Indications and outcomes of pneumonectomy for benign diseases: A single-center experience

Background: Pneumonectomy can be used to manage destroyed lung; however, it is associated with a high risk of complications. This study analyzed the outcomes of pneumonectomy in patients with destroyed lungs. Methods: The study included 28 patients who had pneumonectomy for benign lung diseases from January 2011 to December 2017. Descriptive analysis was used to present patients' demographics, surgical details, and postoperative outcomes. Intraoperative blood loss was compared in tuberculous vs. non-tuberculous patients and those who had extrapleural vs. intrapleural pneumonectomy. Results: The study included 11 (39%) males, and the mean age was 36.6 ± 9.8 years (range: 5– 61). The persistent cough was the presenting symptom in 93% of cases, expectoration in 78.6%, hemoptysis in 46.4%, and chest pain in 28.6% of patients. Indications for pneumonectomy were tuberculosis in 13 (46.4%), septic bronchiectasis in 10 (35.7%), invasive opportunistic infections in 3 (10.7%), neglected endobronchial foreign body in 1 (3.6%), and neglected rupture bronchus in 1 (3.6%) patient. Pneumonectomy was left-sided in 21 (75%) patients. We performed extrapleural pneumonectomy in 7 (25%) patients, intra-pericardial isolation in 5 (17.9%) patients, and two patients (7.2%) had completion pneumonectomy. Mean perioperative bleeding was 390.7± 233.8 ml. The intraoperative blood loss was more in patients with tuberculosis and extrapleural pneumonectomy (P< 0.05). Postoperative complications occurred in 7 patients (25%), and we reported one operative mortality.  Conclusions: Pneumonectomy for benign lung disease is a challenging procedure. Destroyed lung due to TB and bronchiectasis are the most common indications. The outcome could be improved with careful patient selection, appropriate preoperative preparation, meticulous operative techniques, and high postoperative care standards

Cardiac Myxomas: A single center experience and ten-years follow up

Background: Cardiac myxoma is a benign tumor that carries the risk of embolization and obstruction of the blood flow. The ideal surgical approach is still debatable. We present our experience in the surgical treatment of cardiac myxomas and its ideal surgical approach.Methods: We retrospectively analyzed the data for all patients who underwent surgical excision of cardiac myxoma at our institution over 11 years starting from January 2006 to December 2016. Descriptive statistics were used to present preoperative, operative and postoperative data and Kaplan Meier curve to plot long-term survival.Results: Twenty-one patients had surgical excision of a primary, single and sporadic cardiac myxoma. Thirteen patients (62 %) were females, and the mean age at operation was 55.2 years (range: 28 – 71 years). The location of myxomas was in the left atrium in 17 patients (81%) and right atrium in 4 patients (19 %). Dyspnea was the main presenting symptom (71.4%) followed by constitutional symptoms (28%), palpitations (23.8%), syncope (14.2%) and stroke (14.2%). A right atrial trans-septal incision was used in 76.5% of left atrial myxoma cases. Five patients had concomitant operative procedures (coronary artery bypass grafting (n=2), tricuspid valve repair (n=1), mitral valve replacement (n=1) and bullectomy (n=1)). Postoperative complications were reported in six patients (28.6%) (supraventricular arrhythmia (n=2), temporary conduction deficit (n=2), pulmonary atelectasis (n=1), and postoperative bleeding (n=1)). Early postoperative mortality occurred in one patient (4.76 %), and there were no late deaths related to myxoma.Conclusion: Surgical treatment of cardiac myxoma is safe with low morbidity and mortality. The right atrial trans-septal incision is the recommended surgical approach