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

Leadless pacemaker (LP) is reported to have serious complications including cardiac tamponade and ventricular perforation during and after implantation. We report a case of severe tricuspid regurgitation (TR) caused by papillary muscle rupture and hypoxia during LP re-implantation, which required surgical intervention. The patient was an 88-year-old man who had undergone LP implantation for complete atrioventricular block 2 years before. Due to the battery depletion, the additional LP was implanted. After the procedure, he developed persistent hypoxemia despite 9 l oxygen administration. He was hemodynamically stable. On the second postoperative day, a transthoracic echocardiogram revealed papillary muscle rupture of the tricuspid valve. A bubble test was performed, which revealed a right-toleft shunt through the patent foramen ovale (PFO). Tricuspid valve replacement and PFO closure were performed. The patient had a good postoperative course and was moved to cardiology department on postoperative day 14. We report this case with a review of the literature.

A lung hernia is a rare condition in which the lung parenchyma protrudes beyond its normal thoracic cavity boundaries. Traditionally, lung hernias have been associated with chest trauma or congenital weakness of the chest wall. However, in recent years, there have been increasing reports of lung hernias developing at small surgical wound sites, such as those created by minimally invasive cardiac surgery or thoracoscopic procedures. Here, we present a case of a lung hernia that occurred at the port site following a thoracoscopic partial lung resection. The hernia was successfully repaired using a thoracoscopic approach with prosthetic reinforcement. We also discuss relevant literature on the etiology, diagnosis, and treatment of port-site lung hernias, highlighting the importance of careful surgical technique and appropriate wound closure to prevent this rare but significant complication.

A 71-year-old man underwent S8 segmentectomy for mixed hepatocellular carcinoma. The disease recurred three months postoperatively, prompting a right lobectomy of the remaining liver. Prior to the liver recurrence, three nodules were identified in the anterior mediastinum. At the patient's request, dendritic cell vaccine therapy was administered following the recurrence. Two of the nodules decreased in size, while one nodule increased. Consequently, the patient was referred to our department for further evaluation. Differentiating between thymic carcinoma and mediastinal metastasis of hepatocellular carcinoma was challenging, leading to the decision to perform resection under the assumption of thymic carcinoma. A bilateral simultaneous thoracoscopic total thymectomy was conducted. Pathological examination revealed a poorly differentiated carcinoma with sarcomatoid morphology. Histologically similar lesions were observed in the preexisting liver tumor and lymph nodes, indicating metastasis from the mixed liver cancer. As of four and three months post-surgery, no recurrence has been noted. The patient will continue to receive immunotherapy and will be monitored closely. This case represents an extremely rare instance of mediastinal metastasis from mixed hepatocellular carcinoma. The prognosis for mediastinal metastasis of liver cancer is generally poor, underscoring the importance of vigilant follow-up.

A 39-year-old man presented with sudden onset of chest pain. The initial computed tomography angiography (CTA) showed a small amount of pericardial effusion and a soft tissue density localized in the aortic root, but no intimal flap was identified in the aorta. Aortic dissection was suspected, and the patient was hospitalized at the intensive care unit for close monitoring. On the day of admission, repeated non-contrast computed tomography (CT) showed no significant changes in the aorta or pericardial effusion. Electrocardiography-gated, thin-slice contrast-enhanced CTA revealed an intimal flap localized at the sinotubular junction. Intraoperative transesophageal echocardiography showed a flap at the sinotubular junction. An ascending aorta was successfully replaced using a vascular graft. An aortic wall submitted to the pathology showed no evidence of connective tissue disorders. The postoperative course was uneventful.

An 87-years-old woman with a history of right mastectomy for breast cancer, currently undergoing chemotherapy for multiple metastasis via a central venous catheter placed in the left subclavian vein, presented with bradycardia and dyspnea. Electrocardiogram revealed a 2:1 atrioventricular block. Implantation of a leadless pacemaker (LLPM) was planned for the patient. During implantation, right ventricular rupture occurred. Percutaneous cardiopulmonary support was initiated immediately. Subsequently, emergency surgery was performed. LLPM is considered a useful and safe device;however, serious complication, such as cardiac injury, have been reported in a small number of cases. Thorough risk assessment and preparation for complication, including cardiac surgery, may be life-saving.

Left main coronary artery (LMCA) malperfusion due to acute aortic dissection (AAD) is relatively rare but life-threatening. Almost all such patients suffer from cardiogenic shock, and cardiopulmonary arrest occurs in approximately half of them. A 64-year-old man with chest pain was taken to our hospital by ambulance. Acute coronary syndrome was suspected as electrocardiography showed changes in ST segment. Coronary angiography revealed severely stenotic LMCA. Percutaneous cardiopulmonary support was initiated for subsequent cardiogenic shock. Dissection in the LMCA on intravascular ultrasonography suggested that AAD occurred and dissection extended into the LMCA. Percutaneous coronary intervention (PCI) to the LMCA was performed with a drug-eluting stent. Post-PCI contrast-enhanced computed tomography (CT) scan demonstrated Stanford type A AAD. Subsequently, ascending-aortic replacement was successfully carried out. Postoperative echocardiography showed well preserved cardiac contraction. Primary PCI under percutaneous cardiopulmonary support for AAD and LMCA malperfusion shortens myocardial ischemic time and improves prognosis.

A 60-year-old man was admitted to our hospital with chest and back pain. Electrocardiogram, echocardiography, and contrast-enhanced computed tomography (CT) confirmed a Stanford type A acute aortic dissection with right ventriclar infarction and left ventricular inferior wall asynergy due to right coronary artery malperfusion. The patient presented with shock vital signs. So, immediately percutaneous coronary intervention (PCI) was performed to obtain the right coronary revascularization, after which total arch replacement and frozen elefant trunk was performed. Postoperatively, the patient remained stable without right heart failure. In patients with right ventricular infarction, preoperative PCI prior to surgery may be a useful option.

A 59-year-old woman consulted our hospital because of an abnormal shadow on chest X-ray. A chest computed tomography (CT) revealed a tumor on the diaphragm. A diagnosis of lung tumor was suspected and she underwent video-assisted thoracoscopic surgery. The intraoperative findings revealed a tumor through the defect hole in the right diaphragm. Histological examination revealed fibrotic tissue. The final diagnosis was a diaphragmatic hernia. For lung tumors on the diaphragm, diaphragmatic hernia should also be considered in the differential diagnosis.

Objectives: In Japan, surgical repair for Stanford type A acute aortic dissection(AAAD)has been increasingly performed, accompanied by gradual improvement in early outcomes, While ascending or hemiarch replacement remains the mainstream strategy, late aneurysmal dilatation of the residual dissected aorta is still a concern, The frozen elephant trunk(FET)technique, which facilitates aortic remodeling, has been increasingly adopted in AAAD surgery, Since the introduction of a domestic integrated four-branched FET device in late 2022, expectations have risen for improved procedural safety and simplicity, We report our early institutional outcomes of total arch replacement(TAR)using the integrated four-branched FET, Methods:Among 211 AAAD cases treated between December 2022 and April 2025, 110 underwent TAR with FET, of which the first 50 consecutive cases using the integrated four-branched FET[FROZENIX 4 Branched(FZX4B)]were retrospectively analyzed, The primary endpoint was early postoperative outcome, including mortality and spinal cord ischemia(SCI), Secondary endpoints included midterm survival, freedom from aortic events, and morphologic changes in the descending aorta, Results:The median age was 65 years[interquartile range(IQR):56~74], and 29 patients(58%)were male, The median operative time was 372 minutes(IQR:315~506), and the hypothermic circulatory arrest time was 42 minutes(IQR:38~50), The distal anastomosis was performed in zone 3 in 84% of cases, The FZX4B diameter most used was 25 mm(60%), In-hospital mortality was 4%, SCI occurred in one patient(2%), Two patients(4%)required additional thoracic endovascular aortic repair(TEVAR)for FET stenosis, The median follow-up was 248 days(IQR:165~472), Overall survival was 93% at 1 year and 86% at 2 years, and freedom from aortic events was 87% and 81% at 1 and 2 years, respectively, The FET distal level was mainly at Th6(62%), The aortic diameter at the distal edge of the FET decreased from 30 mm(IQR:28~33)preoperatively to 27 mm(25~31)at 1 year(p<0.001), The FET tip diameter correlated with the preoperative outer diameter at the anastomotic site(r=0.66, p<0.001), Conclusions:Although FET-related stenosis should be recognized as a potential procedural risk, TAR using the integrated FET for AAAD achieved acceptable early outcomes, A larger comparative study with conventional repair is warranted to elucidate its statistical impact.

Objective: This single-center retrospective study evaluated postoperative outcomes in Stanford type A acute aortic dissection(AAAD)patients presenting with preoperative cardiopulmonary arrest(CPA)between January 2021 and May 2025, Methods:Among 390 consecutive AAAD cases undergoing emergency surgery, 18(4.6%)presented with CPA, We assessed 30-day mortality, return of spontaneous circulation(ROSC), and use of preoperative veno-arterial extracorporeal membrane oxygenation(VA-ECMO), Results:The 30-day mortality was 72.2%, ROSC occurred in 4 cases(22.2%), and ROSC-positive patients had significantly lower mortality(p=0.022), Preoperative VA-ECMO was used in 7 cases(38.9%), none of whom survived(p=0.013), Conclusions:AAAD with preoperative CPA carries extremely high mortality, but patients achieving ROSC may benefit from urgent surgical intervention, VA-ECMO appears to confer no survival advantage, Early survivors often achieve favorable long-term outcomes, in line with prior literature.