RV-PA Conduit Replacement in d-TGA

Replacement of a stenotic/irregular right ventricle to pulmonary artery Gore-Tex trileaflet graft with a novel KONECT RESILIA Aortic Valved Conduit. This is the only tissue valved conduit currently in use. This patient has d-transposition of the great arteries along with ASD, VSD, pulmonary stenosis, bovine left arch and aberrant right subclavian arteries.

His previous operations include MBTS 4mm Gore-Tex graft, urgent shunt revision secondary to thrombosis and subsequent conversion to a 4mm central shunt, right atrial thrombectomy secondary to indwelling right atrial catheter, takedown of central shunt, primary pledgeted closure of pulmonary valve, Gore-Tex patch closure of ASD/VSD, Rastelli procedure with 24mm Gore-Tex trileaflet with bulging sinuses graft.

Thoracoscopic Management of Bilateral Congenital Pulmonary Airway Malformation with Systemic Blood Supply: Use of a Novel 5mm Stapler

from the APSA 2015 Annual Meeting proceedings

THORACOSCOPIC MANAGEMENT OF BILATERAL CONGENITAL PULMONARY AIRWAY MALFORMATION WITH SYSTEMIC BLOOD SUPPLY: USE OF A NOVEL 5MM STAPLER

Authors:

Sandra M. Farach, MD, Paul D. Danielson, MD, Nicole M. Chandler, MD.
All Childrenâs Hospital Johns Hopkins Medicine, Saint Petersburg, FL, USA.

Purpose:
Congenital pulmonary airway malformations (CPAM) and bronchopulmonary sequestrations (BPS) are two commonly discussed congenital lung malformations (CLM). We present a case of bilateral thoracoscopic lobectomy in a patient with bilateral, combined CPAM and BPS and report the novel use of a 5 mm linear stapling device.

Methods:
This is a retrospective review of a 9-month-old female patient with bilateral, combined CPAM and BPS who underwent bilateral thoracoscopic lower lobectomy.

Results:
The left lower lobectomy is demonstrated in this video. This was performed via a modified lateral position with the left side up using two 3 mm ports and two 5 mm ports. The lower lobe was resected cephalad. The systemic vessel was identified and secured. Polymer clips were placed, and the vessel was divided with a 5 mm stapling device. The pulmonary artery was divided with a vessel sealing instrument. The pulmonary vein was identified and was divided with the 5 mm stapler after endoscopic clips were placed. The bronchus was then identified and was divided with the 5 mm stapler. The most inferior port was
removed and the incision widened to allow for extraction of the specimen. A 12 French chest tube was inserted into the left chest cavity under direct visualization. Total operative time was 146 minutes. The patient did well and was discharged on post-operative day two. Pathology revealed intralobar pulmonary sequestration with pulmonary systemic and pulmonary artery hypertensive changes and congenital cystic pulmonary airway malformation Type I.

Conclusion:
The literature has reported good outcomes with thoracoscopic lobectomy for congenital airway malformations. We present a successful case of bilateral thoracocsopic lobectomy for a rare finding of bilateral, combined CPAM and BPS as well as the effectiveness and safety of using a 5 mm linear stapling device.

Video Assisted Thoracoscopic Thymectomy Langerhans Cell Histiocytosis

Contributors: Gary Nace, Juan Calisto and Marcus Malek

Langerhans Cell Histiocytosis (LCH) is an exceedingly rare proliferative disorder in which pathologic histiocytic cells accumulate in nearly every organ. Our patient, a five-month-old, six kilogram female with mild pulmonary valve stenosis, had both thymic and lung tissue involvement. To date there has never been a report of a thymic LCH with lung metastases in an infant. She underwent a video assisted thoracoscopic thymectomy.

DOI: http://dx.doi.org/10.17797/2qbbejhisy

Total Calvarial Reconstruction for Increased Intracranial Pressure and Chiari Malformation

This procedure is a total calvarial vault expansion to correct pansynostosis in a three-year-old child. Total calvarial reconstruction is an open procedure that consists of removing bone flaps with an osteotome, outfracturing the skull bone edges with a rongeur to allow for future expansion, shaving down the bone flap inner table with a Hudson brace to create a bone mush for packing the interosseus spaces, and modifying then reattaching the bone flaps with absorbable plates and screws. This patient is status post craniofacial reconstruction for earlier sagittal synostosis. Second operations are uncommon after correction of single-suture synostosis, so this more aggressive technique represents an attempt to definitively correct the calvarial deformity and resolve the signs and symptoms of the attendant intracranial hypertension. Indications for surgery include cosmetic and neurologic concerns, here including a Chiari malformation and cervicothoracic syrinx. This educational video is related to a current research project of the Children’s National Medical Center Division of Neurosurgery regarding single-suture craniosynostosis and the factors that place children at risk for surgical recidivism in the setting of intracranial hypertension.

Kelsey Cobourn, BS – Children’s National Medical Center Division of Neurosurgery and Georgetown University

Owen Ayers – Children’s National Medical Center Division of Neurosurgery and Princeton University

Deki Tsering, MS – Children’s National Medical Center Division of Neurosurgery

Gary Rogers, MD, JD, MBA, MPH – Children’s National Medical Center Division of Plastic and Reconstructive Surgery and George Washington University School of Medicine

Robert Keating, MD – Children’s National Medical Center Division of Neurosurgery and George Washington University School of Medicine (corresponding author)

Robotic-Assisted Posterior Mediastinal Mass Resection

A 34-year-old non-hypertensive, obese female with a history of smoking, asthma, fibromyalgia presented at the ED with hemoptysis, dyspnea, and emesis for two weeks. At presentation the patient was afebrile, vital signs were stable and labs showed unremarkable CBC and BMP. Chest X-ray showed an abnormal soft tissue density within the subcarinal region. A follow-up chest CT with contrast revealed a posterior mediastinal mass measuring 5.4 cm x 3.6 cm in size with well-circumscribed borders. The patient was referred to cardiothoracic surgery for complete excision of the mass. She underwent robotic-assisted posterior mediastinal mass resection.

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