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

Ventricular septal defect (VSD) is one of the most common congenital heart diseases, but untreated cases reaching advanced age are rare. We report a case of an 85-year-old woman with an untreated VSD who presented with dyspnea. Despite the relatively large defect (12×16 mm), she had no prior history of heart failure. Echocardiography and catheterization revealed a left-to-right shunt with mild pulmonary hypertension. Surgical closure was performed using a Dacron patch, and the patient had a favorable postoperative course. The absence of early heart failure was likely due to a hypertrophied trabecular muscle partially covering the defect, limiting the left-to-right shunt. However, as right ventricular hypertrophy progressed, the defect widened, leading to acute heart failure. This case highlights the potential for long-term survival in patients with specific anatomical modifications and underscores the importance of individualized surgical decision-making in elderly VSD patients.

A 69-year-old man was referred to our hospital due to an abnormal chest shadow on computed tomography (CT) scan. He underwent thoracoscopic left upper lobectomy followed by mediastinal lymph node dissection under the frozen-section diagnosis of lung cancer. During the left upper mediastinal lymph-node dissection, grasping fat tissue including cardiac branches of the vagus nerve led to cardiac arrest. It is known that left-side upper mediastinal lymph-node dissection can potentially trigger cardiac arrest. Therefore, it is crucial to proceed surgery with caution and to alert anesthesiologists to pay an attention to the risk of cardiac arrest.

We report a case of acute type A aortic dissection (ATAAD) with an isolated left vertebral artery (ILVA), and our successful surgical treatment with a fenestrated frozen elephant trunk (FET). A 56-year-old man was referred to our department for chest and back pain. Contrast enhanced computed tomography (CT) revealed ATAAD. The left vertebral artery branched directly from the aorta. We performed total arch replacement with fenestrated FET to preserve the ILVA and left subclavian artery( LSCA) blood flow. During surgery, the aorta was transected at zone 2, and FET was deployed into the distal aorta, then we manually created a hole on the ILVA and LSCA side in the stented portion. After surgery, angiography confirmed antegrade flow in the ILVA and LSCA. Although care must be taken with the location of the intimal tear, we advocate this technique for treating ATAAD with ILVA in suitable cases.

Coronary artery anomalies (CCAs) are a group of congenital conditions characterized by abnormal origin or course. Coronary artery bypass graft( CABG) surgery in this single coronary artery( SCA) is rarely reported. In this case, A 41-year-old male patient presented with exertional dyspnea and productive cough. The echocardiogram showed a moderately dilated left ventricular (LV) with mild LV systolic impairment and coronary angiography (CAG) revealed the left main coronary artery arises from the right coronary ostium with the right coronary artery. In addition, occlusion in right coronary mid-portion and distal circumflex and moderate to severe stenosis in proximal left anterior descending artery was identified. Considering the significant atherosclerosis and the subpulmonic course of this SCA, CABG with sequential anastomosis of saphenous vein was performed. Postoperatively, he made good progress and was discharged day 6 after surgery without any complication.

A 30-year-old male patient who reported a medical history of bronchial asthma and diabetes mellitus presented with bilateral leg pain and weakness during exercise. He experienced leg numbness for the previous six months. Imaging detected a thromboembolic occlusion in the abdominal aorta, along with a left atrial mass. He underwent an emergency embolectomy with a Fogarty balloon catheter;however, persistent embolism at the aortic bifurcation required surgical embolus removal. The embolus consisted of both fresh thrombus and mucous-like tumor tissue, which was determined as a myxoma. Further left atrial mass assessment indicated a myxoma. After successful revascularization and left atrial mass removal, the patient recovered without complications, and he was discharged home 24 days after rehabilitation.

An 82-year-old man was admitted to our hospital with chest pain as a chief complaint and diagnosed with a ruptured aortic aneurysm in the distal arch by contrast-enhanced computed tomography (CT). The patient underwent surgery using artificial heart-lung and selective cerebral extracorporeal circulation, and a semi-circumferential aortic arch incision was made around the anterior surface of the aortic arch. An open stent graft was inserted through the incision, trimmed to fit the size, and the aortic wall and the stent graft were fixed with 3-0 proline continuous sutures, and finally the incision was closed with 3-0 proline. This method was useful because it may shorten the operation time and decrease the amount of blood loss compared to the common aortic arch replacement with frozen elephant trunk.

Thymic lymphoepithelial carcinoma (LEC) is a rare subtype of thymic cancer and reported in 6% of thymic carcinoma. In terms of histopathology, it closely mimics undifferentiated tumors that originate in the nasopharynx, and in half of the cases, it has been associated to the Epstein-Barr (EB) virus infection. Seven reports have been published on the result of surgical resection, particularly in the early stages of thymic LEC. Recurrence was reported in three patients, and one patient died. In our case, the patient underwent video-assisted thoracoscopic surgery for a partial thymectomy and thymomectomy and was alive without recurrence 92 months after the surgery without adjuvant therapy.

A 74-year-old man was implanted with a permanent pacemaker for sick sinus syndrome ten years earlier and permanent atrial fibrillation( AF). Echocardiography indicated progressive severe tricuspid regurgitation (TR) and right ventricular systolic dysfunction with tricuspid annular dilatation and tricuspid valve tethering. The pacemaker lead passing through the tricuspid valve may have contributed to TR, therefore we decided to perform tricuspid valve surgery, pacemaker lead removal, and leadless pacemaker implantation simultaneously during open heart surgery. Tricuspid annuloplasty was performed with the spiral suspension technique. The leadless pacemaker was anchored to the apical septum of the right ventricle through the tricuspid valve with endoscopic guidance, and left atrial appendage closure was performed for permanent AF. The patient was discharged on postoperative day 18 without major complications. He has been doing well with mild TR on transthoracic echocardiography as of three years post-operation.

Aortic pseudoaneurysm is a rare complication of advanced esophageal cancer. While emergency open aortic surgery is associated with high operative mortality, massive bleeding without treatment is fatal. On the other hand, thoracic endovascular aortic repair (TEVAR) for pseudoaneurysm is far less invasive. We experienced two cases of aortic pseudoaneurysm successfully treated by TEVAR. Case 1:68-year-old male. During preoperative adjuvant chemotherapy for advanced esophageal cancer, he was diagnosed with esophageal non-aortic fistula by computed tomography (CT). Case 2:80-year-old woman. She complained dysphagia, and CT revealed an aortic pseudoaneurysm associated with mediastinal perforation of advanced esophageal cancer and direct invasion to the descending aorta. Considering their general condition, they underwent minimally invasive TEVAR. Clinical condition dramatically improved and they become able to eat well, and they were transferred to the hospice until they died of cachexia due to progression of esophageal cancer.

We report two cases of intraoperative transcatheter embolization for pulmonary artery injury caused by a pulmonary artery catheter( PAC). The 1st case who had severe mitral regurgitation and tricuspid regurgitation with giant left and right atrium underwent mitral and tricuspid annuloplasty. The 2nd case woman underwent aortic valve replacement and coronary artery bypass grafting. Sudden massive hemoptysis occurred during weaning from cardiopulmonary bypass in both cases, and pulmonary artery injury due to PAC was diagnosed. Both cases underwent pulmonary arteriography via the main pulmonary artery trunk and transcatheter embolization, and successful hemostasis was obtained. During intraoperative endovascular treatment, an approach via the main pulmonary artery trunk is very useful for diagnosis and treatment.