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

Cardiac hemangioma is a rare benign tumor, and the cavernous type accounts for 50~60% of all cardiac hemangiomas. Although most cases are asymptomatic, the risk of serious complications, such as embolism, arrhythmia, tumor rupture, coronary artery obstruction, or sudden death, is high, and surgical resection should be considered. In a 60-year-old woman, follow-up imaging studies after a left breast cancer operation incidentally revealed a cardiac tumor in the right atrium. Transthoracic echocardiography showed a poorly mobile, highly echogenic 12×16 mm mass with clear margins, and contrast-enhanced computed tomography (CT) showed a round tumor with no obvious enhancement. The tumor was resected with an atrial wall and diagnosed as a cavernous hemangioma on histopathological examination. Cardiac hemangiomas are enhanced using contrast medium; however, some cases have no contrast enhancement. Histopathological examination confirmed this diagnosis. The patient was discharged on postoperative day 11 in a good condition.

Background: Japan adopts a unique healthcare system that is generous to older adults. We evaluated the cost treatment of transcatheter aortic valve replacement(TAVR) and surgical aortic valve replacement(SAVR) in older adults in Japan.

Objective and methods: The TAVR group(n=333) included patients who underwent the procedure at the age of ≧75 years. The E-SAVR (n=78) and Y-SAVR (n=81) groups included patients who underwent a simple SAVR at the age of ≧75 and ≦74 years, respectively. We compared the clinical outcomes and total inpatient costs among the three groups.

Results: The operative time, length of intensive care unit and hospital stay were significantly shorter in the TAVR group. Drug and blood product cost, procedure fee, and diagnosis procedure combination cost were significantly lower in the TAVR group. The surgical equipment cost and total costs were significantly higher in the TAVR group. The rate of patients' payment was significantly lower in the TAVR group;however, it remained minimal in all three groups. The 5-year survival rate was significantly lower in the TAVR group than in the SAVR group.

Conclusions: The total inpatient costs were higher in patients who underwent TAVR than in those who underwent SAVR. The self-payment for medical care costs for older adults is relatively small in Japan.

We report a case of Stanford type A acute aortic dissection successfully treated with partial remodeling (PR) technique for aortic root reconstruction. A 60-year-old male presented with chest pain and was diagnosed as having acute aortic dissection with pericardial effusion. Emergency surgery revealed intimal tear in the right coronary sinus. We performed PR technique, reconstructing only the right coronary sinus with a prosthetic patch while preserving the native aortic valve. The patient recovered well and postoperative computed tomography (CT) showed patent reconstructed right coronary artery. PR technique, when appropriately indicated, offers advantages of shorter operative time with native valve preservation, making it a valuable option for selected cases of acute aortic dissection involving the aortic root.

A 74-year-old male was admitted with acute cholecystitis, during which computed tomography( CT) revealed a 20 cm anterior mediastinal tumor. He developed septic shock requiring tracheostomy and mechanical ventilation, and was referred to our institution. Biopsy under local anesthesia excluded malignant lymphoma and germ cell tumor, leading to planned surgical resection. Due to the tumor's extensive bilateral spread and proximity to the tracheostomy site, clamshell thoracotomy with lower partial sternotomy was performed instead of median full sternotomy. The final diagnosis was well-differentiated liposarcoma. The sternum was closed with wires and plates, and prophylactic negative pressure wound therapy was applied. Postoperatively, there were no sternal complications. Laparoscopic cholecystectomy was later performed, and the tracheostomy cannula was removed successfully. In surgical resection of giant mediastinal tumors, the approach should be selected based on the tumor's location and its extent of invasion into surrounding tissues.

We report a case of endovascular stent grafting for a pseudoaneurysm at the brachiocephalic artery anastomosis after acute aortic dissection surgery. A 48-year-old male underwent total arch replacement for Stanford type A acute aortic dissection. One month postoperatively, thoracic endovascular aortic repair (TEVAR) was performed to treat true lumen narrowing due to residual dissection. Two months after the initial surgery, he was emergently admitted with anterior chest pain. Close examination revealed a pseudoaneurysm at the brachiocephalic artery anastomosis, forming a mediastinal hematoma. Endovascular stent grafting was performed after creating a right axillary artery-to-right common carotid artery bypass. The stent graft successfully covered the pseudoaneurysm and the dissected segment of the right common carotid artery. The patient had no neurological complications, and postoperative contrast-enhanced computed tomography (CT) confirmed patency of the bypass and exclusion of the pseudoaneurysm. Endovascular stent grafting is a minimally invasive and effective treatment, achieving both pseudoaneurysm exclusion and entry closure.

Massive pulmonary embolism is a life-threatening disease, which requires early intensive care. Surgical pulmonary embolectomy is a last resort for patients with hemodynamic instability. We report the case of an emergency pulmonary embolectomy with using retrograde pulmonary perfusion (RPP) for massive pulmonary thromboembolism. The patient is a 54-year-old male who was admitted to neurosurgical department for brain infarction. Due to his immobility, he developed deep vein thrombosis in the right superficial femoral vein and then, suddenly collapsed with chest pain. While we prepared for introduction of extracorporeal membrane oxygenation, he was resuscitated and diagnosed with massive pulmonary embolism on pulmonary arterial angiography. Emergency pulmonary embolectomy with using RPP was successfully performed. Postoperative course is uneventful except that he had percutaneous tracheostomy in postoperative day 11. We did not detect residual clots in bilateral pulmonary arteries. After 73 days of hospitalization, he was discharged from hospital. As this novel surgical approach has been rarely reported in Japan, we reviewed all three cases from Japan.

A 55-year-old male patient, who was diagnosed as having constrictive pericarditis. He was transferred to our hospital for surgical treatment because of uncontrollable heart failure requiring catecholamine, which was uncontrollable by medical treatment. Postoperative drainage from the pericardial drain tube did not decrease, diuretics and anti-inflammatory drugs were not effective, so a pericardioperative peritoneal window was opened on 34 days after surgery. Postoperatively, it could be controlled with diuretics within two weeks after the window opening. He was discharged from the hospital 37 days after the window opening. Refractory pericardial effusions that do not improve with drug therapy require drainage, but if the drainage volume does not decrease, window opening into the abdominal or thoracic cavity may be an option.

A 80-year-old man presented to our hospital complaining exertional dyspnea. He was diagnosed with combined aortic valve regurgitation and stenosis due to quadricuspid aortic valve. The patient had no other cardiovascular anomaly. We performed aortic valve replacement( AVR) using minimally invasive cardiac surgery( MICS) approach. Four cusps were equal in size. Postoperative course was uneventful. AVR using MICS approach for quadricuspid aortic valve is extremely rare. In endoscopic surgery, the anatomical features of quadricuspid aortic valve can be more precisely understood, which may help in avoiding complications such as damage to the coronary ostia or the conduction system.

Perforation of a pacemaker lead is a serious life-threatening complication. Most cases involve the heart alone and rarely involve adjacent organs. The day after the pacemaker was implanted, the patient suddenly became hypotensive and went into shock, and a computed tomography (CT) scan showed an anterior mediastinal hematoma due to bleeding from the left internal thoracic artery. We report a case in which emergency surgery was performed to save the patient's life after assuming that the hemorrhage was caused by a lead leading hemorrhage.

The case is a woman in her 70s. She was scheduled to receive a hematopoietic stem cell transplant for myelofibrosis with thrombocytopenia. Chest computed tomography (CT) examination showed a part solid lesion in the lower lobe of the left lung, raising suspicion of pulmonary microinvasive adenocarcinoma. Following preoperative platelet transfusion, the count increased up to 11.1×104/μl, and she underwent thoracoscopic wedge resection of the lung lesion. Pathological examination revealed in situ adenocarcinoma. The chest tube was removed 3 days later at a platelet count of 5.1×104/μl and she was discharged on postoperative day 6. The count returned to baseline as early as postoperative 5 or 6 day. We require predictive strategies for the perioperative management of thrombocytopenia because patients with bone marrow failure have a shorter platelet lifespan.