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

A 78-year-old man underwent thoracoscopic right upper lobectomy for lung adenocarcinoma in the right upper lobe. During surgery, a leak test did not reveal any air leakage, but after extubation, the patient coughed and air leaks appeared. After observation, the air leakage did not improve and subcutaneous emphysema was significant, so reoperation was performed the next day. During the reoperation, a bulla not seen the previous time was found in S6, and a hole was formed in the bulla, through which air leaked. The lesion was partially resected, and the absence of air leakage was confirmed, and the operation was completed. Thereafter he had air leaks again and underwent pleurodesis twice. The chest drain was removed on the 12th day after the second operation, and the patient was discharged on the 22nd day.

Right atrial thrombus with pulmonary thromboembolism is a fatal condition. A 70-year-old woman was transferred to our hospital after echocardiography revealed a large mass in the right atrium. The patient's vital signs were stable, but blood tests indicated disseminated intravascular coagulation( DIC). Contrast-enhanced computed tomography (CT) revealed thrombi in the bilateral pulmonary arteries, inferior vena cava, and right common iliac vein. A contrast defect in the right atrium was also observed, suggesting a thrombus. Transthoracic echocardiography revealed a 16-×39-mm floating mass in the right atrium. The patient was diagnosed with a giant floating thrombus in the right atrium complicated by pulmonary embolism and underwent emergency surgery to remove the thrombus. Postoperatively, anticoagulant therapy was administered for the pulmonary thromboembolism. The patient's recovery was uneventful, with no complications. Surgical resection was deemed the optimal treatment because of the high risk of secondary embolism and the patient's DIC status.

Perforation of a pacemaker lead is a serious life-threatening complication. Most cases involve the heart alone and rarely involve adjacent organs. The day after the pacemaker was implanted, the patient suddenly became hypotensive and went into shock, and a computed tomography (CT) scan showed an anterior mediastinal hematoma due to bleeding from the left internal thoracic artery. We report a case in which emergency surgery was performed to save the patient's life after assuming that the hemorrhage was caused by a lead leading hemorrhage.

Congenital anomalies of the inferior vena cava have been reported more frequently with the development of computed tomography (CT). Here, we report a case of a 70-year-old woman who was diagnosed with heterotaxy syndrome and was suitable for mitral valvuloplasty. The diagnosis was made based on the preoperative contrast-enhanced CT findings of the left inferior vena cava with hemiazygos continuation into the coronary sinus and absence of the hepatic segment of the right inferior vena cava. The patient successfully underwent mitral valvuloplasty under cardiac arrest and cardiopulmonary bypass with drainage from the right superior vena cava and left femoral vein. The patient had an uneventful postoperative course and was discharged on postoperative day 13. In conclusion, the accurate preoperative diagnosis of cardiac and vascular anatomy is essential for developing effective surgical strategies in cardiac procedures, especially when a cardiopulmonary bypass is required.

We experienced a case of idiopathic esophageal rupture, which can easily become severe. The patient was a 63-year-old man. At the initial visit, he was diagnosed with pneumothorax, but computed tomography(CT) showed mediastinal emphysema and esophagography showed perforation, which led to the diagnosis of the above disease. Surgery was performed more than 24 hours after the initial diagnosis. The perforation was closed with sutures and covered with mediastinal pleura. An enterostomy was added at the same time. Postoperatively, pneumonia and pleural effusion were observed, but the patient was discharged from the hospital without serious complications due to systemic management including measures against sepsis and respiratory complications and nutritional management. In the postoperative management of this disease, it is important to pay attention to systemic management such as nutritional management as well as countermeasures against infection and respiratory complications.

Background: In April 2024, we aimed to reform the physicians' working style in our hospital, which is a core regional hospital where only two full-time thoracic surgeons work. We report three efforts to enhance productivity despite of limited number of staff in the department of thoracic surgery. Efforts:1)A new on-call system for thoracic surgery was introduced in April, 2024. To reduce the burden of on-call, we designated certain days when the on-call service is unavailable, where as the minimum level of medical care is ensured by transporting patients to other hospitals on those days. 2)The postoperative critical pathway and task shifting are promoted in collaboration with nurses. Task shifting is implemented by enhancing co-medical education to reduce work and establish a safe system for early discharge. 3)A critical pathway for the outpatient follow-up system is being promoted. We built up an outpatient follow-up system with collaborating medical clinics and hospitals. The application rate of the system was 73.1%, indicating that reduces the burden of outpatient work and promotes functional differentiation.

Conclusion: Establishing a sustainable medical system in collaboration with other departments, local medical institutions and residents is crucial in enhancing productivity with limited staff in the thoracic surgery department.

During surgery for acute aortic dissection, reinforcing anastomoses in the aorta with felt strips is helpful for hemostasis. We had two cases of hemolytic anemia that developed due to inversion of an inner felt strip that was applied at the proximal anastomosis in the ascending aorta. A 78-year-old woman underwent ascending aorta replacement for type A aortic dissection, and over the next 2.5 years, she gradually developed hemolytic anemia and underwent reoperation. A 47-year-old woman also had to undergo reoperation due to hemolytic anemia 17 days after ascending aorta replacement for type A aortic dissection. Based on these experiences, we make suture line in the felt much more proximal, and no further cases of hemolytic anemia have occurred since then.

A 63-year-old female patient was emergently admitted to our hospital with complaints of dyspnea and leg edema. She had a history of abdominal total hysterectomy and bilateral salpingo-oophorectomy for uterine leiomyoma 11 years ago. Computed tomography (CT) and echocardiography revealed a local recurrent tumor on the right side of the inferior vena cava in the retroperitoneal cavity, which extended to the right ovarian vein, inferior vena cava, and right atrium/ventricle. The patient suffered shock due to the tumor lodging in the tricuspid valve, so we performed an emergency intracardiac tumor resection under cardiopulmonary bypass, and two months later, we removed the locally recurrent tumor and the intravascular tumor below the diaphragm. The tumor in the inferior vena cava was removed entirely under hypothermic circulatory arrest. In cases such as this one, which is associated with hemodynamic instability before surgery, it is desirable to aim for a complete resection with a two-stage surgery.

Mediastinal teratomas are germ cell tumors that account for 15% of all adult anterior mediastinal tumors. Giant anterior mediastinal tumors sometimes require a median sternotomy and an additional approach or a clamshell approach. We present a case of a large mature teratoma occupying the left thoracic cavity that was treated by a thoracoscopic surgery with a lateral mini-thoracotomy. Preoperatively, we marked the lateral thoracic area near the largest cyst. In the right lateral recumbent position, a 4-cm incision was made in the left 6th intercostal space. Several large cysts were drained as much as possible. In the supine position, three 5-mm ports were placed in the 2nd, 5th, and 6th intercostal spaces. The left lobe of the thymus and the tumor were resected en block. Pathologically, the tumor was a mature teratoma. The patient had a good postoperative course and was discharged on the 8th postoperative day.

A detailed report how to dissect an internal thoracic artery (ITA) from severe adhesion of thoracic bone tissue is not seen. We herein report the "bony pedicled method" as a novel technique for harvesting ITA graft in difficult case, such as severe adhesion to the costosternal portion. Case 1 was a 70-yearold man who had three-vessel-disease (3VD). Case 2 was a 69-year-old man who had unstable angina pectoris( UAP) due to severe 3VD. Case 3 was a 68-year-old man who had UAP due to left main trunk and double-vessel-disease. We planned coronary artery bypass grafting (CABG) using a left internal thoracic artery( LITA) grafts in these 3 cases. In their operative findings, LITAs had severe adhesion to the costosternal portions, so we dissected these portions using the "bony pedicled method" to avoid injury to the LITA grafts. We harvested the LITA grafts without any complications and performed their CABG as preoperative planning. Their postoperative courses were uneventful. All bypasses, including the LITA-left anterior descending artery( LAD) bypass in the 3 cases were patent on postop912 Vol.78 No.11(2025-10) erative three dimensional computed tomography( 3D-CT). The "bony pedicled method" is an appropriate method for harvesting ITA graft without injury in case which graft harvesting is difficult due to adhesion to the costosternal portion.