Category: General

Ann Surg Oncol. 2026 Apr 3. doi: 10.1245/s10434-026-19618-w. Online ahead of print.

ABSTRACT

BACKGROUND: Primary leiomyosarcoma of the inferior vena cava (IVC) is a rare malignant smooth muscle tumor, representing fewer than 1 in 100,000 adult cancers and less than 0.5% of soft tissue sarcomas. Despite its rarity, it is the most common primary tumor of the IVC and typically aff ects women in their 50s to 60s. Clinical presentation is often silent or nonspecific, resulting in late diagnosis and poor long-term outcomes. Surgical resection remains the only potentially curative treatment, and IVC reconstruction may be necessary depending on tumor location and extent.

METHODS: We present a video demonstrating robotic resection and reconstruction of the IVC in a 75-year-old patient with a 5.5 cm leiomyosarcoma located below the left renal vein, exhibiting both intraluminal and extraluminal growth. Patient underwent robotic en bloc resection of the tumor and a 6 cm segment of the IVC.

RESULTS: Reconstruction was performed using a tubularized bovine pericardium graft. Total operative time was 440 minutes, with 80 minutes of IVC clamping and 180 mL of blood loss. No transfusion was required, postoperative recovery was uneventful, and the patient was discharged on postoperative day six. Imaging confi rmed graft patency, and final pathology reported high-grade leiomyosarcoma (T3N0M0).

CONCLUSIONS: To our knowledge, this is the first reported case of robotic resection of IVC leiomyosarcoma and only the second reported robotic IVC resection and reconstruction in the English literature. This case supports the feasibility and safety of a minimally invasive robotic approach for complex vascular oncologic surgery.

PMID:41933245 | DOI:10.1245/s10434-026-19618-w

Interdiscip Cardiovasc Thorac Surg. 2026 Apr 1;41(4):ivag084. doi: 10.1093/icvts/ivag084.

ABSTRACT

Cardiac hemangiomas are rare benign tumours that may cause significant haemodynamic compromise when reaching large dimensions. We report a case of a giant right atrial cavernous hemangioma occupying almost the entire atrial cavity and involving multiple adjacent structures. A 55-year-old woman presented with progressive symptoms and was found to have a large right atrial mass on echocardiography and computed tomography. Urgent surgical resection was performed under mild hypothermic cardiopulmonary bypass. The tumour involved the right atrial free wall, interatrial septum, inferior vena cava, coronary sinus, and posterior wall of the left atrium, requiring radical excision and atrial reconstruction using bovine pericardial patches. Tricuspid annuloplasty was performed due to annular dilatation and moderate regurgitation. Postoperative recovery was uneventful, with preserved venous drainage and no new rhythm disturbances. Histopathology confirmed cavernous hemangioma. This case demonstrates that even extremely large benign atrial tumours can be successfully managed with radical resection and tailored reconstruction.

PMID:41863326 | PMC:PMC13070375 | DOI:10.1093/icvts/ivag084

BMJ Case Rep. 2026 Mar 25;19(3):e272043. doi: 10.1136/bcr-2026-272043.

ABSTRACT

We report the case of a man in his mid 70s with a history of coronary artery bypass grafting and prior surgical repair of an ascending aortic pseudoaneurysm using a bovine pericardial patch. He was subsequently found to have a persistent pseudoaneurysm adjacent to the right coronary ostium. In view of his prior sternotomy and the close proximity of the lesion to the coronary ostium, a transcatheter approach was selected. The pseudoaneurysm was successfully excluded using a duct occluder device, followed by deployment of a covered Papyrus coronary stent to reinforce the neck seal while preserving coronary flow. This case underscores the importance of multimodality imaging for diagnosis and procedural planning in complex, high-risk patients and demonstrates the feasibility of a dual-device transcatheter strategy for managing persistent aortic pseudoaneurysms in anatomically challenging locations.

PMID:41881477 | DOI:10.1136/bcr-2026-272043

Interdiscip Cardiovasc Thorac Surg. 2026 Mar 12;41(3):ivag044. doi: 10.1093/icvts/ivag044.

ABSTRACT

We present a novel technique for tricuspidation of the very asymmetrical bicuspid aortic valve (AV) with commissural orientation of about 120-140, via replacement of the fused AV cusp with 2 neo-cusps. The neo-cusps are fashioned from bovine pericardium and sutured to the annulus. Successful repair using the described technique requires good quality and adequate commissure height of the non-fused cusp. Since 2020, this technique has been applied to 15 patients. To date, all patients are alive with well-functioning AVs, presenting no or trivial insufficiency, large orifice areas, and nearly physiological transvalvular gradients.

PMID:41840768 | PMC:PMC13098162 | DOI:10.1093/icvts/ivag044

Yonsei Med J. 2026 Apr;67(4):297-305. doi: 10.3349/ymj.2025.0174.

ABSTRACT

PURPOSE: Aortic prostheses are used in pulmonary positions due to structural similarities between the pulmonary and aortic valves. However, there are no available studies that have comprehensively evaluated the mechanism of bioprosthetic aortic valves under pulmonary conditions.

MATERIALS AND METHODS: Using a mock circulatory system, we evaluated the hydrodynamic characteristics of bovine pericardial and porcine valves. Geometric orifice area, regurgitant and leakage volume, regurgitant fraction, peak pressure gradient, and forward flow volume were evaluated in different pulmonary pressure conditions (from 15/5 mm Hg to 75/35 mm Hg) and normal aortic pressure (110/80 mm Hg).

RESULTS: Bovine pericardial valves were associated with larger opening area (0.93±0.01 vs.1.70±0.01 for 23-mm valve; 0.99±0.01 vs.1.75±0.01 for 25-mm valve; 1.58±0.01 vs. 2.25±0.02 for 27-mm valve; all p<0.01) and forward flow volume (42.27±0.05 vs. 64.79±0.14 for 23-mm valve; 46.41±0.06 vs. 64.28±0.18 for 25-mm valve; 72.64±0.17 vs.73.25±0.07 for 27-mm valve; all p<0.01). Porcine valves were associated with incomplete opening, smaller opening area, and lower regurgitant fraction. Bovine pericardial valves demonstrated lower peak pressure gradients (15.75±0.14 vs. 12.57±0.47 for 23-mm valve; 14.85±0.05 vs. 12.87±0.28 for 25-mm valve; 15.72±0.32 vs. 7.91±0.03 for 27-mm valve).

CONCLUSION: Bovine pericardial and porcine bioprosthetic valves has different hydrodynamic characteristics under various pulmonary pressure conditions.

PMID:41914313 | PMC:PMC13040176 | DOI:10.3349/ymj.2025.0174

Yonsei Med J. 2026 Apr;67(4):297-305. doi: 10.3349/ymj.2025.0174.

ABSTRACT

PURPOSE: Aortic prostheses are used in pulmonary positions due to structural similarities between the pulmonary and aortic valves. However, there are no available studies that have comprehensively evaluated the mechanism of bioprosthetic aortic valves under pulmonary conditions.

MATERIALS AND METHODS: Using a mock circulatory system, we evaluated the hydrodynamic characteristics of bovine pericardial and porcine valves. Geometric orifice area, regurgitant and leakage volume, regurgitant fraction, peak pressure gradient, and forward flow volume were evaluated in different pulmonary pressure conditions (from 15/5 mm Hg to 75/35 mm Hg) and normal aortic pressure (110/80 mm Hg).

RESULTS: Bovine pericardial valves were associated with larger opening area (0.93±0.01 vs.1.70±0.01 for 23-mm valve; 0.99±0.01 vs.1.75±0.01 for 25-mm valve; 1.58±0.01 vs. 2.25±0.02 for 27-mm valve; all p<0.01) and forward flow volume (42.27±0.05 vs. 64.79±0.14 for 23-mm valve; 46.41±0.06 vs. 64.28±0.18 for 25-mm valve; 72.64±0.17 vs.73.25±0.07 for 27-mm valve; all p<0.01). Porcine valves were associated with incomplete opening, smaller opening area, and lower regurgitant fraction. Bovine pericardial valves demonstrated lower peak pressure gradients (15.75±0.14 vs. 12.57±0.47 for 23-mm valve; 14.85±0.05 vs. 12.87±0.28 for 25-mm valve; 15.72±0.32 vs. 7.91±0.03 for 27-mm valve).

CONCLUSION: Bovine pericardial and porcine bioprosthetic valves has different hydrodynamic characteristics under various pulmonary pressure conditions.

PMID:41914313 | PMC:PMC13040176 | DOI:10.3349/ymj.2025.0174

Int J Surg Case Rep. 2026 Jan 28;138(3):674-679. doi: 10.1097/RC9.0000000000000083. eCollection 2026 Mar.

ABSTRACT

INTRODUCTION: Primary aortoenteric fistulas are rare, life-threatening conditions, usually secondary to abdominal aortic aneurysms. Primary aortoduodenal fistula (PADF) without aneurysmal disease is extremely rare, with very few cases reported in the literature. Delayed diagnosis is common and contributes to high mortality.

CASE PRESENTATION: We report the case of a 71-year-old woman with high-grade serous ovarian cancer who developed a PADF in the absence of an aortic aneurysm. The patient presented with hematemesis and abdominal pain. Initial investigations, including Computed Tomography (CT) scan and upper endoscopy (EGDS), were inconclusive. Although she was initially stabilized, she experienced recurrent gastrointestinal bleeding leading to hemodynamic deterioration. Emergency CT showed active arterial hemorrhage near the duodenum. An urgent exploratory laparotomy confirmed the presence of a PADF, which was surgically repaired using a bovine pericardial patch. Despite surgical intervention, the patient succumbed to postoperative multiorgan failure.

CLINICAL DISCUSSION: PADFs most frequently involve the third or fourth portion of the duodenum and are strongly correlated with aneurysmal disease. However, rare etiologies such as radiation therapy, malignancy, or infection may precipitate fistula formation even in the absence of aneurysms. Our literature review identified only 16 similar cases reported since 2015. Diagnosis remains challenging due to non-specific symptoms and inconclusive early imaging. A high index of suspicion is essential. CT angiography is the most effective diagnostic modality. Definitive management requires urgent surgical or endovascular repair, although prognosis remains poor in hemodynamically unstable patients.

CONCLUSION: This case underscores the need to consider PADF in the differential diagnosis of gastrointestinal bleeding, even in the absence of aneurysmal disease, particularly among oncologic patients with prior radiation exposure or retroperitoneal inflammation. Early diagnosis, prompt imaging, and a multidisciplinary approach are essential to improving patient outcomes.

PMID:41837109 | PMC:PMC12981790 | DOI:10.1097/RC9.0000000000000083

Yonsei Med J. 2026 Apr;67(4):297-305. doi: 10.3349/ymj.2025.0174.

ABSTRACT

PURPOSE: Aortic prostheses are used in pulmonary positions due to structural similarities between the pulmonary and aortic valves. However, there are no available studies that have comprehensively evaluated the mechanism of bioprosthetic aortic valves under pulmonary conditions.

MATERIALS AND METHODS: Using a mock circulatory system, we evaluated the hydrodynamic characteristics of bovine pericardial and porcine valves. Geometric orifice area, regurgitant and leakage volume, regurgitant fraction, peak pressure gradient, and forward flow volume were evaluated in different pulmonary pressure conditions (from 15/5 mm Hg to 75/35 mm Hg) and normal aortic pressure (110/80 mm Hg).

RESULTS: Bovine pericardial valves were associated with larger opening area (0.93±0.01 vs.1.70±0.01 for 23-mm valve; 0.99±0.01 vs.1.75±0.01 for 25-mm valve; 1.58±0.01 vs. 2.25±0.02 for 27-mm valve; all p<0.01) and forward flow volume (42.27±0.05 vs. 64.79±0.14 for 23-mm valve; 46.41±0.06 vs. 64.28±0.18 for 25-mm valve; 72.64±0.17 vs.73.25±0.07 for 27-mm valve; all p<0.01). Porcine valves were associated with incomplete opening, smaller opening area, and lower regurgitant fraction. Bovine pericardial valves demonstrated lower peak pressure gradients (15.75±0.14 vs. 12.57±0.47 for 23-mm valve; 14.85±0.05 vs. 12.87±0.28 for 25-mm valve; 15.72±0.32 vs. 7.91±0.03 for 27-mm valve).

CONCLUSION: Bovine pericardial and porcine bioprosthetic valves has different hydrodynamic characteristics under various pulmonary pressure conditions.

PMID:41914313 | PMC:PMC13040176 | DOI:10.3349/ymj.2025.0174

Yonsei Med J. 2026 Apr;67(4):297-305. doi: 10.3349/ymj.2025.0174.

ABSTRACT

PURPOSE: Aortic prostheses are used in pulmonary positions due to structural similarities between the pulmonary and aortic valves. However, there are no available studies that have comprehensively evaluated the mechanism of bioprosthetic aortic valves under pulmonary conditions.

MATERIALS AND METHODS: Using a mock circulatory system, we evaluated the hydrodynamic characteristics of bovine pericardial and porcine valves. Geometric orifice area, regurgitant and leakage volume, regurgitant fraction, peak pressure gradient, and forward flow volume were evaluated in different pulmonary pressure conditions (from 15/5 mm Hg to 75/35 mm Hg) and normal aortic pressure (110/80 mm Hg).

RESULTS: Bovine pericardial valves were associated with larger opening area (0.93±0.01 vs.1.70±0.01 for 23-mm valve; 0.99±0.01 vs.1.75±0.01 for 25-mm valve; 1.58±0.01 vs. 2.25±0.02 for 27-mm valve; all p<0.01) and forward flow volume (42.27±0.05 vs. 64.79±0.14 for 23-mm valve; 46.41±0.06 vs. 64.28±0.18 for 25-mm valve; 72.64±0.17 vs.73.25±0.07 for 27-mm valve; all p<0.01). Porcine valves were associated with incomplete opening, smaller opening area, and lower regurgitant fraction. Bovine pericardial valves demonstrated lower peak pressure gradients (15.75±0.14 vs. 12.57±0.47 for 23-mm valve; 14.85±0.05 vs. 12.87±0.28 for 25-mm valve; 15.72±0.32 vs. 7.91±0.03 for 27-mm valve).

CONCLUSION: Bovine pericardial and porcine bioprosthetic valves has different hydrodynamic characteristics under various pulmonary pressure conditions.

PMID:41914313 | PMC:PMC13040176 | DOI:10.3349/ymj.2025.0174

J Vasc Access. 2026 Mar 11:11297298261424940. doi: 10.1177/11297298261424940. Online ahead of print.

ABSTRACT

BACKGROUND: Native arteriovenous fistulas remain the preferred vascular access for hemodialysis. However, critically unfavorable venous anatomy can impede their successful creation. Poor-quality or small-sized distal veins with areas of focal stenosis and thickened venous segments compromise the feasibility of placing a standard arteriovenous fistula or lead to fistula nonmaturation or malfunction, requiring adjuncts such as primary angioplasty or staged-balloon assisted maturation.

METHODS: This is a report of a single-stage technique using a short strip of bovine pericardium, tapered at the venous half of the patch in a “boat-shaped” configuration and flared at the arterial half of the patch, which is tubularized to create a cylindrical conduit and bridge an otherwise healthy vein with a focal stenosis to the target artery. With this onlay-tubularized bovine pericardial patch, the diseased segment can be enlarged and a smooth “neovein” created while preserving the autogenous cannulation segment.

RESULTS: The technique is illustrated in the case of a 56-year-old patient with immunoglobulin A nephropathy and a distal basilic vein focal defect. Immediate postoperative results were positive with strong bruit and thrill while follow-up duplex within 2 months showed excellent venous dilation and a flow exceeding 600 mL/min. Patency at 12 months remains intact.

CONCLUSIONS: It is appropriate to use this technique in patients with adequate inflow and outflow, but with focal vein stenoses or short, thickened vein segments that preclude the use of a standard AVF. This hybrid approach, combining principles of patch venoplasty and bovine pericardial bypass grafting, may be used as a salvage option in selected patients with focal venous stenotic lesions considered for native arteriovenous fistula creation.

PMID:41810476 | DOI:10.1177/11297298261424940