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

We report a case of hemoptysis due to pulmonary artery pseudoaneurysms controlled by transcatheter arterial embolization (TAE) and surgery. An 83-year-old man presented with hemoptysis one month after treatment for pneumonia and referred to our hospital. Chest computed tomography( CT)revealed a lung abscess in the left lower lobe and two pulmonary artery pseudoaneurysms by the abscess. TAE was performed to control hemoptysis, and the hemoptysis improved. After his general condition improved, a left lower lobectomy was safely performed.

Cold agglutinins are a rare autoimmune hemolytic disorder in which immunogloburin( Ig) M antibodies bind to red blood cells at low temperatures, potentially causing hemagglutination and complement-mediated hemolysis during cardiac surgery under hypothermic cardiopulmonary bypass (CPB). We report a 73-year-old woman with severe aortic regurgitation and positive cold agglutinin (titer 1:512, critical temperature 30 ℃). To avoid intraoperative hemagglutination, normothermic CPB was performed with a minimum rectal temperature of 34.7 ℃. Warm blood cardioplegia( 34 ℃) with increased potassium concentration was used for myocardial protection. The postoperative course was uneventful without hemolytic or thrombotic complications. This case demonstrates that normothermic CPB with warm cardioplegia can be safely applied in patients with cold agglutinin positivity when the critical temperature is above the target intraoperative temperature.

A 66-year-old woman with lung cancer and an anomalous branching of the right posterior segmental vein( V2) underwent robot-assisted right upper lobectomy. Preoperative computed tomography( CT)revealed that the V2 existed dorsal to the right main bronchus and drained directly into the left atrium. Intraoperatively, the V2 was identified and divided using a stapler. The right upper lobectomy and lymph node dissection were performed safely, and the V2 stump was covered with an anti-adhesive material. Anomalous V2 branching may pose significant risks, making detailed preoperative imaging evaluation essential. In robot-assisted surgery, the risk of vascular injury from grasping or traction is higher, necessitating careful technique. In addition, central ligation may prevent thrombus formation at the pulmonary vein stump.

Hypernatremia due to polyuria following cardiac surgery is rare. We report a case that required to identify the cause of massive polyuria. A 50-year-old male underwent aortic arch replacement for acute aortic dissection. Early postoperatively, he developed marked polyuria [over 3,000 ml within 6 hours after intensive care unit (ICU) admission, over 15,000 ml within 24 hours] and hypernatremia (peak value 187 mEq/l). We first assumed vasopressin deficiency due to cardiopulmonary bypass, and desmopressin nasal spray was somewhat effective. Continuous vasopressin infusion combined with massive 5 % glucose infusion started to reduce serum sodium value to 160 mEq/l. Neither a vasopressin challenge test on post operative day 16 nor a water restriction test on post operative day 48 demonstrated an increase in urine osmolality, leading to a diagnosis of nephrogenic diabetes insipidus. This case highlighted the complexity of fluid management when nephrogenic diabetes insipidus complicates postoperative course after surgery using cardiopulmonary bypass.

Concomitant left atrial( LA)-only surgical ablation( SAB) of atrial fibrillation( AF) with mitral valve procedure was performed in nine cases with radiofrequency ablation devices. LA-SAB includes connected bilateral pulmonary vein isolations, mitral isthmus ablation, and LA appendage ablation and occlusion at its base. There were no such adverse events as 30-day mortality, thromboembolic event, permanent pacemaker implantation, readmission due to heart failure, or cardiac death (follow-up:mean:10±5 years, range:0.75~15 years). Freedom from AF without classⅠ/Ⅲ antiarrhythmic drugs at six months was 77.8%(7 of 9 cases), and sinus rhythm (SR) has been maintained more than 10 years in 4 of those 7 cases. In one of two postoperative AF cases, SR recovery was confirmed four years after surgery, and AF has not been detected for three years. LA-SAB is considered to be safe, effective, and feasible, although further investigation and patient selection are needed.

Subepicardial ventricular aneurysm is a form of ventricular aneurysm that occurs concomitantly with acute myocardial infarction, characterized by a rupture limited to the myocardium while the epicardium remains intact. Herein, we report a case in which closure of the aneurysm was performed via left mini-thoracotomy minimally invasive cardiac surgery (MICS). The patient was a 75-year-old female with a history of ascending aortic replacement, who developed a subepicardial ventricular aneurysm in the apex during percutaneous coronary intervention( PCI) for the left anterior descending artery. Due to the risk of aortic injury at the anastomotic pseudoaneurysms of the ascending aorta, cautious observation was undertaken, and four months later, closure of the aneurysm under beating heart conditions was successfully performed via left mini-thoracotomy MICS. The postoperative course was uneventful.

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.

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.

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.