Tracheostomy and venovenous extracorporeal membrane oxygenation for difficult airway patient with carinal melanoma:A case report and literature review

BACKGROUND Anesthesia for tracheal tumor resection is challenging,particularly in patients with a difficult upper airway.We report a case of a difficult upper airway with a metastatic tracheal tumor causing near-total left bronchial obstruction and requiring emergency tracheostomy and venovenous extracorporeal membrane oxygenation(VV-ECMO)support for rigid bronchoscopy-assisted tumor resection.CASE SUMMARY A 41-year-old man with a history of right retromolar melanoma treated by tumor excision and myocutaneous flap reconstruction developed progressive dyspnea on exertion and syncope episodes.Chest computed tomography revealed a 3.0-cm tracheal mass at the carinal level,causing 90%tracheal lumen obstruction.Flexible bronchoscopy revealed a pigmented tracheal mass at the carinal level causing critical carinal obstruction.Because of aggravated symptoms,emergency rigid bronchoscopy for tumor resection and tracheal stenting were planned with standby VV-ECMO.Due to limited mouth opening,tracheostomy was necessary for rigid bronchoscopy access.While transferring the patient to the operating table,sudden desaturation occurred and awake fiberoptic nasotracheal intubation was performed for ventilation support.Femoral and internal jugular vein were catheterized to facilitate possible VV-ECMO deployment.During tracheostomy,progressive desaturation developed and VV-ECMO was instituted immediately.After tumor resection and tracheal stenting,VV-ECMO was weaned smoothly,and the patient was sent for intensive postoperative care.Two days later,he was transferred to the ward for palliative immunotherapy and subsequently discharged uneventfully.CONCLUSION In a difficult airway patient with severe airway obstruction,emergency tracheostomy for rigid bronchoscopy access and standby VV-ECMO can be life-saving,and ECMO can be weaned smoothly after tumor excision.During anesthesia for patients with tracheal tumors causing critical airway obstruction,spontaneous ventilation should be maintained at least initially,and ECMO deployment should be prepared for high-risk patients,such as those with obstructive symptoms,obstructed tracheal lumen>50%,or distal trachea location.

Atrioventricular Septal Defect with Intact Interatrial Septum. Case Report

In atrioventricular septal defect (AVSD), anatomical lesions usually are an ostium primum atrio-septal defect;a common atrioventricular valve, an inlet ventricular septal defect (VSD). It is most often associated with major chromosomal abnormalities. It is the most common congenital disease in Down syndrome. Our case was an infant with a Down syndrome who was admitted for a dyspnea (stage 3 in New York Heart Association classification) and tachycardia. The diagnosis was made by a transthoracic echocardiography. It showed a rare variety of atrioventricular septal defect without an atrial septal defect. The child was treated successfully with one patch technic and no recurrence was noted.

Surgical Treatment of Tetralogy of Fallot with Pulmonary Valve Agenesis in a 22 Years Old Patient

Agenesis of pulmonary valve is a rare variant and severe form of Tetralogy of Fallot (ToF). The evolution is usually marked by respiratory and cardiac failure at early age, which needs early surgical correction. Uncorrected treatment of Tetralogy of Fallot diagnosed at adult age is infrequent and only few studies have been described. We present here a rare case of a 22 years old patient who presented with dyspnea since childhood. Subsequent investigations allowed diagnosis of treatment of Tetralogy of Fallot with agenesis of the pulmonary valve. Following the assessment, the patient underwent a surgical repair and the recovery was uneventful. The management of treatment of Tetralogy of Fallot with pulmonary valve agenesis in adult period remains complex, requiring different surgical techniques.

Umbilical cord-derived mesenchymal stem cells:strategies,challenges,and potential for cutaneous regeneration

Umbilical cord mesenchymal stem cells(MSCs)are a unique,accessible,and non-controversial source of early stem cells that can be readily manipulated.As the most common pluripotent cell,bone marrow-derived MSCs display limitations with the progress of stem cell therapy.By contrast,umbilical cord-derived cells,which have plentiful resources,are more accessible.However,several uncertain aspects,such as the effect of donor selection or culture conditions,long-term therapeutic effects,product consistency,and potential tumorigenicity,are the bottleneck in this clinical therapy.MSCs are predicted to undergo an unprecedented development in clinical treatment when a generally acknowledged criterion emerges.In the current paper,we highlight the application of umbilical cord-derived MSCs in skin therapies based on our previous studies,as well as the achievements of our peers in this field.This paper focuses on the strategies,challenges,and potential of this novel therapy.

关于气管替代物研究的进展与展望

目前,广泛切除后气管重建仍然是胸外科领域的一大挑战。对于长度>6 cm的气管缺损,常需要气管替代物移植进行重建。气管替代物包括人工合成假体、自体组织气管、同种异体移植、异种移植和组织工程气管。理想的气管替代物尚不清楚,但一些技术已在动物或临床应用中显示出较好效果。本文回顾了过去几十年间气管替代物在应用中的成果与不足。其中,自体组织气管和同种异体主动脉移植展现出良好的应用前景。对于干细胞、组织工程气管的研究近年来引起人们的极大兴趣,但目前这种方法的长期结果欠佳,尚需要进一步的研究与优化。

Case report of a rare giant left anterior descending coronary artery aneurysm

Giant coronary artery aneurysm(CAA)is a rare condition,reportedly seen in 0.02-0.2%of patients undergoing coronary angiography.Asymptomatic in most cases,patients may present with angina pectoris,myocardial infarction,cardiac tamponade or sudden death.Given that the natural history of the CAA is still not predictable,the optimal treatment remains still debatable.In this case report,we present a male patient with a sudden non-exertional dyspnea and angina in a context of obesity,multiple large and medium vessels aneurysms and chronic kidney disease(CKD).A contrast CT detected a giant left anterior descending artery(LAD)CAA measuring 73 mm×47 mm,apparently compressing the circumflex(CX)and the pulmonary artery(PA).After undergoing a full(etiologic and aneurysm extension)panel of exams,the patient underwent a surgical exclusion of the giant CAA and a coronary artery bypass grafting(CABG)by using the left thoracic mammary artery(LITA).The hospitalization was uneventful,and the patient left the hospital completely asymptomatic.In conclusion,even in cases of giant coronary aneurysms,the treatment is surgical by excluding the aneurismatic sac and performing a surgical revascularization.