Surgical management of endobronchial tumors: analysis of 24 patients

To evaluate the variable surgical options performed in the management of endobronchial tumors and the factors determining selection of the appropriate surgical technique. Retrospective study of a series of 24 patients with endobronchial tumors who were diagnosed and underwent surgery in the cardiothoracic surgery department, Mansoura university hospital from January 1985 to March 2006. Full history taking and complete clinical examination, routine laboratory investigations, chest x-ray, and computerized tomography, and bronchoscope were done for all cases. Surgery was the line of treatment for all patients. Close sex distribution with age ranges from 20-64 years. Cough with expectoration was the main presentation. Zonal opacity was the most common radiological finding. CT chest showed sensitivity of 79.2% for detection of endobronchial lesions. Bronchoscopic examination revealed endobronchial lesions in all patients. Benign tumors were detected in 5 patients and malignant lesions in 19 patients, 14 patients were neuroendocrine tumors and 5 patients were other malignant varieties. Surgical interference included bilobectomy [7 patients], lobectomy [5 patients] pneumonectomy [7 patients], and one patient underwent surgical exploration for open biopsy while 4 bronchoplastic procedure were performed. Endobronchial tumors occur over a wide range of age without significant sex differentiation. Endobronchial tumor should be suspected in case of prolonged chest complaint inspite of maximal medical treatment. Bronchoscope is the main diagnostic tool and is important for detection of the provisional plane for surgery. Early diagnosis and screening should be established for early detection of endobronchial tumors and more conservative resectional and bronchoplastic techniques

Left ventricular rupture associated with mitral valve replacement

This study included six patients [three males and three females] with early rupture; the age range was 23-47 years [mean 33.8 years]. All patients had a complete excision of their native valve. One patient had type I rupture that was repaired internally, four had type I rupture that was repaired externally and one had type II rupture and had an external repair. Only one patient survived the repair. Five patients died in theater due to a continuous bleeding and a progressive deterioration of the cardiac function with inability to be weaned from cardiopulmonary bypass [CPB]. The high mortality indicated the importance of avoiding left ventricular rupture [LVR]. Meticulous technique, posterior leaflet preservation and implementing measures to reduce left ventricular [LV] distension and pressure- volume work were all very important to avoid LVR. The treatment of LVR started with prompt re-institution of CPB to reduce a further damage to LV. Ruptures limited to the free LV wall can be repaired externally, while ruptures involving the posterior annulus usually require the reopening of the left atrial [LA] suture line and repair from within