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

A 67-year-old female, diagnosed with atrial fibrillation over 35 years ago, presented with mild heart failure symptoms. However, due to mild mitral regurgitation, she had been managed conservatively at local hospital. Recently, she developed severe dyspnea and was referred to our institution for surgical intervention. Comprehensive evaluation revealed significant enlargement of both atria, leading to a restrictive ventilatory impairment. The surgical procedure included mitral annulus repair, tricuspid annulus repair, maze procedure, and extensive cylindrical resection of the left atrium, along with right atrial repair, all performed under cardiopulmonary bypass. Post-surgery, her atrial volume decreased from 830 ml to 275 ml, and her vital capacity improved from 1.28 l to 1.77 l. Following the procedure, she maintained sinus rhythm, with complete resolution of her dyspnea. These improvements have been sustained for three years postoperatively.

An 82-year-old man receiving anticoagulants was referred to our hospital with dyspnea and back pain. One day earlier, he bruised his back in his house. On arrival, the hemoglobin value was 5.6 g/dl, and computed tomography( CT) showed bilateral pleural effusion along with left lower rib fractures. In the left hemithorax, irregular high-density lesion which was surrounded by a low-density stripe was observed. He was initially diagnosed with left traumatic hemothorax, and managed through inpatient care with bed rest and blood transfusion. Although anemia was improved, bilateral compression atelectasis was observed compromising cardiopulmonary function. We therefore performed surgical treatment on the 14th hospital day. Under general anesthesia, a chest tube was inserted into the right thoracic cavity, removing 1,000 ml of serous pleural effusion. We subsequently performed a left-sided thoracotomy. After suctioning 400 ml of bloody pleural effusion, we found a pleural bulge in the posterior chest wall. Hematoma was accumulated in the extrapleural space. The parietal pleura was opened and the extrapleural hematoma was bluntly curetted and evacuated. The deviated rib fracture was repaired. Postoperative course was uneventful. He was discharged home after rehabilitation on postoperative day 54.

We report a rare case of a non-anastomotic pseudoaneurysm following ascending aortic replacement. A 73-year-old woman presented with anterior chest swelling after undergoing sternal wire removal due to suspected metal allergy. A pseudoaneurysm was identified on computed tomography (CT) at the site where the removed sternal wire had been in contact with the anterior surface of the vascular graft. Surgical repair with cardiopulmonary bypass identified a bleeding pinhole at the graft surface, successfully closed with a 4-0 monofilament mattress suture. This case suggests that prevention of such complications requires protective coverage of the graft with autologous tissue prior to chest closure, careful selection and handling of sternal wires, and thorough preoperative imaging evaluation before wire removal.

We report a case of synchronous double cancer involving the left lung and esophagus treated with a minimally invasive one-stage procedure combining thoracoscopic lobectomy and mediastinoscopic esophagectomy. Although a two-stage approach is often selected due to the technical complexity and invasiveness of simultaneous surgery, both tumors in this case were advanced, and a single-stage resection was considered the most appropriate option to avoid losing the opportunity for curative treatment. The postoperative course was complicated by anastomotic leakage, which was managed conservatively;however, early recurrence of esophageal cancer occurred, followed by multiple brain metastases from small cell lung carcinoma. These recurrences may have been related to limited mediastinal lymph node dissection, performed to preserve bronchial blood flow, and to the delayed initiation of adjuvant therapy due to treatment for esophageal recurrence. This case demonstrates not only the feasibility and advantage of a less invasive simultaneous approach but also emphasizes the need to optimize lymph node dissection strategies and the timing of postoperative therapy in complex synchronous malignancies.

A 76-year-old woman underwent percutaneous coronary intervention (PCI) to the right coronary artery for subacute myocardial infarction six months earlier. Subsequently, PCI was also performed for a residual lesion in the left anterior descending artery. On follow-up transthoracic echocardiography, performed six months later, a localized bulging of the inferior wall of the left ventricle was observed, which had markedly enlarged compared to the previous study, leading to the decision for surgical intervention. Intraoperatively, there were no significant adhesions between the aneurysm and the pericardium. A saccular aneurysm was identified in the inferior wall of the left ventricle. A thin layer of myocardial tissue was observed beneath the epicardium, suggesting the diagnosis of a pseudopseudoaneurysm. The aneurysm was incised, and patch closure was performed at the aneurysmal orifice. The postoperative course was uneventful. Left ventricular pseudo-pseudoaneurysm is an extremely rare entity. We report this case to highlight the effectiveness of surgical patch closure in the management of this condition.

A 49-year-old man was diagnosed with acute myocardial infarction and underwent percutaneous coronary intervention (PCI) for complete left anterior descending artery (LAD) occlusion. Two weeks later, transthoracic echocardiography revealed a mobile left ventricular thrombus. Due to its increasing size despite anticoagulation therapy, he was transferred to our department. Emergency surgery was performed using a totally endoscopic trans-atrial and trans-mitral approach through a right minimally invasive thoracotomy. The thrombus was completely removed under direct endoscopic visualization without the need for left ventricular incision. The postoperative course was uneventful, and no residual thrombus was observed. This minimally invasive approach is considered safe and effective for selected patients.

We present a 61-year-old man who developed worsening glycemic control and a massive evolving left ventricular( LV) thrombus following steroid therapy for immunoglobulin( Ig) G4-related ophthalmic disease. He had a history of old myocardial infarction. Brain magnetic resonance imaging( MRI) disclosed a subacute cerebral infarction. Based on a large, mobile thrombus and an embolic event, surgery was indicated. He underwent successful LV thrombus removal and coronary artery bypass grafting to the left anterior descending artery. His postoperative course was uneventful, and he was discharged on day 28. This case highlights that steroid therapy can exacerbate LV thrombosis, and surgical intervention can be an effective treatment to prevent further serious embolism in high-risk patients.

A 76-year-old man with angina pectoris underwent percutaneous coronary intervention (PCI) of the left anterior descending artery. While attempting to withdraw the balloon catheter, it fractured and became irretrievable, and he was transferred to our hospital. The ascending aorta was incised under cardiopulmonary bypass to remove the retained catheter, which was entangled with a coronary stent, requiring partial excision of the stent to achieve removal. Intraoperative coronary angiography revealed intimal injury of the left coronary artery. Due to the high risk of subsequent dissection and occlusion, coronary artery bypass grafting (CABG) was performed. The postoperative course was uneventful, and the patient was discharged. This case illustrates a rare complication of PCI in which catheter retention with stent entanglement necessitated surgical removal and concomitant CABG. Prompt surgical intervention is necessary in such cases to prevent life-threatening complications.

We report a case of a young male patient diagnosed with Marfan syndrome who presented with lower limb ischemia due to Stanford type B aortic dissection. Initial imaging revealed significant dilation of the aortic root and occlusion of the right iliac artery. Surgical treatment was performed in three stages:revascularization of the lower limbs, valve-sparing aortic root and total arch replacement, and finally thoracoabdominal aortic replacement. This stepwise approach prioritized organ perfusion and allowed for safe and effective repair of the extensive aortic pathology. The postoperative course was uneventful, and the patient remains in good condition. This case highlights the importance of staged surgical strategy in complex aortic disease associated with Marfan syndrome.

A man in his 60s presented with an abnormal shadow on chest radiography. Computed tomography (CT) showed a tumor, measuring 6.1 cm, in the right upper lobe and an anomalous bronchus arising from the trachea. Following transbronchial biopsy and examinations, the patient was diagnosed with stageⅡB lung adenocarcinoma. The patient underwent a multiport thoracoscopic right upper lobectomy and lymph node dissection. Preoperatively, the information of the tracheal bronchus was shared in the surgical team. During the procedure, the tracheal bronchus was detected behind the azygos arch. The azygos arch and tracheal bronchus were dissected by a stapler. The tracheal bronchus stump was covered by a pedicled pericardial fat pad. No complications were observed perioperatively. Information of anomalies should be shared in the surgical team, including anesthesiologists preoperatively.