Kyobu geka. The Japanese journal of thoracic surgery最新文献

We report a successful case of mitral valve replacement and coronary artery bypass grafting under mild hypothermia and systemic hyperkalemia in a patient with severely atheromatous ascending aorta on which placing a clamp seemed contraindicated. A 78-year-old man was referred to our hospital with the diagnosis of heart failure associated with severe mitral regurgitation and coronary artery disease. Echocardiography showed severe mitral regurgitation due to A3, P3 and posterior commissure (PC) prolapse and coronary angiography showed three vessel disease. Computed tomography( CT) revealed a severely atheromatous ascending aorta. Surgery was performed under cardiac arrest using systemic hyperkalemia and superior transseptal approach. Although cardiopulmonary bypass (CPB) time was a little prolonged in order to wash out potassium with dilutional ultrafiltration, the patient was uneventfully separated from CPB. The patient had no neurological complications and was discharged from the hospital 15 days after surgery. Mitral valve replacement under cardiac arrest using systemic hyperkalemia without cross clamping the aorta is useful to avoid neurological complications.

A 79-year-old woman was revealed to have an abnormal shadow in the right upper lung field by a chest radiography at the time of medical examination. Contrast-enhanced chest computed tomography( CT) revealed a solid, irregularly-shaped nodule with pleural indentation and total/solid diameter of 26 mm in the S3 segment of the right upper lobe. A diagnosis could not be made with bronchoscopy, although positron emission tomography( PET)-CT showed accumulation of 18F-fluoro-2-deoxy-D-glucose( FDG) in the same area. The lung cancer in the right upper lobe was considered to be cT1cN0M0 stage ⅠA3, and surgery (thoracoscopic right upper lobectomy ND2a-1) was performed for diagnostic and therapeutic purposes. The histopathological diagnosis was high-grade fetal adenocarcinoma of the lung with metastasis to the #12 lymph node, pT1cN1M0 stage ⅡB. Currently, 3.5 years postoperatively, the patient has shown no apparent metastasis or recurrence. In future, the epidemiology and treatment methods of high-grade fetal adenocarcinoma of the lung should be established by accumulating more cases.

Present case is a 74-year-old man, given a diagnosis of huge mediastinal dedifferentiated liposarcoma. Surgical complete resection of the tumor and involved anterior chest wall( all body of sternum and bilateral 3rd~5th rib) followed by reconstruction of the defected chest wall using three artificial prosthetic materials of putting titanium mesh plate between ePTFE mesh seat at inner (mediastinal) site and polypropylene mesh seat at outer site was perfomed. The patient is doing well without respirately failure and disease free even 6 years after surgery. This surgical procedure could be thought of effective treatment method in sense of preventing postoperative complication and preserving respiratory function.

The patient was an 86-year-old woman. She was brought to the emergency department because of chest pain and respiratory distress symptoms that did not improve. 12-lead electrocardiogram, echocardiography, and blood tests were negative for acute coronary syndrome, but a chest contrast computed tomography( CT) -scan showed pericardial effusion and a coronary artery aneurysm 20 mm in diameter, and punctured pericardial effusion revealed bloody fluid. A cardiac catheterization was performed. He underwent emergent surgery after being diagnosed as having a ruptured coronary aneurysm associated with a coronary pulmonary artery fistula. The aneurysm was dissected using cardiopulmonary bypass, and the coronary artery-pulmonary artery fistula was closed. The patient had a good postoperative course and was discharged in good condition. There have been few reports of rupture when the aneurysm diameter is less than 30 mm. Regardless of the size of the aneurysm, it has a risk of rupture and it is important to consider surgery.

Case 1 is a 65-year-old woman with right ventricular outflow tract stenosis due to dyspnea on exertion. Preoperative echocardiography revealed no shunt between the right and left ventricles. After resecting the right ventricular muscle bundle and weaning from cardiopulmonary bypass, transesophageal echocardiography confirmed a shunt between both ventricles. Right ventriculotomy under second cardiopulmonary bypass revealed a ventricular septal defect (VSD) that was closed with an expanded polytetrafluoroethylene patch. Case 2 is a 58-year-old woman with a double-chambered right ventricle due to dyspnea on exertion. Preoperative echocardiography revealed a perimembranous VSD that coexisted;however, the VSD was completely covered by a membranous septal aneurysm, and no shunt appeared between both ventricles perioperatively. If right ventricular outflow tract stenosis/double-chambered right ventricle has been diagnosed in adulthood, the echocardiographic findings could have differed preoperatively and postoperatively. Combined use with other imaging modalities should improve the diagnostic accuracy of congenital heart disease.

A 54-year-old man with a history of atopic dermatitis was admitted to our hospital for persistent fever and multiple arthralgias unresponsive to antibiotics. On the second day of hospitalization, Staphylococcus aureus was detected in the blood culture, and debridement for presumed pyogenic arthritis was performed on the patient's bilateral wrists and right ankle joints. Echocardiography showed evidence of infective endocarditis of the aortic valve. The patient's fever persisted after drainage of multiple joint abscesses, and blood cultures remained positive. A right sternoclavicular joint abscess that had been noted on computed tomography (CT) at the time of admission had not decreased in size on repeat CT performed 10 days post-admission. After additional drainage of the sternoclavicular joint abscess on the 15th day, the patient's fever subsided, and blood culture was negative. On the 29th day, an aortic valve replacement was performed via a right anterior thoracotomy to prevent sternal osteomyelitis. The postoperative course was uneventful, and the patient was discharged on the 35th day after valve surgery. One year after the surgery, he continues to take antibiotics, and recurrence of infection has not been observed.

A 41-year-old asymptomatic male with no significant medical history had a heterogenous cystic tumor with a diameter of 5.1 cm containing fatty density in the anterior mediastinum and a nearby homogeneous enhancing nodule with a diameter of 2.0 cm were observed on chest computed tomography( CT). A malignant teratoma with mediastinal lymph node metastasis was suspected preoperatively. The tumor was completely removed via median sternotomy, with concomitant resection of the lung, pericardium, and right phrenic nerve. Postoperative pathological examination revealed a large mature cystic teratoma, 6.0 cm in diameter, and a small nodule, 3.7 cm in diameter, diagnosed as stageⅠ, type B2 thymoma. The postoperative course was uneventful, with no recurrence 30 months later. The simultaneous occurrence of mature teratoma and stageⅠthymoma is extremely rare. When suspecting a teratoma with small satellite nodules preoperatively, consideration of concurrent small thymoma is suggested.

Blunt thoracic aortic injury (BTAI) is associated with high morbidity and mortality. Recently, minimally invasive thoracic endovascular aortic repair (TEVAR) has been reported to be a safe surgical treatment for acute BTAI. Here, we report the success of TEVAR using the concomitant chimney technique for BTAI. A 70-year-old man in shock was referred to our emergency room following a traffic accident. Computed tomography( CT) scan demonstrated multiple rib fractures, hemothorax, and BTAI. According to the severity of BTAI as classified by the Society for Vascular Surgery( SVS) guidelines, the patient was diagnosed with grade 4 free rupture. We performed TEVAR twice because of the endoleak; however, this method saved the patient's life. The use of the chimney technique to preserve the patency of the left subclavian artery is beneficial because the majority of BTAI cases occur in the aortic isthmus from a pathophysiological perspective.

Objectives: This study aimed to investigate incidence and risk factors for permanent pacemaker implantation for sick sinus syndrome( SSS) after maze procedure.

Methods: Medical records of 59 patients who underwent maze procedure for atrial fibrillation at our hospital from 2018 to 2022 were retrospectively reviewed.

Results: Mean age was 70 years and 32 patients (54%) were male. Major cardiac procedure was mitral valve surgery in 43( 72%). Radiofrequency ablation device was used in 35( 59%) and cryoablation was used in 24 (41%). Nineteen patients (32%) required temporary pacing after surgery;7 for type Ⅰ or Ⅱ SSS, 9 for type Ⅲ SSS and 3 for bradycardiac atrial fibrillation. Of these, all the 7 patients with type Ⅰ or Ⅱ SSS regained sinus rhythm, whereas 2 with type Ⅲ SSS underwent permanent pacemaker implantation. Overall, permanent pacemaker was implanted in 3( 5%). Forty-six patients( 78%) were in sinus rhythm at the outpatient clinic after surgery.

Conclusions: Type Ⅰ or Ⅱ SSS after maze procedure is likely to resume sinus rhythm at the time of discharge whereas type Ⅲ is not. For type Ⅲ SSS after maze procedure, adequate anti-arrhythmic medication early after surgery may be required to avoid permanent pacemaker implantation.

Eight patients underwent coronary artery bypass grafting( CABG) by left thoracotomy approach to the left coronary artery territory after CABG. The left subclavian artery was selected as an inflow anastomosis site, and the greater saphenous vein was used as a graft. The average operative time was 187 minutes, and the hospital stay was 12.2 days. Off-pump CABG was complete in all patients. There were no cases of mortality during hospitalization, and grafts were patent in the confirmed cases. We believe that the left thoracotomy approach avoids problems such as injury of the patent graft due to redo sternotomy, and reduces the mortality and complication rate.