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Background: This survey aimed to explore the availability and accessibility of echocardiography during noncardiac surgery worldwide. Methods: An internet-based 45-item survey was sent, followed by reminders from August 30, 2021, to August 20, 2022. Results: 1189 responses were received from 62 countries. Nearly seventy-one percent of respondents had intraoperatively used transesophageal or transthoracic echocardiography (TEE and TTE, respectively) for monitoring or examination. The unavailability of echocardiography machines (30.3%), lack of trained personnel (30.2%), and absence of clinical indications (22.6%) were the top 3 reasons for not using intraoperative echocardiography in noncardiac surgery. About 61.5% of participants had access to at least one echocardiography machine. About 41% had access to at least 1 TEE probe, and 62.2% had access to at least 1 TTE probe. Seventy-four percent of centers had a procedure to request intraoperative echocardiography if needed for noncardiac cases. Intraoperative echocardiography service was immediately available in 58% of centers. Conclusions: Echocardiography machines and skilled echocardiographers are still unavailable at many centers worldwide. National societies should aim to train a critical mass of certified TEE/TTE anesthesiologists and provide all anesthesiologists access to perioperative TEE/TTE machines in anesthesiology departments, considering the increasing number of older and sicker surgical patients scheduled for noncardiac surgery. [ABSTRACT FROM AUTHOR]

Papillary fibroelastoma of aortic valve is a rare benign tumor that can present with symptoms of obstruction or embolization and can be asymptomatic. The main stay of diagnosis is echocardiography. The size of the tumor affects the sensitivity of transthoracic echocardiography which can miss small size tumors. The treatment is surgical resection. Here, we report a case of papillary fibroelastoma of aortic valve that was detected intraoperatively by transesophageal echocardiography and was missed by transthoracic echocardiography in a patient undergoing coronary artery surgery. The tumor was resected successfully with preservation of aortic valve with no complication. This case highlights importance of intraoperative transesophageal echocardiography in making the diagnosis. [ABSTRACT FROM AUTHOR]

Background: Transcutaneous hitching sutures in paediatric minimally invasive surgery (MIS) is a unique and rare technique. This technique has been used previously in adult patients undergoing gastric resections and laparoscopic cholecystectomy; however, its use in paediatric population has never been reported in the world literature. The primary objective of this study was to bring out the advantages and feasibility of this technique in minimally invasive gastrointestinal, hepatobiliary, urological and thoracoscopic surgeries on paediatric patients. Materials and Methods: This retrospective observational study was conducted on 167 paediatric patients who underwent MIS surgery for different indications between April 2016 and March 2020 at two paediatric surgery tertiary care centres. Results: A total of 167 patients, including 91 boys and 76 girl patients between the age group of new-born period to 12 years were operated. The mean hospital stay was 4 days. Five out of 167 cases (3%) had post-operative surgical emphysema, which resolved spontaneously. At 6-month follow-up, parental satisfaction was 100%, and in 99% of patients, scars were imperceptible. Conclusion: This versatile technique is of exemplary utility, especially in paediatric patients where there is a paucity of working space at low intra-abdominal pressure, and eases the dissection even in narrow and closed spaces with a better functional and cosmetic outcome. [ABSTRACT FROM AUTHOR]

Background Breast implant–associated anaplastic large cell lymphoma (BIA-ALCL) is a type of non-Hodgkin lymphoma first linked with breast implants in 2011. The correlation between BIA-ALCL and textured devices has led to increased use of smooth devices. However, much of the data surrounding smooth and textured devices investigates breast implants specifically and not tissue expanders. Objectives We performed a systematic review and a meta-analysis to compare surgical outcomes for smooth tissue expanders (STEs) and textured tissue expanders (TTEs). Methods A search was performed on PubMed, including articles from 2016 to 2023 (n = 419). Studies comparing TTEs and STEs and reported complications were included. A random-effects model was utilized for meta-analysis. Results A total of 5 articles met inclusion criteria, representing 1709 patients in the STE cohort and 1716 patients in the TTE cohort. The mean duration of tissue expansion with STEs was 221.25 days, while TTEs had a mean time of tissue expansion of 220.43 days. Our meta-analysis found no differences in all surgical outcomes except for explantation risk. STE use was associated with increased odds of explantation by over 50% compared to TTE use (odds ratio = 1.53; 95% CI = 1.15 to 2.02; P =.003). Conclusions Overall, STEs and TTEs had similar complication profiles. However, STEs had 1.5 times higher odds of explantation. The incidence of BIA-ALCL is low, and only a single case of BIA-ALCL has been reported with TTEs. This indicates that TTEs are safe and may lower the risk of early complications requiring explantation. Further studies are warranted to further define the relationship between tissue expanders and BIA-ALCL. Level of Evidence: 4 [ABSTRACT FROM AUTHOR]

While transthoracic echocardiography and clinical findings are used to assess body volume status, lung ultrasonography (LUS), which is a non-invasive method, has also been used in assessing hypervolemia in recent years. This study aims to compare LUS, transthoracic echocardiography (TTE) and clinical findings in the assessment of body volume status in patients receiving renal replacement therapy (RRT). The study included 99 subjects who received RRT and were followed-up in our hospital. The patients were randomly selected from kidney transplant patients and those who had been receiving peritoneal dialysis (PD) or hemodialysis (HD) for at least the past three months. In addition, a control group consisting of 52 healthy subjects was also enrolled. LUS and TTE were simultaneously performed (within 24 hours). The mean left atrial (LA) diameter was 37.8±2.7 mm, 37.9±3.4 mm, 38.6±3.5 mm and 29.0±4.4 mm in patients who received PD, kidney transplantation, HD and in the control group, respectively. There was a moderate positive correlation between the total number of B-lines and LA diameter (mm) in the combined group consisting of the patient and control groups (p=0.0001, r=0.286). In this study, the number of B-lines on LUS has been found to be higher in patients receiving renal replacement therapy due to the effect of hypervolemia compared to the control group. However, there was no statistically significant difference in terms of the number of B-lines and LA diameter in echocardiography. [ABSTRACT FROM AUTHOR]

Abstract Background Left ventricular diastolic dysfunction has a significant impact on perioperative morbidity and mortality, and its incidence is high in elderly individuals. Anesthetic agents may impair diastolic function, which may increase the incidence of perioperative complications. The aim of this prospective, clinical, phase 4 study was to investigate the effects of remifentanil on left ventricle (LV) diastolic function in patients with diastolic dysfunction. The study was performed on 30 spontaneously breathing subjects (aged 60–80 years) with diastolic dysfunction. Methods Thirty patients (aged 60–80 years) with diastolic dysfunction scheduled for surgery were recruited between November 2019 and March 2023. Left ventricle function was evaluated once the intravenous remifentanil infusion reached a target-controlled concentration of 2 ng/ml with transthoracic echocardiography. Analysis of systolic function focused on left ventricular ejection fraction and mean mitral annular S velocity (Sm), whereas diastolic function focused on changes in transmitral peak flow (E), E/A, mitral septal and lateral e’ waves, E/e’ ratios and left atrial volume index following remifentanil infusion. Results Diastolic function measures of LV (mitral E/e’, septal and lateral e’ waves) statistically significantly improved (E/e’ from 10.6 ± 2.9 cm.sn− 1 to 9.5 ± 2.2 cm.sn− 1; p = 0.006) following remifentanil infusion. Left atrial volume index decreased following remifentanil infusion without statistical significance (from 55 ± 14.4 ml.cm− 2 to 51.6 ± 13.3 ml.cm− 2; p = 0.1). Systolic function (ejection fraction and Sm) did not change following remifentanil infusion. Conclusions Remifentanil improves left ventricular diastolic parameters in patients with preexisting diastolic dysfunction. Our study suggests that remifentanil at a plasma concentration of 2 ng.ml− 1 might be used safely in patients with left ventricular diastolic dysfunction.

Background: Transcutaneous hitching sutures in paediatric minimally invasive surgery (MIS) is a unique and rare technique. This technique has been used previously in adult patients undergoing gastric resections and laparoscopic cholecystectomy; however, its use in paediatric population has never been reported in the world literature. The primary objective of this study was to bring out the advantages and feasibility of this technique in minimally invasive gastrointestinal, hepatobiliary, urological and thoracoscopic surgeries on paediatric patients. Materials and Methods: This retrospective observational study was conducted on 167 paediatric patients who underwent MIS surgery for different indications between April 2016 and March 2020 at two paediatric surgery tertiary care centres. Results: A total of 167 patients, including 91 boys and 76 girl patients between the age group of new-born period to 12 years were operated. The mean hospital stay was 4 days. Five out of 167 cases (3%) had post-operative surgical emphysema, which resolved spontaneously. At 6-month follow-up, parental satisfaction was 100%, and in 99% of patients, scars were imperceptible. Conclusion: This versatile technique is of exemplary utility, especially in paediatric patients where there is a paucity of working space at low intra-abdominal pressure, and eases the dissection even in narrow and closed spaces with a better functional and cosmetic outcome.

Pseudoaneurysm of aorto-mitral intervalvular fibrosa (P-AMIVF) is a rare fatal complication of endocarditis; however, balloon aortic valvuloplasty has been associated with this condition. In the absence of complications, this entity is usually asymptomatic. Trans-thoracic and trans-esophageal echocardiography are the mainstay to assess the severity of valve lesion and myocardial abscess in this hidden region. The 38-year-old patient diagnosed with critical calcified bicuspid aortic valve stenosis; dilatation of aortic root and aneurysmal aorto-mitral curtain with moderate mitral regurgitation was treated successfully. We share our views and challenges related to mural endocarditis, myocardial abscesses, and P-AMIVF. [ABSTRACT FROM AUTHOR]

Mitral valve surgery (MVS), with repair preferred to replacement, is a common procedure for the treatment of severe primary mitral regurgitation related to leaflet prolapse. Structural complications after MVS include left ventricular outflow obstruction, paravalvular leak and atrial septal defect. Intraoperative transoesophageal echocardiography and predischarge transthoracic echocardiography (TTE) specifically screen for these complications. Ventricular septal defect (VSD), a known complication after aortic valve surgery, is rarely reported after MVS. Recently, unsuccessful valvuloplasty prior to replacement was suggested as a risk factor. We present such a case and explore mechanisms with advanced cardiac imaging. In this case, the patient was found to have an elongated membranous septum that likely predisposed her to septal injury. Finally, we provide guidance on specific transoesophageal/transthoracic echocardiography views to avoid a missed diagnosis. [ABSTRACT FROM AUTHOR]

Real-time three-dimensional echocardiography (RT3DE) is increasingly available in the veterinary field due to continuous reduction in costs and improvement of equipment. Much like its motion-mode and bi-dimensional counterparts, acquisition and analysis of RT3DE images and datasets is greatly improved by a thorough understanding of the technological aspects, basic physic principles, and knowledge of available modalities with their advantages and drawbacks. In this review, the authors aim to describe how the currently available RT3DE technology has evolved, explain technical aspects of the equipment, and illustrate the most commonly available modalities for image acquisition and visualization. [ABSTRACT FROM AUTHOR]

OBJECTIVES This study aimed to find the frequency of indications for Transthoracic echocardiography and its impact on non-cardiac patient management in Peshawar, Pakistan. METHODOLOGY A cross-sectional study was conducted in Medical B Ward, Department of Internal Medicine at Hayatabad Medical Complex, Peshawar, Pakistan, over six months from July to 31st December 2020. A non-consecutive probability sampling technique was used. The sample size was calculated using an Openepi calculator, keeping 25.9 % as the frequency of requesting heart failure as an indication of echocardiography, 6.15 % as the confidence limit, and 95 % as a confidence interval. RESULTS A total of 195 patients were included in the study. The mean age of the patients was 483 years, with 59% females and 41% males. The major indication for TTE was assessing left ventricular systolic function in 146 (75%) patients and then finding the cause of the observed arrhythmias in 15 (7.5%) patients. A major proportion (95%) of the evaluated patients had no major change in the ongoing management plan following TTE. The working diagnosis in evaluated patients was changed by 12.7%, whereas new management plans were devised in only 4.9% of the cases. CONCLUSION Designing a randomized study to fully elaborate on the utility of TTE in patients admitted to acute medical wards while trying to address all confounding variables is an extremely difficult task.

Abstract Background Whether a transthoracic (TT) procedure by a thoracic surgeon or a transabdominal (TA) by a gastrointestinal surgeon is best for Siewert type II esophagogastric junction adenocarcinoma (EGJA) remains unknown. Survival and perioperative outcomes were compared between the two groups in this meta-analysis to clarify this argument. Methods We searched 7 databases for eligible studies comparing TT and TA procedures for Siewert type II EGJA. The final analyzed endpoints included intraoperative and hospitalization outcomes, recurrence, complication, and survival. Results Seventeen studies involving 10,756 patients met the inclusion criteria. The TA group had higher rates of overall survival (OS) (HR: 1.31 [1.20 ~ 1.44], p

Background: Whether a transthoracic (TT) procedure by a thoracic surgeon or a transabdominal (TA) by a gastrointestinal surgeon is best for Siewert type II esophagogastric junction adenocarcinoma (EGJA) remains unknown. Survival and perioperative outcomes were compared between the two groups in this meta-analysis to clarify this argument. Methods: We searched 7 databases for eligible studies comparing TT and TA procedures for Siewert type II EGJA. The final analyzed endpoints included intraoperative and hospitalization outcomes, recurrence, complication, and survival. Results: Seventeen studies involving 10,756 patients met the inclusion criteria. The TA group had higher rates of overall survival (OS) (HR: 1.31 [1.20 ~ 1.44], p < 0.00001) and disease-free survival (DFS) (HR: 1.49 [1.24 ~ 1.79], p < 0.0001). The survival advantage of OSR and DFSR increased with time. Subgroup analysis of OS and DFS suggested that TA remained the preferred approach among all subgroups. More total/positive lymph nodes were retrieved, and fewer lymph node recurrences were found in the TA group. The analysis of perioperative outcomes revealed that the TA procedure was longer, had more intraoperative blood loss, and prolonged hospital stay. Similar R0 resection rates, as well as total recurrence, local recurrence, liver recurrence, peritoneal recurrence, lung recurrence, anastomosis recurrence and multiple recurrence rates, were found between the two groups. The safety analysis showed that the TT procedure led to more total complications, anastomotic leakages, cases of pneumonia, and cases of pleural effusion. Conclusions: The TA procedure appeared to be a suitable choice for patients with Siewert type II EGJA because of its association with longer survival, fewer recurrences, and better safety. [ABSTRACT FROM AUTHOR]

Background: The field of robotic liver resection (RLR) has developed in the past decades. This technique seems to improve the access to the posterosuperior (PS) segments. Evidence of a possible advantage over transthoracic laparoscopy (TTL) is not yet available. We aimed to compare RLR to TTL for tumors located in the PS segments of the liver in terms of feasibility, difficulty scoring, and outcome. Methods: This retrospective study compared patients undergoing robotic liver resections and transthoracic laparoscopic resections of the PS segments between January 2016 and December 2022 in a high-volume HPB center. Patients' characteristics, perioperative outcomes, and postoperative complications were evaluated. Results: In total, 30 RLR and 16 TTL were included. Only wedge resections were performed in the TTL group, while 43% of the patients in the RLR group had an anatomical resection (p < 0.001). The difficulty score according to the IWATE difficulty scoring system was significantly higher in the RLR group (p < 0.001). Total operative time was similar between the two groups. Complication rates, either overall or major, were comparable between the two techniques and hospital stay was significantly shorter in the RLR group. Patients in the TTL group were found to have more pulmonary complications (p = 0.01). Conclusion: RLR may provide some advantages over TTL for the resection of tumors located in the PS segments. [ABSTRACT FROM AUTHOR]

Simple Summary: Every year lung cancer takes the lives of many patients, making it the most common cause of cancer-related deaths. While surgery is the gold standard treatment for early-stage lung cancer, its share in treating more advanced disease stages is limited. Therefore, clinicians advise a multimodal treatment consisting of chemotherapy, radiotherapy and/or immunotherapy to treat advanced lung cancers. There has been a growing interest in loco-regional techniques as they are expected to have advantages over current therapies. In this article, we provide an overview of the established and promising innovative invasive loco-regional techniques ordered by their route of administration (endobronchial, endovascular and transthoracic route) and an overview of their implementation and effectiveness. Although the results of these techniques show improved local disease control and effect, there is a need for more clinical studies to guarantee their efficacy and safety before they can be used within the clinic. Surgical resection is still the standard treatment for early-stage lung cancer. A multimodal treatment consisting of chemotherapy, radiotherapy and/or immunotherapy is advised for more advanced disease stages (stages IIb, III and IV). The role of surgery in these stages is limited to very specific indications. Regional treatment techniques are being introduced at a high speed because of improved technology and their possible advantages over traditional surgery. This review includes an overview of established and promising innovative invasive loco-regional techniques stratified based on the route of administration, including endobronchial, endovascular and transthoracic routes, a discussion of the results for each method, and an overview of their implementation and effectiveness. [ABSTRACT FROM AUTHOR]

Abstract Background Transhiatal esophagectomy (THE) and transthoracic esophagectomy (TTE) are both accepted procedures for esophageal cancer but still the most effective surgical approach continues to be controversial. This study aimed to determine post-operative complications and outcomes of TTE compared with THE. Methods A retrospective analysis was performed on data of 243 adult patients with resectable esophageal cancer who underwent THE or TTE between December 2016 and October 2018. Demographic data, consisting of preoperative co-morbidities, disease stage, and perioperative morbidity and mortality were collected. Results Among the patients, 99 individuals (40.7%) had a transhiatal resection and 144 (59.3%) had a transthoracic resection. Most patients (83.1%) were above 50 years old with no significant difference between groups (p = 0.297). The frequency distribution of comorbidities was similar in both groups. The most common site of the tumor in TTE group was middle esophagus and in THE group was lower esophagus. The most common complication was recurrence of dysphagia which was more common in THE group without significant difference. The other complications including pulmonary and cardiac events, tracheal and recurrent laryngeal nerve injury, chylothorax and anastomosis stricture did not differ between the groups. The operative mortality within 30 days after the operation was 2.8% with significant difference favored the THE group (THE 0%, TTE 5.2%, p = 0.033). Conclusion Because of the controversies, the decision on the type of surgical technique in esophageal cancer treatment hinges on patient’s co-morbidities, cancer stage, tumor location and surgeon’s experience.

The article presents the discussion on case study of 61-year-old woman with a mechanical mitral valve replacement who was found to have a mobile echo-dense image resembling a mass on echocardiography. Topics include the identification and differentiation of microcavitation from other echo-dense lesions, the significance of this finding to avoid unnecessary interventions; and techniques for improving echocardiographic image interpretation.

Introduction: Clinical practice guidelines (CPG) are a component of evidence‐based practice allowing standardisation across departments and individuals' skill levels. Australian Cardiac Sonographers (ACS) are not obliged to follow specific CPG when performing a transthoracic echocardiogram (TTE). This research aimed to determine guidelines/workplace protocols ACS follow when performing a TTE, and what attitudes, subjective norms and perceived behavioural controls exist that may prevent adherence to guidelines. Methods: A national mixed methods online survey, exploring adherence to and opinions of guideline use when performing a TTE. The 'Theory of Planned Behaviour' model (attitudes, subjective norms and perceived behavioural controls) was used to develop the survey. Results: Of n = 131 ACS, 73% reported following a mix of guidelines, practice protocol and doctor preference when performing TTE. The majority followed the American Society of Echocardiography (ASE) guidelines (59%), considered guidelines beneficial (84%) and felt encouraged to adhere to them (56%). Most however (61%) reported finding measurement or pathology discrepancies with their own TTE studies compared with those performed at other practices. Factors negatively influencing guideline adherence included insufficient guideline education, time constraints for scanning and education, leadership influence and lack of quality control. These factors were considered largely workplace dependant. Conclusion: While the majority of ACS do not follow a single specific guideline when performing a TTE, ACS believe guidelines are important. Several negative influences may prevent adherence in different workplace environments. Further examination of national standardisation and education/quality control programs is recommended with observation of patient and economic outcomes. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this case is to describe, for the first time, a case of adolescent idiopathic scoliosis treated with right sided transthoracic fusion and complicated by the cranial aspect of the rod boring through the fourth rib head. In this case we present a 25 year old female with idiopathic adolescent scoliosis who underwent transthoracic correction surgery in 2010. While initially coping well, she progressively developed pain in the right medial scapular region, at the level of T4, which was exacerbated by deep breathing. PET/CT scan showed increased uptake at the T4 rib head with the most cranial aspect of the rod boring itself into the head of the fourth rib. Principal results: Due to the challenge with removal of metalware, she proceeded for a right sided fourth rib head resection surgery a decade after her primary surgery. She experienced immediate resolution of pain. She has remained asymptomatic with complete resolution of pain beyond one year follow up. Major conclusions: With this case report we hope to raise awareness of this rare complication of transthoracic correction surgery. It would be prudent for clinicians managing patients with scoliosis to consider rib head pathology should new pain arise following surgery.Written informed consent was obtained from the patient for publication of this case report and any accompanying images.

Perfluoropropane droplets (PDs) cross endothelial barriers and can be acoustically activated for selective myocardial extravascular enhancement following intravenous injection (IVI). Our objective was to determine how to optimally activate extravascular PDs for transthoracic ultrasound-enhanced delineation of a developing scar zone (DSZ). Ultrafast-frame-rate microscopy was conducted to determine the effect of pulse sequence on the threshold of bubble formation from PDs. In vitro studies were subsequently performed at different flow rates to determine acoustic activation and inertial cavitation thresholds for a PD infusion using multipulse fundamental non-linear or single-pulse harmonic imaging. IVIs of PDs were given in 9 rats and 10 pigs following prolonged left anterior descending ischemia to detect and quantify PD kinetics within the DSZ. A multipulse sequence had a lower myocardial index threshold for acoustic activation by ultrafast-frame-rate microscopy. Acoustic activation was observed at a myocardial index ≥0.4 below the inertial cavitation threshold for both pulse sequences. In rats, confocal microscopy and serial acoustic activation imaging detected higher droplet presence (relative to remote regions) within the DSZ at 3 min post-IVI. Transthoracic high-mechanical-index impulses with fundamental non-linear imaging in pigs at this time post-IVI resulted in selective contrast enhancement within the DSZ. [ABSTRACT FROM AUTHOR]

Background: To implement Enhanced Recovery After Surgery (ERAS) protocols for liver transplant (LT) candidates, it is essential to identify tools that can help risk stratify patients by their risk of early adverse post‐LT outcomes. Objective: We aimed to identify pre‐LT tools that assess functional capacity, frailty, and muscle mass that can best risk stratify patients by their risk of adverse post‐LT outcomes. Methods: We first conducted a systematic review following PRISMA guidelines, expert panel review and recommendations using the GRADE approach (PROSPERO ID CRD42021237434). After confirming there are no studies evaluating assessment modalities for ERAS protocols for LT recipients specifically, the approach of the review focused on pre‐LT modalities that identify LT recipients at higher risk of worse early post‐LT outcomes (≤90 days), considering that this is particularly pertinent when evaluating candidates for ERAS. Results: Twenty‐two studies were included in the review, encompassing three different types of pre‐LT modalities: evaluation of physical function (including frailty and general physical scores like the Karnofsky Performance Status (KPS), assessment of cardiopulmonary capacity, and estimation of muscle mass and composition. The majority of studies evaluated frailty assessment and muscle mass. Most studies, except for liver frailty index (LFI), were retrospective and single‐center. All assessment modalities could identify, in different grade, LT recipients with higher risk of early post‐LT mortality, length of stay or postoperative complications. Conclusions: We identified four pre‐LT assessment tools that could be used to identify patients who are suitable for ERAS protocols: (1) KPS (quality of evidence moderate, grade of recommendation strong); (2) LFI (quality of evidence moderate, grade of recommendation strong); (3) abdominal muscle mass by CT (quality of evidence moderate, grade of recommendation strong); and (4) cardiopulmonary exercise testing (CPET) (quality of evidence moderate, grade of recommendation weak). We recommend that selection of the appropriate tool depends on the specific clinical setting and available resources to administer the tool, and that use of a tool be incorporated into the routine preoperative assessment when considering implementation of ERAS protocols for LT. [ABSTRACT FROM AUTHOR]

Percutaneous Transthoracic Biopsy (TTB) is a minimally invasive method of obtaining tissue specimens from a previously detected thoracic lesion for further analysis in order to reach a definite diagnose. The study aimed at determining the role of percutaneous transthoracic biopsy in the light of current international recommendations for performing the intervention, and presenting our experiences - success rate, and complications. The study included 57 patients (17 women and 40 men) of average 64.4 years, who underwent biopsy procedures from January 2016 to November 2019. The procedure was performed using the cutting biopsy technique, using an automated BARD MAGNUM Reusable Core Biopsy System with 14-18 G diameter needles, under the guidance of GE 16 and GE 64 MDCT, with a postprocedural scan for complication evaluation. The material was sent to the Pathology Clinic, Clinical Center Niš. The procedure was successful in 53 patients (92.98%). Of the complications, pneumothorax was reported in 14 patients (24.56%), hemoptysis in 4 patients (7%), and intrapulmonary hemorrhage in 10 patients (17.54%). Only 4 cases of pneumothorax (7%) required drainage. The smallest lesion was 20 mm in diameter and the longest pathway through the lung parenchyma was 50 mm. Based on our results, we can conclude that CT-guided transthoracic biopsy with core biopsy technique is a minimally invasive inexpensive procedure, with high rates of diagnostic accuracy, and acceptably low complication rates, and therefore one of the mandatory procedures to be considered in diagnosis of thoracic masses. [ABSTRACT FROM AUTHOR]

Abstract Penetrating aortic ulcer (PAU) is one of the three subtypes of acute aortic syndrome. PAUs occur at any point throughout the aorta, most commonly in the descending thoracic aorta and less frequently in the aortic arch. Open surgical repair and total/hybrid endovascular repair are currently available to treat aortic arch PAUs. Herein, we present a patient with aortic arch PAU who underwent transthoracic minimally invasive closure, which is a novel method for the treatment of PAU. We describe a 52-year old Asian man who presented with sudden chest and back pain for 8 h. Computed tomography angiography showed that the PAU occurred in the aortic arch and had a diameter of 16 mm and a depth of 6 mm. The opening was successfully closed via transthoracic minimally invasive closure with an atrial septal defect occluder.

Background: Interstitial lung disease [ILD] is a difficult-to-treat disease. The patient continues treatment for his/her whole life. However, certain causes – when diagnosed - could change their treatment plan. Radiological investigations cannot elicit the underlying pathology 100%. Thus, transthoracic lung biopsy is of utmost importance, especially in undiagnosed patients. But, it is not free of risk, and thus, its use is still controversial.Aim of the work: This work aims to evaluate the role of medical thoracoscopic lung biopsy [TLB] in diagnosing diffuse parenchymal lung diseases.Patients and Methods: Fifty patients with diffuse lung infiltrate on high-resolution computed tomography [HCRT] of unconfirmed diagnosis were included. All patients have been submitted to detailed clinical examination and specific laboratory investigations. Furthermore, all had high resolution computed tomography, pulmonary function tests], echocardiography, arterial blood gas analysis, and bronchoalveolar lavage assessment. The thoracoscopic lung biopsy was performed under local anesthesia. The specimens were preserved in formalin containing cups till examination. Patients were followed up, and any complications were documented.Results: The lung HCRT revealed ground-glass opacity [44%], reticulonodular interstitial pattern [38%], honeycombing [14%], crazy paving [10.0%], and consolidation [20.0%]. The histopathology revealed alveolar proteinosis [2.0%], alveolar hemosidrosis [2.0%], hypersensitivity pneumonitis [24.0%], sarcoidosis [8.0%], nonspecific interstitial pneumonia [20%], Idiopathic pulmonary fibrosis [12.0%], respiratory bronchiolitis ILD [18%], and desquamative ILD [14.0%]. All patients positive on HCRT had pathological change. Complications were [12%] bulla in partnehymea, [4%] plural disear, [2%] pneumothorax, and 2% died during follow up duration.Conclusion: TLB is an effective and relatively safe, minimally invasive intervention for interstitial lung disease diagnosis. Accordingly, it must be considered a standard diagnostic tool for undiagnosed suspected cases.

Background and Importance: Sequestrated thoracic disc herniation after a traumatic event without an apparent spinal fracture or dislocation is an extremely rare scenario. Case Presentation: Evaluation of an elderly female with acute paraparesis secondary to a fall down to the ground revealed a right-sided extruded disc at the level of T10-T11. At 6-month follow-up, she made a dramatic recovery following an appropriate surgical intervention. Conclusion: With occurrence of acute paraparesis following a traumatic event, MRI of the vertebral column is necessary, even in the absence of tomographic evidence of fracture-dislocation

Purpose: Diastolic waveforms in the left ventricular outflow tract (LVOT) are commonly observed with Doppler echocardiography. The incidence and mechanism are not well described. Methods: This was a retrospective observational study of 186 adult patients, athletes and non‐athletes, free of known cardiac disease, presenting for comprehensive transthoracic echocardiography at a research institute. We aimed to evaluate the incidence and echocardiographic associations between LVOT diastolic waveforms. Results: Left ventricular outflow tract early to mid‐diastolic waveforms were present in 100% of athletes and 95% of non‐athletes. The LVOT diastolic velocity time integral was larger in athletes than non‐athletes with a mean 8.3 cm (95% CI (7.6–8.9)) vs. 5.1 cm (4.4–5.9) (P < 0.0001). Multivariate predictors of this diastolic waveform were age (P = 0.002), slower heart rate (P = 0.035), higher stroke volume (P = 0.003), large mitral E (P = 0.019) and higher E/e' (P = 0.015). Discussion: An LVOT early diastolic wave is a normal physiological finding. It is related to a flow vortex redirecting diastolic mitral inflow around anterior mitral valve leaflet into the LVOT. Conclusions: Early to mid‐diastolic LVOT waves are present in almost all patients but more prominent in young athletes than non‐athletes. Diastolic LVOT waves increase with younger age, slower heart rate, larger stroke volume and enhanced diastolic function. [ABSTRACT FROM AUTHOR]

Background: Transhiatal esophagectomy (THE) and transthoracic esophagectomy (TTE) are both accepted procedures for esophageal cancer but still the most effective surgical approach continues to be controversial. This study aimed to determine post-operative complications and outcomes of TTE compared with THE.Methods: A retrospective analysis was performed on data of 243 adult patients with resectable esophageal cancer who underwent THE or TTE between December 2016 and October 2018. Demographic data, consisting of preoperative co-morbidities, disease stage, and perioperative morbidity and mortality were collected.Results: Among the patients, 99 individuals (40.7%) had a transhiatal resection and 144 (59.3%) had a transthoracic resection. Most patients (83.1%) were above 50 years old with no significant difference between groups (p = 0.297). The frequency distribution of comorbidities was similar in both groups. The most common site of the tumor in TTE group was middle esophagus and in THE group was lower esophagus. The most common complication was recurrence of dysphagia which was more common in THE group without significant difference. The other complications including pulmonary and cardiac events, tracheal and recurrent laryngeal nerve injury, chylothorax and anastomosis stricture did not differ between the groups. The operative mortality within 30 days after the operation was 2.8% with significant difference favored the THE group (THE 0%, TTE 5.2%, p = 0.033).Conclusion: Because of the controversies, the decision on the type of surgical technique in esophageal cancer treatment hinges on patient's co-morbidities, cancer stage, tumor location and surgeon's experience. [ABSTRACT FROM AUTHOR]

Background Transthoracic core needle biopsy (TTCNB) became a routinely offered procedure in Tanzania in October 2018. This study evaluates the safety and effectiveness of establishing a TTCNB program in a resource-limited setting. Methodology A single center, prospective, observational cohort study was conducted at Muhimbili National Hospital on 90 patients who underwent computed tomography-guided TTCNB from October 2018 to May 2021. Patient and procedural data, including demographic information, complications, pathology results, and clinical outcomes, were stored in a Research Electronic Data Capture (REDCap) database. Follow-up was conducted at 4 weeks postprocedure by phone. Descriptive analysis was performed using Statistical Package for Social Sciences. Results A total of 90 patients underwent TTCNB. Seven samples were lost or never processed. In total, 68/83 (81.9%) of processed samples were diagnostic, with 89.7% (n = 61) classified as malignant and 10.3% (n = 7) classified as benign. Overall, 82.4% (n = 56) were classified as primary malignancies, 7.4% (n = 5) as metastatic malignancies, 5.9% (n = 4) as benign tumors, and 4.4% (n = 3) as infectious. Reasons for nondiagnostic samples were crashed/insufficient samples in 53.3% (n = 8) and nonspecific chronic inflammation in 46.7% (n = 7). Minor (Society of Interventional Radiology [SIR] class A and B) complications occurred in 8 cases (8.9%), while there was 1 (1.1%) major complication (SIR class F). A total of 44/90 (48.9%) patients could be reached for follow-up at 4 weeks postprocedure. In addition, 31/44 (70.5%) of these patients had a diagnosis of malignancy. Of these, 20 received chemotherapy, 8 died prior to receiving any treatment, 2 declined any further medical or surgical intervention, and 1 was treated with surgical excision and adjuvant chemotherapy. Conclusion Although recently introduced in Tanzania, TTCNB has been performed with 81.9% diagnostic accuracy and a complication rate comparable to existing literature.

Abstract Background Point-of-care cardiac ultrasound (cardiac POCUS) has potential to become a useful tool for improving cardiovascular care in Tanzania. We conducted a pilot program to train clinicians at peripheral health centers to obtain and interpret focused cardiac POCUS examinations using a hand-held portable device. Methods Over a 5-day period, didactic and experiential methods were used to train clinicians to conduct a pre-specified scanning protocol and recognize key pathologies. Pre- and post-training knowledge and post-training image acquisition competency were assessed. In their usual clinical practices, trainees then scanned patients with cardiovascular signs/symptoms, recorded a pre-specified set of images for each scan, and documented their interpretation as to presence or absence of key pathologies on a case report form. A cardiologist subsequently reviewed all images, graded them for image quality, and then documented their interpretation of key pathologies in a blinded fashion; the cardiologist interpretation was considered the gold standard. Results 8 trainees (6 Clinical Officers, 1 Assistant Medical Officer, and 1 Medical Doctor) initiated and completed the training. Trainees subsequently performed a total of 429 cardiac POCUS examinations in their clinical practices over a 9 week period. Stratified by trainee, the median percent of images that were of sufficient quality to be interpretable was 76.7% (range 18.0–94.2%). For five of eight trainees, 75% or more of images were interpretable. For detection of pre-specified key pathologies, kappa statistics for agreement between trainee and cardiologist ranged from − 0.03 (no agreement) for detection of pericardial effusion to 0.42 (moderate agreement) for detection of tricuspid valve regurgitation. Mean kappa values across the key pathologies varied by trainee from 0 (no agreement) to 0.32 (fair agreement). Conclusions The 5-day training program was sufficient to train most clinicians to obtain basic cardiac images but not to accurately interpret them. Proficiency in image interpretation may require a more intensive training program.

Diagnosing childhood tuberculosis (TB) is challenging, and novel diagnostic tools are urgently needed. Mediastinal lymphadenopathy is a hallmark of primary pulmonary TB (PTB) in children. We aimed to summarise available methodological and diagnostic data of transthoracic mediastinal ultrasound for childhood TB. Literature review identified two prospective and three retrospective studies, a case report, and a technical report including cases. All reported on suprasternal scanning of the mediastinum; additional parasternal scanning was reported by five studies. The proportion of children with lymphadenopathy detected by mediastinal ultrasound ranged between 15% and 85%, with studies including both supra- and parasternal scanning achieving higher detection ratios. Three retrospective studies reported mediastinal lymphadenopathy on ultrasound for most cases presenting with a normal or inconclusive CXR. Data on ultrasound for mediastinal lymphadenopathy in children are limited but indicate that mediastinal ultrasound can successfully detect mediastinal lymphadenopathy in children with TB. [ABSTRACT FROM AUTHOR]

Fast technology development over the past decade as well as changes in practical echocardiography (EchoCG) lead to have given rise to a need in the update of previous guidelines for cardiac chambers quantification, which was the aim of this publication by working group of the Association of Cardiovascular Surgeons of Ukraine and Ukrainian Society of Cardiology. This paper provides up-to-date evidence-based data regarding reference ranges for all cardiac chambers, including available data regarding 3D-echocardiography and myocardial deformation (strain), based on the wide range of studies of healthy individuals found in many databases in healthy individuals. In addition, this document contains an attempt to adjust several minor controversies from previous guidelines. This document is based on “Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging” (2015) adapted according to the local peculiarities and printed abridged. Full content of “Cardiac Chamber Quantifica-tion by Echocardiography in Adults: Recommendations from the Association of Cardiovascular Surgeons of Ukraine and Ukrainian Society of Cardiology” is available online at the official Website https://amosovinstitute.org.ua of the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine. This paper contains key recommendations, reference ranges and quantification methods in pictures and tables.

The use of intraoperative transesophageal echocardiography (TEE) has become the standard of care for most cardiac surgical procedures. There are guidelines established for training, practice, and quality improvement in perioperative TEE by the joint efforts of the American Society of Echocardiography and Society of Cardiovascular Anesthesiologists. Cardiac point-of-care ultrasound (POCUS) increasingly is being incorporated into anesthesiologists' training and practice. While a special "certification in Critical Care Echocardiography" was created by the National Board of Echocardiography in 2019, there currently exist no guidelines for training, certification, and practice of perioperative TTE by anesthesiologists. In this review, the authors describe the categories, indications and applications of perioperative TTE and provide a recommended sequence for performing an examination tailored to the evaluation of perioperative patients. Although the authors describe a protocol utilized at their institution, there are no standards described in the literature for PTTE. Cardiac anesthesiologists and cardiac anesthesia societies (Society of Cardiovascular Anesthesiologists, European Association of Cardiothoracic Anesthesiologists) must come forward to establish standards working in collaboration with echocardiography societies (American Society of Echocardiography, European Society of Cardiology). [ABSTRACT FROM AUTHOR]

Background and Importance: Sequestrated thoracic disc herniation after a traumatic event without an apparent spinal fracture or dislocation is an extremely rare scenario. Case Presentation: Evaluation of an elderly female with acute paraparesis secondary to a fall down to the ground revealed a right-sided extruded disc at the level of T10-T11. At 6-month follow-up, she made a dramatic recovery following an appropriate surgical intervention. Conclusion: With occurrence of acute paraparesis following a traumatic event, MRI of the vertebral column is necessary, even in the absence of tomographic evidence of fracture-dislocation. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of the study were to determine the safety and efficacy of computed tomography (CT)- guided transpulmonary percutaneous microwave ablation (MWA) for hepatic malignancies without the use of ancillary techniques. Material and Methods: A retrospective review was performed on patients who underwent MWA for hepatic malignancy between January 2014 and February 2020 at a single tertiary center. Imaging was reviewed for each procedure to identify MWA showing transpleural transgression on CT scans. For these patients, demographics, ablation data, pulmonary complication rate, and predictors of pneumothorax were analyzed. Results: A total of 71 consecutive sessions (62.1 ± 11.3 years, 79% of males) of MWA were performed to treat 71 tumors (1.90 ± 0.96 cm) via transpulmonary approach under CT guidance. Technical success was achieved in all cases immediately after the procedure. At 1-month follow-up, 65/69 (94.2%) patients had no residual disease (two patients were lost to follow-up). Pulmonary complications occurred in 26/71 (36.6%) sessions, and 15/26 (57.7%) were minor requiring no intervention. Pneumothorax occurred in 14/71 (19.7%) sessions, and the rate of major pneumothorax requiring chest tube was 8/71 (11.3%). Lesions on the left side of the liver (segments I–IV) and intraprocedural probe adjustment were found to be independent predictors of developing major pneumothorax (P = 0.007 and 0.028, respectively). There were no reported pulmonary complications at the 1-month follow-up. Conclusion: CT-guided transpulmonary MWA is safe and effective in treating hepatic malignancies. Although it is associated with the risk of developing pulmonary complications, patients underwent successful ablation of their hepatic malignancies without life-threatening complications and mortality. [ABSTRACT FROM AUTHOR]

Objective: The detection of pulmonary embolism in emergency department requires an urgent therapeutic and diagnostic attention. This study was performed to determine the accuracy and efficacy of ultrasound in the diagnosis of pulmonary embolism. Methods: In this study, 110 patients who referred to the emergency department with traumatic embolism symptoms were enrolled. All the patients underwent computed tomography (CT) angiography. Patients were divided into positive and negative outcomes according to the results of transthoracic ultrasonography and CT angiography. Results: In this study, 110 patients were enrolled, of whom 52 (47.3%) were male and 58 (52.7%) were female. Among the patients, 100 (90.9%) patients presented with dyspnea, whereas the frequency of pleural pain was 27% (24.5%). Sensitivity, specificity, positive predictive value, and negative predictive value for ultrasound were 45.67%, 77.41%, 88.09%, and 35.29%, respectively. The positive outcomes from CT scan were significantly associated with gender, p = 0.005. The gender and transthoracic ultrasonography outcomes were also significantly correlated, p = 0.019, and the outcomes of ultrasound were significantly different from those of CT scan, p = 0.008. Conclusion: Transthoracic ultrasonography may be used to diagnose pulmonary embolism as a technique in the emergency department, especially in patients who are unable to move due to the severity of the disease. However, further comparative studies are required in this aspect. [ABSTRACT FROM AUTHOR]