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

The infected brachiocephalic arterial aneurysm is a very rare but highly lethal, life-threatening, and difficult-to-treat condition. We report a case of infected brachiocephalic arterial aneurysm involving ascending aorta. An 81-year-old woman with a history of colon diverticulitis was referred to our hospital because of infected brachiocephalic aneurysm. Emergent operation was performed because the aneurysm grew rapidly. The aneurysm was excised, extra-anatomical grafting was performed with a prosthetic vascular graft and the ascending aorta was repaired with bovine pericardium patch. The aortic infection was successfully cured postoperatively, but she died of peritonitis. Due to the rarity, history-taking and physical examination should be thorough, and symptoms and signs should be closely analyzed.

A woman in her 40s was referred to our department with segmental emphysematous lesion in the right lower lobe, which were incidentally detected on computed tomography (CT) performed for another disease. She had experienced a brief episode of cough and right chest pain one year earlier, which resolved spontaneously. CT revealed interruption of the B10 bronchus, a dilated bronchus not communicating with the normal airway, fluid retention, and surrounding emphysematous lesion, suggesting bronchial atresia. Given the previous episode suggested an infection and the risk of recurrence, a robot-assisted basilar segmentectomy was performed for diagnostic and therapeutic purposes. Histopathological examination confirmed bronchial atresia with interruption of the B10 bronchus. A mild postoperative air leak occurred but resolved spontaneously, and the patient was discharged in good condition.

The patient was a woman in her 40s. She had a 13 mm pulmonary tumor in the left upper lobe that was identified on chest computed tomography( CT). Fluorodeoxyglucose-positron emission tomography (FDG-PET)/CT revealed no FDG uptake. Surgery was performed for diagnostic and therapeutic purposes. A portion of the tumor was submitted for frozen section diagnosis. No malignant findings were observed, so enucleation was performed. The postoperative pathological diagnosis was a benign perivascular epithelioid cell tumor( PEComa). Although most PEComas are benign, their biological malignancy remains unclear in some aspects;therefore, careful postoperative follow-up is considered necessary.

We report a surgical case of giant ascending aortic aneurysm presenting with dyspnea due to compression of the right thoracic cavity. A 58-year-old man was referred after computed tomography( CT)revealed a large intrathoracic lesion. Contrast-enhanced CT demonstrated a 14.8×18.5 cm dissecting aneurysm of the ascending aorta and arch with severe aortic regurgitation, superior vena cava obstruction, occlusion of the right pulmonary artery and vein, and extensive right lung atelectasis. Because both safe median sternotomy and conventional venous drainage were difficult, cardiopulmonary bypass was established through the femoral vessels before sternotomy, with additional adjustments for venous drainage and left ventricular venting. Bentall procedure and partial arch replacement were successfully performed. Postoperative recovery was prolonged, likely because of the long-standing compressive effects of the aneurysm. CT at 1 year still showed superior vena cava and right pulmonary venous obstruction, with persistent right lung collapse.

Background: Pure red cell aplasia( PRCA) is a rare hematologic disorder that can be associated with thymoma. Optimal management requires both tumor resection and immunosuppressive therapy, but the clinical course varies among patients.

Case presentation: A 76-year-old woman was referred to our hospital for evaluation of severe anemia and was diagnosed with thymoma accompanied by PRCA. After receiving a blood transfusion, she underwent robot-assisted thymothymectomy. Histopathological examination revealed a type AB thymoma [World Health Organization (WHO) classification] of Masaoka stageⅠ. Two weeks postoperatively, cyclosporine A (CyA) therapy was initiated. The patient has subsequently maintained a favorable clinical course without the need for additional blood transfusions for 15 months.

Conclusion: We report a rare case of thymoma-associated PRCA successfully managed with surgery followed by CyA administration. This case highlights the importance of combined surgical and immunosuppressive therapy for achieving long-term transfusion independence in patients with thymoma-associated PRCA.

A 79-year-old man was referred to our hospital because of an abnormal shadow observed on a chest radiograph. Computed tomography (CT) revealed a 7 cm mass in the right thoracic cavity. Additionally, T1-weighted, T2-weighted, and contrast-enhanced magnetic resonance images (MRI) exhibited a heterogenous mass in the same area. An extensive unenhanced area with a reticular septum was noted within the mass. An open axillary thoracotomy was performed. Postoperative pathological diagnosis was atypical thymic carcinoid. No clinically evident recurrence was observed at 19 months after treatment. Thymic carcinoid is highly malignant with a poor prognosis. Imaging findings are characterized by a heterogeneous tumor interior and the presence of reticular septum. Based on our experience with the current case, thymic carcinoid should be deliberated in the differential diagnosis, and an early resection should be considered.

In patients with severe ischemic mitral regurgitation, annuloplasty alone results in early recurrence due to deterioration in tethering. Therefore, additional procedures targeting the subvalvular tissue, such as approximation or suspension of papillary muscle, have been considered. Ischemic mitral regurgitation mainly results from tethering due to left ventricular enlargement, with varying severity among cases and difficult prediction of reverse remodeling. Residual mitral regurgitation affects prognosis, necessitating reliable regurgitation control during mitral repair procedure. In some cases, valve replacement with chordal preservation may be preferable. We performed mitral valve repair for severe ischemic mitral regurgitation due to leaflet tethering. The patient was a 75-year-old male who had an acute myocardial infarction 10 years prior, which led to the progression of ischemic cardiomyopathy. Anterior leaflet augmentation using an autologous pericardial patch, suspension of the papillary muscles, and implantation of an artificial ring were performed. Six years postoperatively, the mitral valve remains in good condition and left ventricular reverse remodeling is favorable, with no heart failure observed. This procedure is considered an effective surgical option for ischemic mitral regurgitation and is hereby reported.

We report a case of chylopericardium with cardiac tamponade after lung cancer surgery. A 47-yearold female underwent right lower lobectomy with mediastinal lymph node dissection and postoperative adjuvant therapy for lung cancer with mediastinal lymph node metastases. Three months postoperatively, chylothorax developed, and pleurodesis was performed. One month after receiving treatment for chylothorax, the patient returned to the hospital with complaints of chest tightness and dyspnea on exertion. The patient developed hypotension, and echocardiography revealed a massive pericardial effusion consistent with cardiac tamponade. A drainage tube was immediately inserted into the pericardial space, releasing a chylous effusion, which confirmed the diagnosis of chylopericardium. Because conservative treatment was unsuccessful, thoracic duct ligation was performed. This resolved the chylous pericardial effusion;however, a serous effusion subsequently accumulated in the pericardial cavity, leading to recurrent cardiac tamponade. An additional pericardial fenestration was then performed, after which the pericardial effusion resolved. Chylopericardium is a rare complication following intrathoracic surgery;however, the possibility of its occurrence should be considered.

We experienced a case of primary cardiac malignant lymphoma arising from the right atrium that achieved remission following complete surgical resection combined with chemotherapy. The patient was a 67-year-old man who presented with exertional dyspnea. Further examination revealed a primary cardiac tumor, and surgical excision was performed for diagnostic and therapeutic purposes. Histopathological examination established the diagnosis of diffuse large B-cell lymphoma. Metastatic lesions were identified at the adrenal gland and left pleura. Postoperatively, chemotherapy with Pola-R-CHP was initiated. Positron emission tomography-computed tomography (PET-CT) performed approximately six months after surgery demonstrated a complete metabolic response (CMR). At one year postoperatively, the patient remains in a good general condition and continues to maintain remission.

We report a case of transcatheter aortic valve-in-surgical aortic valve( TAV in SAV) implantation for structural valve deterioration of a small bioprosthetic valve. An 81-year-old woman presented with heart failure 19 years after aortic valve replacement using a 19-mm bioprosthetic valve. Imaging studies revealed severe prosthetic valve stenosis. Considering high surgical risk and anatomic feature of misalignment between the axis of ascending aorta and bioprosthetic valve, balloon-expandable transcatheter heart valve implantation was successfully performed via femoral approach without complications. Postoperative echocardiography showed improved hemodynamic condition and the patient became less symptomatic. During TAV in SAV for small bioprosthetic valve, valve selection should be individualized based on anatomical and clinical characteristics.