caused by interference of the robotic forceps and the suction tube outside the field of view during upper mediastinal LN dissection. The injury was controlled by continuous pressure while layering polyglycolic acid sheets and fibrin glue. In the three bronchial injuries, B10 was injured during subcarinal LN dissection, right main bronchus was injured during upper bronchus dissection and the stapling failure of the bronchus occurred by strong traction. They were all repaired by suturing. All lung parenchymal injuries were caused by manipulation of robotic instruments outside the field of view. The lung injuries were repaired by suturing with pledgets. No cases were converted to thoracotomy. The 30-day mortality rate was 0.7%. The cause of mortality was pneumonia.ConclusionsIn robot-assisted anatomical pulmonary resection for lung cancer, most major intraoperative complications can be safely managed robotically without conversion to thoracotomy.

Variations in lung fissures and lobes morphology in population of Andhra Pradesh of South India (a cadaveric study)

Knowledge of the position of lung fissures is necessary for the appreciation of lobar anatomy and thus locating the bronchopulmonary segments. The study aimed to investigate the patterns of fissures and lobes of the lungs and their variations in Andhra Pradesh, India and to find their clinical implications and compare them with the previous studies. Methods: The patterns of lobes, fissures, and hilar anatomy of lungs and its variations of 47 lungs by dissection method of embalmed cadavers was performed in the Department of Anatomy, Narayana Medical College (Nellore, India). The specimens were macroscopically observed for gross morphology of fissures and lobes. Results. The study showed oblique fissure in 33 % (grade 1), 26 % (grade 2), 24 % (grade 3) and 14 % (grade 4) of right lungs and 27 % (grade 1), 31 % (grade 2), 12 % (grade 3) and 12 % (grade 4) of left lungs. The incomplete horizontal fissure was seen in 38 % of right-sided lungs (grade 1). 19 % of right lungs and 10 % of left lungs had accessory lung fissures. Conclusions. Awareness of the variations in the lobes and fissures of the lungs is important for radiologists while interpreting magnetic resonance imaging and computed tomography scans. Also, we believe that the data from the present study certainly adds an important reference in the medical literature to thoracic surgeons in performing pneumonectomy and segmental resection.

Ruptured Lung Abscess with Empyema Thoracis without Pneumothorax in Children - A Rare Presentation

A 5-month-old male infant was admitted with the complaints of cough &amp; fever for 18 days and respiratory distress for 4 days. He was febrile, tachypneic (RR-58/min) with SpO2 - 94% on 2 L/min with face mask with left sided restricted chest movement with diminished breath sound. Initially he was diagnosed as left sided pleural effusion. Chest x-ray was suggestive of encysted pleural effusion (left). CT of chest revealed collapsed left lower lobe with pleural effusion and inflammatory changes in left upper lobe. Per operative finding showed pleural thickening, adhesion of oblique fissure, and perforated lower lobe of left lung. And finally infant was diagnosed as ruptured lung abscess of lower lobe of left lung with empyema thoracis. The patient was managed with decortication with segmental resection, and inj. linezolid after getting C/S and recovered.

Anatomical variations in lung fissures leading to supernumerary lobes in the lungs

IntroductionLung fissures are partially incomplete in 50% of different populations. Incomplete formation of the fissures leads to a merging of lobes and conversely accessory lobes form due to the formation of new fissures. This study aims to describe the morphology of the lungs in terms of fissures and lobes. Materials and methodsA descriptive observational study was done on a total of 82 formalin fixed bodies. Both the left and right lungs of each body were examined for accessory lobes and fissures. ResultsA wide range of variations was seen in the present study. On the right, the horizontal fissure was absent in six lungs (7.3%), incomplete in 32 lungs (39.0%) and complete in 33 lungs (40.2%). No lungs had an absent oblique fissure. The oblique fissure was incomplete in 24 lungs (29.3%) and complete in 47 lungs (57.3%). No right lung solely had an oblique fissure absent. However, both the horizontal and oblique fissures were absent in one lung (1.2%). In the left lungs, the obliques fissure was absent in one lung (1.2%), incomplete in 24 lungs (29.3%) and complete in 47 lungs (57.3%). An accessory fissure was seen in the territory of the upper lobe forming a partial separation in the right superior lobe of one lung. ConclusionThe high prevalence of morphological variations in this study emphasizes the need for greater understanding of lung fissure anatomy. For example, in video-assisted thoracoscopic surgery lobectomies, higher morbidity in patients is linked with incomplete fissures [12]. Thus, more knowledge of lung fissure and lobe variations will be of significant clinical relevance to anatomy students, cardiothoracic surgeons, and radiologists.

Prevalence of ophthalmological manifestations in pediatric and adolescent populations with Down syndrome: a systematic review of the literature

BackgroundDown syndrome (DS) is a chromosomal anomaly that is characterized by an extra chromosome 21. Ophthalmological manifestations have a high prevalence in patients with DS.PurposeTo review the scientific evidence and estimate the prevalence of ophthalmological manifestations in the pediatric population with DS.Data sourcesElectronic databases including MEDLINE, Cochrane Library, EMBASE, ScienceDirect, and LILACS.Study eligibility criteriaPublished observational studies with available and original data were included. Articles were excluded if the study design was a review, letter to the editor, case report, case series, or systematic review and if the subjects had ophthalmological manifestations secondary to other conditions.Participants and interventionsPediatric and adolescent population with DS and with ophthalmological evaluation.Study appraisal and synthesis methodsA data collection form was designed in Excel. Five reviewers extracted relevant details about the design and results of each study. The quality of the studies was assessed by applying the tools for systematic reviews of prevalence and incidence from the Joanna Briggs Institute. We calculated the weighted prevalence of ophthalmological manifestations, considering only the studies reporting the measurement of each manifestation.ResultsTwenty-two articles (from 15 countries, published during 1994–2020) were included in the present systematic review. Ocular manifestations were observed in 85% of the studied pediatric and adolescent populations with DS. The most frequent ones were slanting fissures, oblique fissures, epicanthus, and epiblepharon.ConclusionThe ocular manifestations in the pediatric and adolescent populations with DS are varied, and some can irreversibly affect visual development. Screening of the pediatric population with DS should be conducted from the first months of age and continued annually.Systematic review registrationPROSPERO CRD42019127717

Boyden's triad in the left lung: an interesting phenomenon.

Boyden's triad of the right lung was first proposed in 2021. Here, we report 5 cases of this malformation found in the left lung. A total of 5280 patients with pulmonary lesions underwent three-dimensional computed tomography bronchography and angiography between January 2019 and January 2021, prior to surgery; 5 cases of this malformation were identified in the left lung. Bronchovascular patterns were analysed in each patient. The incidence rate of Boyden's triad in the left lung was 0.1%. This malformation was further divided into B3 on B4+5 type and B3 on B4 type. In B3 on B4+5 type, B3 was shifted downwards on the common trunk of B4+5, and A3 arose from the common trunk of A4+5 running alongside B3. In B3 on B4 type, B3 was shifted downwards on B4. A4 and A5 appeared separately. A3 arose from A4, running alongside B3; A5 arose from the common trunk of A8 - 10, and there was also an extraordinary 'posterior vein' (V. post): V1+2c. The incidence of V. post was 0.17%. An additional 'fissure' lies longitudinally between S1+2 and S3+4+5, nearly perpendicular to the oblique fissure, dividing the upper lobe into 'two lobes'. The B3 downwards-shifting malformation can be found on both lungs, and this is the first description of Boyden's triad in the left lung; it appears to be much rarer than that in the right lung, with some accompanying unique variations.

Variations in Pulmonary Fissure: A Source of Collateral Ventilation and Its Clinical Significance.

Introduction: Oblique and horizontal fissures divide the lungs into lobes. Assessing the incompleteness or absence of fissures is important when planning any surgical procedure in this region. This study aimed to investigate the incidence of variations in the fissures and their implication in clinical practice.Methods: The sample consists of 70 formalin-fixed lungs (32 right and 38 left lungs). These lungs were assessed for complete, incomplete, and absent fissures and any variations in the fissures on the sternocostal and mediastinal surfaces.Results: Oblique fissure was incomplete on the sternocostal surface in 18.75% and 21% and on the mediastinal surface in 25% and 21% on the right and left lungs, respectively. Additionally, it was absent in 10.5% of the left lung samples. The horizontal fissure was incomplete in 12.5% on both surfaces and was absent in 25% on the right lung samples, of which 50% had no oblique fissure. No accessory fissure was seen in any of the lungs.Conclusion: Incomplete and absent fissures can be observed in the right as well as the left lung, suggesting the source of collateral ventilation. This study imparts important information to pulmonologists doing bronchoscopic lung volume reduction therapy or bronchopulmonary segment resection and also to radiologists and anatomists.

A CASE OF INTRA-OPERATIVE INJURY TO LEFT MAIN PULMONARY ARTERY REPAIRED WITH A PERICARDIAL PATCH

Introduction: Patients with central lung tumours often undergo surgery, offering them a chance of cure. With central lung tumours, there is always the dreaded risk of injury to the left main pulmonary artery (PA) and rupture of the anterior segmental artery, known as the artery of sorrow. Case Presentation: A 75-year-old lady with a background of breast cancer presented to our cardiothoracic centre because computed tomography (CT) of the chest revealed a left lung lesion of 5 x 4 x 3.7 cm, in contact with oblique fissure, radiological staging T3 N2 M0, which was later shown to be highly avid on positron emission tomography (PET-CT). Resection via thoracotomy was done, due to dense attachment to PA, Left PA defect was noted after resection which was repaired with a pericardial patch with no post-operative complication. Discussion: In the event of tumours invading the PA, it is safe to divide the tumours completely and repair the PA using a patch if there are any complications. Conclusion: We performed a repair of the PA using a pericardial patch and reconstruction of the PA using a pericardial patch, and evidence shows that there is excellent long-term survival associated with this.