Pulmonary vein stenosis requiring lobectomy after radiofrequency catheter ablation for atrial fibrillation.

Pulmonary vein stenosis is one of the potential complications of radiofrequency catheter ablation for atrial fibrillation. This complication is generally treated by transcatheter techniques using balloon angioplasty or stent implantation. We report a case of a 17-year-old boy with acquired left inferior pulmonary vein stenosis following radiofrequency catheter ablation for atrial fibrillation, conditioning recurrent pneumonia. Despite three attempts of vein dilation by means of angioplasty, the stenosis always recurred with worsening of symptoms. A left inferior lobectomy was then performed and after 33 months the patient is well and with no symptoms.

Functional and structural effects of percutaneous edge-to-edge double-orifice repair under cardiac cycle in comparison with suture repair.

Percutaneous procedures for double-orifice mitral valve repair using the MitraClip device (clip) have been recently introduced as new treatment options as alternatives to medical management and open-heart surgery, especially for patients with high estimated operative risk. Similarly to the open-heart surgical technique, where suturing is used, the clip creates a double-orifice configuration that not only improves the closing function of the valve, but also significantly modifies its behaviour, particularly in the diastolic phase. While several clinical trials have been conducted, and are ongoing, in order to assess the safety and effectiveness of this technique, a deeper knowledge of the structural and functional effects on the valve, and of the cyclic loads transmitted to the clip itself, would allow a comparison with other repair techniques, and could serve as a foundation for possible further optimization of the clip design. The effects of the MitraClip device developed by Evalve Inc. were studied by means of a finite element model of the mitral valve, specifically developed to study the structural effects of the original, suture-based, edge-to-edge technique. A second model was developed in order to simulate the effects of a suture with similar extension from the leaflet edge in a direction to the annulus, in order to compare the two repair techniques. The mitral valve area and transvalvular pressure gradient predicted by the models for the clip and the suture are quite similar. Similar leaflet cyclic stresses, both in value and in location, were noted for the two mechanisms of linking the leaflets, while minor differences were found in the load transmitted to the suture and the clip, with slightly higher values for the clip. The model satisfactorily allowed functional parameters (valve area and transvalvular pressure gradient) and structural parameters (load, leaflet stress) to be determined. Overall, the structural effects of the clip and the suture are quite similar under the cyclic loading conditions imposed by the cardiac cycle.

Surgical treatment of multiple primary adenocarcinomas of the lung.

INTRODUCTION: The incidence of lung adenocarcinomas has steadily increased over the last decades. The aim of this study was to assess the results of surgical treatment of multiple primary adenocarcinomas of the lung (MPAL) analyzing the radiological and histological features. METHODS: From 1988 to 2005, 26 patients underwent surgical treatment for MPAL at our department, for a total of 52 tumors. Three patients had synchronous and 23 had metachronous tumors. RESULTS: Thirty-seven tumors were classified as solid, two as ground-glass opacities (GGO) and 13 as mixed solid/GGO tumors on the basis of CT scan evaluation. Histology revealed 26 adenocarcinomas, five adenocarcinomas with a bronchioloalveolar (BAC) pattern and 21 BAC. There was no postoperative mortality. Five-year survival of patients with synchronous tumors was 66 %. Survival of patients with metachronous tumors was 95 % and 70 % from the first and second operation. Patients with stage II and III a tumors had significantly reduced survival rates ( P < 0.05). Survival was 60 % after lobectomy and 78 % after wedge resection. CONCLUSIONS: Surgical treatment of MPAL is associated with favorable results. Sublobar resections, when technically feasible, provide adequate oncological management.

Preoperative assessment in patients with postintubation tracheal stenosis : Rigid and flexible bronchoscopy versus spiral CT scan with multiplanar reconstructions.

BACKGROUND: Postintubation stenosis remains the most frequent indication for tracheal surgery. Rigid bronchoscopy has traditionally been considered the technique of choice for the preoperative diagnostic assessment. However, this technique is not routinely available, and new techniques such as flexible videobronchoscopy and spiral computed tomography (CT) scan with multiplanar reconstructions have been proposed as alternatives to rigid bronchoscopy. The aim of this study was to compare these techniques in the diagnostic assessment of patients with tracheal stenosis submitted to surgical treatment. METHODS: Twelve patients who underwent airway resection and reconstruction for postintubation tracheal and laryngotracheal stenosis were preoperatively evaluated with rigid and flexible bronchoscopy and with spiral CT scan with multiplanar reconstructions. The following parameters were examined: involvement of subglottic larynx, length of the stenosis, and associated lesions. The results were compared with the intraoperative findings. RESULTS: The accuracy of rigid bronchoscopy, flexible bronchoscopy, and CT scan in the evaluation of the involvement of subglottic larynx was, respectively, 92%, 83%, and 83%. The evaluation of the length of the stenosis was correct in 83%, 92%, and 25% of the patients, respectively, with rigid bronchoscopy, flexible bronchoscopy, and CT scan. A significant correlation was observed between the length of the stenosis measured intraoperatively and preoperatively with rigid (p < 0.001) and flexible bronchoscopy (p < 0.05) but not with CT scan (p = 0.08). The three techniques correctly showed the presence of an associated tracheoesophageal fistula in two patients, but CT scan did not correctly show the exact location of the fistula in relation to the airway. Flexible bronchoscopy was the only effective technique in the assessment of laryngeal function. CONCLUSIONS: Rigid bronchoscopy remains the procedure of choice in the evaluation of candidates for tracheal resection and reconstruction for postintubation stenosis, and it should be available in centers that perform surgery of the airway. Flexible bronchoscopy and CT scan have to be considered complementary techniques in the evaluation of laryngeal function and during follow-up.

Neoadjuvant chemotherapy and pneumonectomy in a lung cancer patient on hemodialysis.

Major pulmonary resections are rarely performed in non-small cell lung cancer patients on hemodialysis. To date only two cases of pneumonectomy performed in such patients are reported in the literature. Moreover, chemotherapy, as a treatment for advanced non-small cell lung cancer, is not routinely administered to patients with end-stage renal disease requiring hemodialysis. We present the case of a stage IIIB non-small cell lung cancer patient on hemodialysis who successfully underwent neoadjuvant chemotherapy followed by pneumonectomy. To our knowledge, this is the first case of non-small cell lung cancer patient on hemodialysis reported in the literature who successfully underwent this type of combined therapy.