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

In recent years, endovascular aortic repair has become one of the standard treatments for aortic aneurysms. However, when the aneurysm involves the branches of the abdominal aorta or the aortic arch, the procedure becomes more complex and often necessitates surgical reconstruction of the involved branches. To address these challenges, the use of physician-modified endografts in which fenestrations are manually created by physicians has been reported. This approach, known as fenestrated and branched endovascular aortic repair, involves the placement of small-diameter bridging stent grafts through the fenestrations, and its utility has recently been highlighted. Herein, we report a case of successful fenestrated and branched endovascular aortic repair using physician-modified endografts in a patient with both thoracoabdominal and aortic arch aneurysms.

The patient is a 69-year-old woman who underwent surgery for rectal cancer in January 202X. In July 202X+2, computed tomography (CT) revealed a nodule shadow with a maximum diameter of 4 mm in S1 of the right lung. After three months, the nodule increased in size. Based on the patient's history, a metastatic lung tumor was suspected, and the patient underwent surgical resection. Preoperative CT revealed the presence of B1 tracheobronchus and abnormal running of A1. B 1 was more centrally located than usual and branched directly from the trachea, whereas A1 branched from the main pulmonary artery trunk. S1 segmentectomy was performed for suspected metastatic lung tumor nodule in S1. Abnormal running of the pulmonary artery poses a risk of vascular injury during surgery. In the case of abnormal bronchial branching, the pulmonary vessels may be abnormal, and it is important to recognize such abnormalities using contrast-enhanced or three-dimensional CT preoperatively.

The patient is a 66-year-old man. He came to our hospital with fever for two weeks. Based on blood sampling and abdominal computed tomography (CT) scan, a diagnosis of liver abscess was made, and antibiotic treatment was started, but symptoms did not improve, so percutaneous drainage was performed. One week later, he became dyspnea and chest CT scan revealed right pyothorax, so video-assisted thoracoscopic curettage was performed. It has been reported that liver abscesses are complicated by pyothorax in a few percent of cases. There are two hypotheses as to the mechanism. The one is the spread of inflammation from the liver abscess through the diaphragm into the pleural space, and the other is iatrogenic complication of percutaneous liver drainage.

Vascular lesions, including aneurysms, are rare but well-documented complications of von Recklinghausen's disease. Although aneurysms associated with this condition are often asymptomatic, rupture can lead to life-threatening events such as hemothorax. We report a 63-year-old male with von Recklinghausen's disease who presented with sudden onset of chest pain. Imaging revealed left-side hemothorax, and contrast-enhanced computed tomography( CT) suggested rupture of the left 10th intercostal artery. Given his hemodynamic stability, percutaneous coil embolization was performed. Angiography revealed two adjacent aneurysms at the origin of the left 10th intercostal artery, both of which were successfully embolized. Postoperative course was uneventful, and the patient was discharged on postoperative day 6. This case highlights the importance of considering vascular complications in von Recklinghausen's disease and supports the efficacy and safety of coil embolization in managing ruptured intercostal artery aneurysms.

This retrospective analysis assessed surgical outcomes in patients aged 85 years or older who underwent emergency open thoracic aortic surgery for acute Stanford type A dissection between 2012 and 2025. Among 352 patients, 27 were classified as very elderly. Compared to younger cohorts, this group exhibited a higher prevalence of DeBakey typeⅡ dissection and thrombotic false lumen occlusion, with a lower incidence of malperfusion. The majority underwent hemiarch replacement. In-hospital mortality was low at 3.7%, and postoperative complication rates were comparable to the control group. Due to slow functional recovery, the proportion of patients discharged directly home was reduced. Despite a limited follow-up rate, three-year outcomes-including overall survival (77.4%), freedom from aortic-related mortality( 91.7%), and distal reoperation-free survival( 91.7%)-were favorable. The implementation of advanced techniques, such as staged thoracic endovascular aortic repair (TEVAR) and zone 0 TEVAR utilizing the retrograde in-situ branched stent graft (RIBS) method, effectively minimized the necessity for reintervention via thoracotomy or laparotomy. These findings underscore the clinical viability of surgical intervention in selected very elderly patients, notwithstanding inherent limitations such as referral bias and incomplete longitudinal data.

A 75-year-old man, who had undergone total arch replacement for a thoracic aortic aneurysm 4 years earlier, presented with transient left hemiplegia and right upper extremity weakness. Contrast-enhanced computed tomography (CT) revealed a large pseudoaneurysm at the proximal anastomosis of the ascending aortic graft, compressing and occluding the brachiocephalic graft. Surgical resection of the pseudoaneurysm and ascending aortic graft replacement with a 1-branched graft were performed. Cardiopulmonary bypass was established via peripheral vessels prior to re-median sternotomy. Thrombi were removed from the brachiocephalic graft, followed by replacement of the ascending aorta with a branched artificial graft for the brachiocephalic artery. The patient was discharged without complications. We report a rare case of transient hemiplegia due to brachiocephalic graft compression by a pseudoaneurysm.

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 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 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 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.