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

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.

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.

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.

The patient is a 69-year-old man with a 15-year history of rheumatoid arthritis. He has admitted to our hospital due to dyspnea, and his chest computed tomography (CT) scan revealed right pneumothorax. Chest CT scan four months before the onset of pneumothorax demonstrated subpleural nodule with cavity in the right lung. After chest drainage treatment, video-assisted thoracic surgery was performed. The pulmonary nodule of his right upper lobe was successfully excised. The histopathological examination showed the features of a rheumatoid nodule with bacterial infection. Pneumothorax secondary to rheumatoid nodule is a rare complication of rheumatoid arthritis.

Here, we report a case of catamenial pneumothorax that occurred during endometriosis treatment. A 46-year-old woman presented with a history of right pneumothorax. At 43 years of age, the patient was diagnosed with endometriosis and progesterone therapy was initiated. The patient developed rightsided chest pain and was diagnosed with right-sided pneumothorax. Video-assisted thoracoscopic surgery was performed, because of persistent air leakage. Intraoperative findings revealed a suspected pleural defect in the right upper lobe and multiple perforations around the central tendon of the right diaphragm. The pleural defect was resected, and the diaphragm surface was covered with a polyglycolic acid sheet. Pathologically, the diagnosis was associated with thoracic endometriotic pneumothorax, including immunostaining findings. Hormonal therapy was continued after discharge. The patient has remained free of recurrence for one year postoperatively.

Left ventricular( LV) tamponade is rare and can occur in special circumstances like regional pericardial effusion overlying LV. The therapeutic approach of LV tamponade is different according to the causative factor and the place of loculated pericardial effusion. We report a case of neoplastic cardiac tamponade manifesting as left ventricular diastolic dysfunction. A 78-year-old man with a history of aortic arch surgery and lung cancer surgery presented with dyspnea. Echocardiogram showed posterior loculated pericardial effusion and LV diastolic dysfunction. Pericardial window operation was performed, then revealed bloody effusion and cytodiagnosis examination revealed class V( adenocarcinoma). Atypical forms of cardiac tamponade with varied clinical presentations may be seen in patients after cardiac surgery. It is important to accurately understand the pathological condition through clinical progress and echocardiography, and to select an appropriate approach and surgical procedure.

The patient was a 54-year-old male. He underwent invasive seminoma resection, bypass grafting from the left subclavian vein to the right atrial appendage, and patch plasty of the superior vena cava( SVC) 18 years ago in 1990. In 1992, graft obstruction was demonstrated, and in 1994, subsequent downhill esophageal varices developed. Varices deteriorated to grade F3 with a red-colored sign in 2008. Therefore, bypass grafting from bilateral subclavian veins to the right atrial appendage was performed to prevent rupture. Endoscopy performed two weeks after surgery showed that the varices had improved to grade F1. The patient was discharged without adverse events. In 2023, the graft remained patent and the varices did not worsen. After SVC reconstruction, strict follow-up is necessary because fatal event in esophageal varices can occur owing to graft obstruction.