Medzirebrová herniácia pľúc je definovaná ako protrúzia pľúcneho tkaniva za normálne hranice hrudnej steny. Prvý prípad pľúcnej hernie opísal v roku 1499 Roland. Pomer získaných a vrodených pľúcnych hernií je 4 : 1. Na základe anatomickej lokalizácie sú známe cervikálne, medzirebrové (interkostálne) a diafragmatické formy pľúcnej herniácie. Rizikovou zónou posttraumatickej a pooperačnej medzirebrovej pľúcnej hernie je v dôsledku slabého svalového krytu predná stena hrudníka. Kazuistika prezentuje 71-ročného muža, ktorý pred 9 rokmi podstúpil aortokoronárny bypass, náhradu mitrálnej chlopne, plastiku trikuspidálnej chlopne a zákrok MAZE. Pred pol rokom ďalej podstúpil transapikálnu implantáciu mitrálnej chlopne. Po implantácii chlopne pacient podstúpil opakovanú pleurálnu punkciu z dôvodu pleurálneho výpotku. Pacient prišiel do nemocnice pre bolestivú rezistenciu v mieste jazvy po torakotómii, ktorá sa zväčšila počas Valsalvovho manévru. Ultrasonografia a počítačová tomografia potvrdili diagnózu medzirebrovej pľúcnej hernie. Bola vykonaná resekcia herniálneho vaku a defekt bol uzavretý implantáciou polypropylénovej sieťky. Pacient bol prepustený v dobrom stave. Transapikálna implantácia chlopne predstavuje unikátnu kombináciu rizikových faktorov pre vznik medzirebrovej pľúcnej hernie ako zo strany pacienta, tak aj zo strany operačného prístupu. Dôsledné sledovanie pacientov za účelom včasnej identifikácie prítomnosti medzirebrovej pľúcnej hernie by malo byť bezpodmienečnou súčasťou pooperačného sledovania pacientov po transapikálnej implantácii chlopne.

Intercostal lung herniation is defined as a protrusion of lung tissue beyond the normal limits of the chest wall. The first case of pulmonary hernia was described in 1499 by Roland. The ratio of acquired to congenital lung hernias is 4 : 1. Based on anatomical localisation, cervical, intercostal, and diaphragmatic forms of lung herniation are known. The risk zone for posttraumatic and postoperative intercostal lung hernia is the front wall of the chest due to the poor muscular cover. The case report presents a 71-year-old man who underwent aortocoronary bypass, replacement of the mitral valve, repair of the tricuspid valve, and the MAZE procedure 9 years ago, as well as transapical implantation of the mitral valve through thoracotomy half a year ago. Repeat pleural puncture due to pleural effusion after valve implantation was needed. The pa- tient came to the hospital because of a painful resistance at the site of the thoracotomy scar which increased during the Valsalva manoeuvre. Ultrasonography and computed tomography confirmed the diagnosis of an intercostal lung hernia. A resection of the hernial sac was performed, and the defect was closed by implant- ing a polypropylene mesh. The patient was discharged in a good condition. Transapical valve implantation represents a unique combination of risk factors for the formation of an intercostal lung hernia, both from the patient's side and from the operative approach. Consistent monitoring of patients for the purpose of early identification of the presence of an intercostal lung hernia should be an unconditional part of the postoperative monitoring of patients after transapical valve implantation.

• MeSH
• Heart Valve Prosthesis Implantation * methods   adverse effects   MeSH
• Diagnosis, Differential MeSH
• Hernia * diagnostic imaging   etiology   pathology   therapy   MeSH
• Thoracic Surgical Procedures methods   adverse effects   MeSH
• Humans MeSH
• Mitral Valve surgery   MeSH
• Pleural Effusion etiology   MeSH
• Lung Diseases surgery   diagnostic imaging   etiology   pathology   MeSH
• Tomography, X-Ray Computed MeSH
• Risk Factors MeSH
• Aged MeSH
• Thoracotomy methods   adverse effects   MeSH
• Valsalva Maneuver MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged MeSH
• Publication type
• Case Reports MeSH

The authors present the case of a 9-year-old boy who sustained a gunshot injury to the pericardium by an air gun. The penetrative wound to the pericardium was, according to the performed pre-operative diagnostic methods, initially believed to be a penetrative wound into the cardiophrenic angle of the left pleural cavity. The stabilized patient was indicated for an extraction of the projectile through a left anterior minithoracotomy, during which the projectile was found and successfully removed from the pericardium. The limits of pre-operative assessment, optimal treatment procedures, and surgical approaches in pediatric patients with gunshot injuries to the chest and heart are discussed.

• MeSH
• Foreign Bodies * surgery   MeSH
• Child MeSH
• Humans MeSH
• Pericardium diagnostic imaging   surgery   MeSH
• Thoracic Injuries * surgery   MeSH
• Wounds, Gunshot * diagnostic imaging   surgery   MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Case Reports MeSH

OBJECTIVES: Conventional mitral valve surgery through median sternotomy improves long-term survival with acceptable morbidity and mortality. However, less-invasive approaches to mitral valve surgery are now increasingly employed. Whether minimally invasive mitral valve surgery is superior to conventional surgery is uncertain. METHODS: A retrospective analysis of patients who underwent mitral valve surgery via minithoracotomy or median sternotomy between 2012 and 2018. A propensity score-matched analysis was generated to eliminate differences in relevant preoperative risk factors between the two groups. RESULTS: Data from 525 patients were evaluated, 189 underwent minithoracotomy and 336 underwent median sternotomy. The 30 day mortality was similar between the minithoracotomy and conventional surgery groups (1 and 3%, respectively; p = 0.25). No differences were seen in the incidence of stroke (p = 1.00), surgical site infections (p = 0.09), or myocardial infarction (p = 0.23), or in total hospital cost (p = 0.48). However, the minimally invasive approach was associated with fewer patients receiving transfusions (59% versus 76% in the conventional group; p = 0.001) or requiring reoperation for bleeding (3% versus 9%, respectively; p = 0.03). There were no significant differences in 5 year survival between the minithoracotomy and conventional surgery groups (93% versus 86%, respectively; p = 0.21) and freedom from mitral valve reoperation (95% versus 94%, respectively; p = 0.79). CONCLUSIONS: In patients undergoing mitral valve surgery, a minimally invasive approach is feasible, safe, and reproducible with excellent short-term outcomes; mid-term outcomes and efficacy were also seen to be comparable to conventional sternotomy.

• MeSH
• Cardiac Surgical Procedures * methods   MeSH
• Middle Aged MeSH
• Humans MeSH
• Minimally Invasive Surgical Procedures * methods   MeSH
• Mitral Valve surgery   MeSH
• Heart Valve Diseases surgery   MeSH
• Retrospective Studies MeSH
• Risk Factors MeSH
• Aged MeSH
• Sternotomy * methods   MeSH
• Propensity Score MeSH
• Thoracotomy methods   MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

The evidence supporting surgical aneurysmectomy in ischemic heart failure is inconsistent. The aim of the study was to describe long-term effect of minimally invasive hybrid transcatheter and minithoracotomy left ventricular (LV) reconstruction in patients with ischemic cardiomyopathy. Twenty-three subjects with transmural anterior wall scarring, LV ejection fraction 15-45%, and New York Heart Association class ≥ II were intervened using Revivent TC anchoring system. LV end-systolic volume index was reduced from 73.2 ± 27 ml at baseline to 51.5 ± 22 ml after 6 months (p < 0.001), 49.9 ± 20 ml after 2 years (p < 0.001), and 56.1 ± 16 ml after 5 years (p = 0.047). NYHA class improved significantly at 5 years compared to baseline. Six-min walk test distance increased at 2 years compared to the 6-month visit. Hybrid LV reconstruction using the anchoring system provides significant and durable LV volume reduction during 5-year follow-up in preselected patients with ischemic heart failure. Legend: Hybrid left ventricular reconstruction using the anchoring system provides significant and durable LV volume reduction throughout 5-year follow-up in preselected patients with ischemic heart failure.

• MeSH
• Ventricular Dysfunction, Left diagnostic imaging   surgery   MeSH
• Myocardial Ischemia diagnostic imaging   surgery   MeSH
• Cardiac Surgical Procedures methods   MeSH
• Cardiomyopathies diagnostic imaging   surgery   MeSH
• Middle Aged MeSH
• Humans MeSH
• Prospective Studies MeSH
• Stroke Volume MeSH
• Walk Test MeSH
• Plastic Surgery Procedures methods   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Research Support, Non-U.S. Gov't MeSH

OBJECTIVE: To report the early and mid-term results of patients who underwent minimally invasive aortic valve replacement (MI-AVR) with a sutureless prosthesis from an international prospective registry. METHODS: Between March 2011 and September 2018, among 957 patients included in the prospective observational SURE-AVR (Sorin Universal REgistry on Aortic Valve Replacement) registry, 480 patients underwent MI-AVR with self-expandable Perceval aortic bioprosthesis (LivaNova PLC, London, UK) in 29 international institutions through either minithoracotomy (n = 266) or ministernotomy (n = 214). Postoperative, follow-up, and echocardiographic outcomes were analyzed for all patients. RESULTS: Patient age was 76.1 ± 7.1 years; 64.4% were female. Median EuroSCORE I was 7.9% (interquartile range [IQR], 4.8 to 10.9). Median cardiopulmonary bypass and cross-clamp times were 81 minutes (IQR 64 to 100) and 51 minutes (IQR 40 to 63). First successful implantation was achieved in 97.9% of cases. Two in-hospital deaths occurred, 1 for noncardiovascular causes and 1 following a disabling stroke. In the early (≤30 days) period, stroke rate was 1.4%. Three early explants were reported: 2 due to nonstructural valve dysfunction (NSVD) and 1 for malpositioning. One mild and 1 moderate paravalvular leak were reported. In 16 patients (3.3%) pacemaker implantation was needed. Mean follow-up was 2.4 years (maximum = 7 years). During follow-up 5 explants were reported, 3 due to endocarditis and 2 due to NSVD. Follow-up stroke rate was 2.5%. Three structural valve deteriorations not requiring reintervention were reported. Five-year survival was 91.45%. CONCLUSIONS: In this large prospective international registry, MI-AVR with Perceval valve confirmed to be safe, reproducible, and effective in an intermediate-risk population, providing excellent clinical recovery both in early and mid-term follow-up.

• MeSH
• Aortic Valve Stenosis surgery   MeSH
• Sutureless Surgical Procedures methods   statistics & numerical data   MeSH
• Bioprosthesis MeSH
• Heart Valve Prosthesis Implantation methods   statistics & numerical data   MeSH
• Echocardiography methods   MeSH
• Cardiac Surgical Procedures methods   MeSH
• Cardiopulmonary Bypass statistics & numerical data   MeSH
• Humans MeSH
• Minimally Invasive Surgical Procedures methods   MeSH
• Prospective Studies MeSH
• Prosthesis Design trends   MeSH
• Registries MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Heart Valve Prosthesis MeSH
• Treatment Outcome MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Observational Study MeSH

BACKGROUND: To report single-institution experience with minimally invasive mitral valve operations through the right minithoracotomy over a 5-year period. METHODS: Patients who underwent minimally invasive mitral valve surgery (MIMVS) between January 2012 and December 2016 were included. Clinical follow-up data were collected in a prospective database and analyzed retrospectively. RESULTS: Data from 151 patients were assessed (mean age, 63.4 ± 9.7 years; 55% were females). Overall 30-day mortality was 0.7% (n = 1). Mean operating time, cardiopulmonary bypass, and aortic cross-clamp times were 254.9 ± 48.7, 140.5 ± 36.1, and 94.8 ± 27.0 minutes, respectively. Associated procedures were tricuspid valve annuloplasty (37.1%, n = 56) and closure of atrial septal defect (6.0%, n = 9). Cryoablation was performed in 43.7% of patients (n = 66). One patient (0.7%) required conversion to median sternotomy and six patients (4.0%) underwent re-explorations due to bleeding. Median postoperative hospital stay was 12 days. Overall survival at 5 years was 94.1% ± 2.0%. Freedom from reoperation was 94.6% ± 2.9% at 5 years. CONCLUSIONS: MIMVS is a feasible, safe, and reproducible approach with low mortality and morbidity. Mitral valve surgery through a small thoracotomy is a good alternative to conventional surgical access.

• MeSH
• Mitral Valve Annuloplasty * adverse effects   mortality   MeSH
• Time Factors MeSH
• Heart Valve Prosthesis Implantation * adverse effects   mortality   MeSH
• Databases, Factual MeSH
• Echocardiography MeSH
• Middle Aged MeSH
• Humans MeSH
• Mitral Valve diagnostic imaging   physiopathology   surgery   MeSH
• Mitral Valve Insufficiency diagnostic imaging   mortality   physiopathology   surgery   MeSH
• Postoperative Complications etiology   surgery   MeSH
• Reoperation MeSH
• Retrospective Studies MeSH
• Risk Factors MeSH
• Aged MeSH
• Feasibility Studies MeSH
• Thoracotomy adverse effects   methods   mortality   MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Czech Republic MeSH

Chirurgická léčba je základním kamenem léčby u časných stadií nemalobuněčného karcinomu plic. Zlatým standardem je lobektomie a systematická mediastinální lymfadenektomie. U vysoce rizikových pacientů může být ve velmi selektovaných případech zvážena sublobární resekce. VATS (video-assisted minithoracothomy, minithorakotomie) resekce se stává metodou volby pro rychlejší zotavení pacientů, nižší morbiditu a srovnatelnou onkologickou účinnost ve srovnání s otevřenými výkony. Pro dobré výsledky je klíčová centralizace do vysokoobjemových specializovaných pneumoonkochirurgických center.

The gold standard is lobectomy and systematic mediastinal lymphadenectomy. In high-risk patients, sublobar resections may be considered in very selected cases. VATS (video-assisted minithoracothomy, minithoracotomy) resection becomes the method of choice for faster recovery of patients, lower morbidity and comparable oncological effectiveness compared to open chest surgery. Centralization to high-volume specialized pneumo-oncosurgical centers is key for good results.

• MeSH
• Pulmonary Surgical Procedures * methods   trends   MeSH
• Thoracic Surgery, Video-Assisted MeSH
• Humans MeSH
• Neoplasm Recurrence, Local diagnosis   therapy   MeSH
• Lymph Node Excision methods   MeSH
• Carcinoma, Non-Small-Cell Lung * diagnosis   surgery   classification   MeSH
• Pneumonectomy * methods   trends   MeSH
• Statistics as Topic MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

AIMS: A retrospective analysis of patients with thoracolumbar junction fractures who underwent video-assisted thoracoscopic surgery via a minimally invasive approach (minithoracotomy) for reconstruction of the anterior spinal column. METHODS: Between 2002 and 2014, a total of 176 patients were treated by this technique. The patients received either posterior stabilization and, at the second stage, the minimally invasive technique via an anterior approach, or the minimally invasive anterior procedure alone. RESULTS: In the anterior procedure, the average operative time was 90 min. (50 to 130 min). Bony fusion without complications was achieved in all patients within a year of surgery. The loss of correction after the anterior procedure with an allograft or titanium cage was up to 2 degrees at two years follow-up. CONCLUSION: The minimally invasive approach (minithoracotomy up to 6-7 cm) combined with thoracoscopy is an alternative to an exclusively endoscopic technique enabling us to provide safe surgical treatment of the anterior spinal column.

• MeSH
• Lumbar Vertebrae injuries   MeSH
• Adult MeSH
• Spinal Fractures surgery   MeSH
• Spinal Fusion methods   MeSH
• Thoracic Vertebrae injuries   MeSH
• Blood Loss, Surgical MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Tomography, X-Ray Computed MeSH
• Retrospective Studies MeSH
• Aged MeSH
• Thoracoscopy methods   MeSH
• Thoracotomy methods   MeSH
• Fracture Fixation, Internal methods   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Adolescent MeSH
• Young Adult MeSH
• Aged MeSH
• Publication type
• Journal Article MeSH

Úvod: Miniinvazivní videoasistovaný přístup v chirurgické léčbě některých srdečních vad představuje alternativu klasického přístupu ze sternotomie. Cílem práce je zhodnotit zkušenosti a výsledky s miniinvazivním chirurgickým přístupem v kardiocentru Hradec Králové. Materiál a metodika: V období listopad 2011 až březen 2013 bylo na Kardiochirurgické klinice v Hradci Králové odoperováno celkem 52 nemocných videoasistovaným přístupem z pravostranné minitorakotomie. Kanyly mimotělního oběhu byly zavedeny cestou femorálních cév. Výsledky: Průměrný věk nemocných v souboru byl 60,9 ? 11,6 roku (ženy 63,5 %). U 44 (85 %) nemocných byla provedena plastika mitrální chlopně, u 25 (48 %) plastika trikuspidální chlopně. Uzávěr defektu septa síní byl proveden u 8 (15 %) nemocných. Konkomitantní MAZE procedura pomocí kryoenergie byla provedena u 26 nemocných (50 %). Kombinovaných výkonů bylo 39 (75 %). Střední délka operace byla 235 minut (155–315), délka mimotělního oběhu 139 minut (89–225) a délka srdeční zástavy 92 minut (51–168). Střední délka pooperační hospitalizace byla 12,5 dne (6–34). Časná revize pro krvácení byla provedena u 1 nemocného (2 %). Cévní mozková příhoda nebo tranzitorní ischemická ataka byla zaznamenána u 2 nemocných (3,8 %). V našem souboru byla 30denní mortalita 0 %. Průměrná délka follow-up je 121,3 ? 32,72 dne. Reoperace byla provedena u 2 nemocných (3,8 %) (1krát hemotorax, 1krát aortální vada). Závěr: Miniinvazivní přístup z pravostranné minitorakotomie představuje bezpečný přístup s reprodukovatelnými výsledky. Naše výsledky jsou srovnatelné s údaji publikovanými v zahraniční literatuře.

Introduction: Minimally invasive surgical access for the treatment of mitral and tricuspid valves has become an alternative method to the conventional approach via median sternotomy. The aim of this paper is to evaluate our experience and results with minimally invasive approach in cardiac surgery at our institution. Material and methods: A total of 52 patients underwent minimally invasive cardiac surgery between November 2011 and March 2013. Right lateral minithoracotomy and femoral vessels cannulation for cardiopulmonary bypass was used. Follow-up data was collected in a prospective database and analysed retrospectively. Results: The mean age of patients was 60.9 ? 11.6 years (female patients accounted for 63.5%). The procedures performed included mitral valve repair in 44 (85%) patients and tricuspid valve repair in 25 (48%). Atrial septal defect closure was performed in 8 (15%) patients and cryoablation of atrial fibrillation in 26 (50%) patients. There were 75% combined procedures. The median duration of the operation was 235 (155–315) minutes. The median length of cardiopulmonary bypass and crossclamp time was 139 (89–225) and 92 (51–168) minutes, respectively. The median duration of postoperative hospital stay was 12.5 (6–34) days. Hospital and 30-day mortality was 0%. At follow-up (121.3 ? 32.72 days), two patients (3.8%) required reoperation (1 for right haemothorax, 1 for aortic valve insufficiency). Conclusion: Minimally invasive access has been adopted as a routine method for the therapy of valve disease. The minithoracotomy approach is a safe and feasible technique with comparable mortality and in-hospital morbidity.

• MeSH
• Time MeSH
• Cardiac Surgical Procedures * MeSH
• Middle Aged MeSH
• Humans MeSH
• Minimally Invasive Surgical Procedures * methods   MeSH
• Aged MeSH
• Thoracotomy * MeSH
• Video-Assisted Surgery * MeSH
• Treatment Outcome MeSH
• Outcome and Process Assessment, Health Care MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH

V přehledovém článku jsou zmíněny ně­kte­ré aspekty a nové trendy v intervencích na aortální chlopni pro stenózu. Jsou zdůrazněny limity standardizované operace ze střední stereotomie a možná náhradní řešení. Jde jednak o alternativní přístupy, jako jsou parciální sternotomie a minitorakotomie. Dále o bezstehové chlopně, katetrové chlopně implantované bez mimotělního oběhu a alternativní přístupy v trvalé antikoagulaci.

New trends in aortic valve surgery. This article presents some aspects and new trends in the surgery of aortic valve stenosis. We focused particularly on the limits of the standard procedures from median sternotomy and the possible alternative solutions. It means partial sternotomy and minithoracotomy, sutureless valves, transcatheter valves without extracorporeal circulation and new trends in monitoring of anticoagulation.

• Keywords
• transkatetrová náhrada aortální chlopně,
• MeSH
• Anticoagulants adverse effects   therapeutic use   MeSH
• Aortic Valve surgery   MeSH
• Aortic Valve Stenosis * surgery   MeSH
• Bioprosthesis * MeSH
• Heart Valve Prosthesis Implantation * methods   MeSH
• Thoracic Surgical Procedures MeSH
• International Normalized Ratio methods   MeSH
• Humans MeSH
• Extracorporeal Circulation adverse effects   MeSH
• Self Care MeSH
• Postoperative Complications MeSH
• Prosthesis Design MeSH
• Heart Valve Prosthesis MeSH
• Cardiac Catheterization MeSH
• Sternum surgery   MeSH
• Age Factors MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH