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General Thoracic and Cardiovascular Surgery

Taichi Sakaguchi, Toshinori Totsugawa, Kentaro Tamura, Arudo Hiraoka, Genta Chikazawa, Hidenori Yoshitaka
OBJECTIVE: Despite excellent long-term results reported for a trans-aortic septal myectomy for hypertrophic obstructive cardiomyopathy (HOCM), surgery for patients with diffuse hypertrophy is very challenging. In addition, a left ventricular outflow obstruction is often aggravated by an abnormal mitral valve and subvalvular apparatus. METHODS: We performed video-assisted minimally invasive trans-mitral septal myectomy procedures in 3 patients with diffuse-type HOCM, who were highly symptomatic despite maximal medical therapy...
March 16, 2018: General Thoracic and Cardiovascular Surgery
Makoto Mori, Frank C Detterbeck
Primary carcinoma of the trachea is an exceeding rare entity. We present a case of radiation-induced primary squamous cell carcinoma of the trachea in a young woman. The case highlights a diagnostic challenge of this atypical disease entity.
March 15, 2018: General Thoracic and Cardiovascular Surgery
Kazuyuki Komori, Aritoshi Hattori, Takeshi Matsunaga, Kazuya Takamochi, Shiaki Oh, Kenji Suzuki
PURPOSE: We evaluated the feasibility of surgery for pulmonary aspergilloma. METHODS: We retrospectively evaluated 35 surgical patients with pulmonary aspergilloma. The clinical characteristics and perioperative surgical morbidity were compared based on the operative modes. Preoperative artery embolization (PAE) was selectively performed to reduce the expected surgical stress caused by intraoperative blood loss. RESULTS: The cohort comprised 19 males and 16 females with a mean age of 56 years...
March 14, 2018: General Thoracic and Cardiovascular Surgery
Shinya Higuchi, Iwao Matsunaga, Kiyokazu Koga, Eiichi Teshima, Atsuhiro Nakashima, Ryuji Tominaga, Tsuyoshi Ito
In almost every type of artificial valve, structural failure has been described. We are reporting on a case of a sudden leaflet escape of an Edwards TEKNA mitral valve prosthesis 12 years after implantation. The patient had a sudden onset of dyspnea and severe pulmonary edema with subsequent cardiogenic shock. An emergency mitral replacement was successfully performed. A multi-detector computed tomography scanning and three-dimensional imaging showed two fragments that had embolized in the terminal aorta and the left common iliac artery...
March 13, 2018: General Thoracic and Cardiovascular Surgery
Takashi Murakami, Ryoji Sada, Yosuke Takahashi, Shinsuke Nishimura, Kazuki Mizutani, Asahiro Ito, Shinichi Iwata, Tokuhiro Yamada, Minoru Yoshiyama, Toshihiko Shibata
Transcatheter aortic valve implantation was performed on a 78-year-old patient. Elective circulatory support with cardiopulmonary bypass was planned because of left ventricular function impairment and hemodynamic instability. Limited vascular access was due to a severe atherosclerotic aorta distal to the origin of the left carotid artery. The right arm was the only safe vascular access site. However, at least 2 vascular access sites for angiographic catheter and inflow of circulatory support were required. An arterial inflow line equipped with a side arm was developed to enable single access to the right axillary artery to be used for the above purposes...
March 6, 2018: General Thoracic and Cardiovascular Surgery
Gabrielle Drevet, J M Maury, F Farhat, F Tronc
A 75 year old man presented with left upper lobe squamous cell carcinoma. Severe aortic stenosis has been discovered during preoperative assessment. In this situation, two therapeutic strategies are described: concomitant or two-staged procedures. The debate has not yet led to the conclusion on whether preferably performing one or the other. Furthermore, in an oncologic context, using cardiopulmonary bypass is still controversial. So, thoracic and cardiac surgeons jointly proposed to the patient a transcatheter aortic valve implantation followed, 72 h later, by lung cancer resection...
February 28, 2018: General Thoracic and Cardiovascular Surgery
Hesham Alkady, Sobhy Abouramadan, Mohamed Nagy, Ahmed Talaat, Tarek Hashem, Abdalla Khaleel
Entometrioid stromal sarcomas are seen in extra-uterine as well as extra-gonadal sites and have a strong association with endometriosis. Although having better prognosis than other sarcomas, yet these tumors may relapse (whether local or distant) in up to 56% of cases, even as late as 20 years after surgery. We report a case of a 30-year-old female patient with a mass in the inferior vena cava and right atrium which was surgically removed using cardiopulmonary bypass and deep hypothermic circulatory arrest and turned to be an entometrioid stromal sarcoma...
February 27, 2018: General Thoracic and Cardiovascular Surgery
Hiroshi Furukawa, Takeshi Honda, Takahiko Yamasawa, Hisao Masaki, Kazuo Tanemoto
BACKGROUND: We retrospectively evaluated the initial clinical experience of the surgical management of extensive dissecting thoracic aortic aneurysm (TAA) via the semi-clamshell approach. METHODS: Thirteen patients (3 women and 10 men, mean age 67 ± 15 years) who underwent elective surgical intervention for extensive dissecting TAA via semi-clamshell approach in our institute between May 2007 and April 2017 participated in this study. Regarding surgical techniques, left thoracotomy with transverse sternotomy was initially performed via the third or fourth intercostal space following an incision from the right sternal borderline to the anterior axillary line on the left sternal borderline...
February 22, 2018: General Thoracic and Cardiovascular Surgery
Hironobu Sugiyama, Ryo Tohma, Takuya Misato, Kazuma Okamoto, Taro Hayashi, Satoshi Tobe, Tatsuro Matsuo, Kotaro Tsunemi, Takanori Oka, Nobuhiro Tanimura
We report a rare case of right heart failure caused by distal aortic aneurysm. Although aortopulmonary fistula is a common complication of giant aortic arch aneurysm, right heart failure caused by mechanical pressure by aneurysm is very rare. A 79-year-old female patient presented dyspnea. Contrast computed tomography (CT) of the thorax delineated a 78 mm aortic arch aneurysm pressing the main to left pulmonary artery and a 40 mm pericardial effusion at maximum depth at posterior side. Echocardiography showed the acceleration flow from main to left pulmonary artery and moderate pulmonary hypertension...
February 17, 2018: General Thoracic and Cardiovascular Surgery
Yuting P Chiang, Yuichi J Shimada, Jonathan Ginns, Shepard D Weiner, Hiroo Takayama
Hypertrophic cardiomyopathy (HCM) is the most commonly inherited cardiac disease-recent studies suggest a prevalence as high as 1 in 200. For symptomatic patients with obstructive HCM who are refractory to medical therapy, septal reduction is indicated. Septal myectomy (SM) is considered the gold standard septal reduction technique. However, due to a shortage of surgeons who are experienced in this technique, alcohol septal ablation (ASA) has overtaken SM as the most commonly performed procedure for obstructive HCM...
February 15, 2018: General Thoracic and Cardiovascular Surgery
Kenta Nakahashi, Hiroyuki Oizumi, Hirohisa Kato, Jun Suzuki, Akira Hamada, Takayuki Sasage, Mitsuaki Sadahiro
A 64-year-old woman, with a history of hepatocellular carcinoma, developed recurrent metastatic lung nodules after lung metastasectomy 10 years ago. Computed tomography (CT) revealed tumors in the right middle, and left lower lobes. We planned a right middle lobectomy. Before operating, a contrast-enhanced CT in the pulmonary venous phase revealed a tumor in the pulmonary vein resembling a thrombus, indicating that the CT failed to facilitate accurate diagnosis. Following venous clamping and incision, the intravenous polypoid mass was surgically removed...
February 6, 2018: General Thoracic and Cardiovascular Surgery
Hitoshi Ogino
In some instances, we encounter cases suffered from inflammatory aortic diseases (aortitis) in Japan, some of which are at the active stages with systemic inflammation. Most of them are refractory with some technical difficulties of surgical treatment. The aortic wall, particularly, at the active stage, is too fragile to hold the surgical sutures. Consequently, the suture reinforcement with Teflon felt is required. In the late stage after surgery, false aneurysms on the suture line, that is, suture detachment potentially occur...
February 5, 2018: General Thoracic and Cardiovascular Surgery
Yoshiaki Osaka, Shingo Tachibana, Yoshihiro Ota, Takeshi Suda, Yosuke Makuuti, Takafumi Watanabe, Kenichi Iwasaki, Kenji Katsumata, Akihiko Tsuchida
OBJECTIVES: We started robot-assisted thoracoscopic esophagectomy using the da Vinci surgical system from June 2010 and operated on 30 cases by December 2013. Herein, we examined the usefulness of robot-assisted thoracoscopic esophagectomy and compared it with conventional esophagectomy by right thoracotomy. METHODS: Patients requiring an invasion depth of up to the muscularis propria with preoperative diagnosis were considered for surgical adaptation, excluding bulky lymph node metastasis or salvage surgery cases...
February 3, 2018: General Thoracic and Cardiovascular Surgery
Yuichi Matsuzaki, Takeshi Hiramatsu, Takahiko Sakamoto, Mitsugi Nagashima, Hiroshi Niinami, Kenji Yamazaki
BACKGROUND: There has been no report observing the LV function of Konno incision. We examined the outcomes of the Konno operations over 20 years. METHODS: We investigated 63 Konno operations with mechanical valves performed from 1984. This study aimed to evaluate the effects of Konno incision including LV function changes and the long-term outcomes of patient survival and reoperation rate (RVOT and LVOT complications). RESULTS: The postoperative follow-up period was 20...
February 2, 2018: General Thoracic and Cardiovascular Surgery
Yoshimasa Seike, Hitoshi Matsuda, Tetsuya Fukuda, Yosuke Inoue, Atsushi Omura, Kyokun Uehara, Hiroaki Sasaki, Junjiro Kobayashi
OBJECTIVES: This study aimed to reveal the differences in intermediate outcomes between TAR and d-TEVAR in octogenarians and to identify risk factors for adverse events after aortic arch repair in octogenarians. METHODS: We reviewed medical records of 125 patients aged > 80 years who underwent surgical intervention for aortic aneurysm between 2008 and 2016. Of these, 60 underwent conventional TAR (43 men; age, 82 ± 2.2 years) and 65 underwent d-TEVAR (49 men; age, 84 ± 3...
January 31, 2018: General Thoracic and Cardiovascular Surgery
Fumiya Yoneyama, Fujio Sato, Hiroaki Sakamoto, Yuji Hiramatsu
The gold standard for aortic endograft infection includes the excision of infected endograft, debridement, and reconstruction. However, these methods are not always the best option for patients with poor clinical status. We assessed the suitability of alternative methods for managing aortic endograft infection. The patient was a 72-year-old man whose previous abdominal surgeries provoked recurrent cholangitis. The patient had also undergone thoracic endovascular aortic repair (TEVAR). One month after the TEVAR, he was readmitted with high-grade fever and diagnosed with endograft infection...
January 30, 2018: General Thoracic and Cardiovascular Surgery
Minoru Tabata
The left ventricular apex has excellent accessibility to the aortic valve, mitral valve, left ventricular outflow tract and thoracic aorta. Although the number of transapical approach in transcatheter aortic valve replacement has been decreasing in recent years, it is still a useful option for patients with very poor peripheral vascular access. The apex has been chosen as a primary access site for many devices of transcatheter mitral valve repair/replacement and mitral valve-in-valve procedures. Additionally, the transapical approach has been used for other transcatheter cardiovascular interventions such as paravalvular leak repair after mitral or aortic valve replacement, pseudoaneurysm repair of the left ventricular outflow tract, and thoracic endovascular aortic repair...
January 25, 2018: General Thoracic and Cardiovascular Surgery
Goki Inno, Yosuke Takahashi, Yasuyuki Kato, Yasuyuki Sasaki
We report the successful surgical treatment of aortic regurgitation in a 27-year-old woman with Turner syndrome (TS) who was admitted with exacerbation of dyspnea on exertion. Echocardiography showed a bicuspid aortic valve with severe aortic regurgitation and computed tomography showed dilatation of the ascending aorta and aortic root. Due to the patient's low body surface area (due to TS), standard determination of aortic size was not possible; therefore, we used the reference curves of aortic diameters in children...
January 25, 2018: General Thoracic and Cardiovascular Surgery
Takanori Tokuda, Kazushige Inoue, Takashi Murakami
A 72-year-old woman presented with a post-infarction ventricular septal defect, presumably within 10 days after the onset of acute myocardial infarction. An emergency surgery was performed because of hemodynamic instability. Using the sandwich patch technique, we approached the posteriorly oriented defect through a right atriotomy and detached tricuspid valve. By avoiding either left or right ventriculotomy, additional damage to the already infarcted ventricle and risk of bleeding were avoided. The patient showed an uneventful postoperative recovery, with no residual shunt detected...
January 24, 2018: General Thoracic and Cardiovascular Surgery
Toru Takahashi, Jun Mohara, Hiroomi Ogawa, Takamichi Igarashi, Yoko Motegi
A 69-year-old male had catheter-based ablation for atrial fibrillation. He was admitted with high fever and had neurological disorder; he was diagnosed with atrioesophageal fistula by CT scan. Intraoperative findings showed that the fistula existed adjacent to the left lower pulmonary vein with a vegetation. The esophageal fistula was repaired, and the left atrial fistula was closed. A nasogastric tube tip was placed in the esophagus for decompression and advanced into the stomach for nutritional support. After vomiting, the patient showed loss of consciousness and left hemiplegia...
January 23, 2018: General Thoracic and Cardiovascular Surgery
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