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Toshihiko Moroga, Shin-ichi Yamashita, Keita Tokuishi, Michiyo Miyawak ...
2012 Volume 18 Issue 2 Pages
89-94
Published: April 20, 2012
Released on J-STAGE: April 21, 2012
Advance online publication: November 15, 2011
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Objectives: Segmentectomy is the treatment of choice for small-sized non-small cell lung cancer (NSCLC); however, it is difficult to decide the surgical procedure because accurate evaluation of hilar lymph node metastasis remains unclear. We here report the outcome of video-assisted thoracic surgery (VATS) segmentectomy with and without the assessment of sentinel nodes.
Materials and Methods: Eighty-three patients with stage IA NSCLC underwent VATS segmentectomy between January 2003 and December 2010. Twenty patients underwent indocyanine green fluorescence imaging for sentinel node biopsy (SNB) and 63 did not. Intraoperative real-time quantitative RT-PCR to determine the expression of CK-19 was used for evaluation of metastasis. Perioperative outcome, local recurrence rates and survival were compared in both groups.
Results: Sentinel lymph nodes were identified in 16 of 20 patients (80%) with segmentectomy in the SNB group. The false negative rate was 0%. By RT-PCR for CK-19 expression, only one of these patients showed positive sentinel nodes, which indicated isolated tumor cells; however, segmentectomy was not converted to lobectomy. Seven of 63 patients with VATS segementectomy without SNB and none of the SNB group relapsed. In the relapsed patients without SNB, 4 (6.3%) were local recurrences and 3 (4.7%) were distant metastases. Recurrence-free survival rates in both groups were not significantly different because of the short follow-up period of the SNB group.
Conclusions: Our study demonstrated that VATS segmentectomy with SNB was useful for deciding intraoperatively to perform segmentectomy with an accurate lymph node status.
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Jong Bum Choi, Kyung Hwa Kim, Min Ho Kim, Won Ho Kim
2012 Volume 18 Issue 2 Pages
95-100
Published: April 20, 2012
Released on J-STAGE: April 21, 2012
Advance online publication: November 15, 2011
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Purpose: The aim of this study was to evaluate a newly-designed mitral annuloplasty strip (the Mitra-Lift
® strip) in patients undergoing mitral valve repair for mitral regurgitation (MR).
Methods: A total of 30 patients who underwent posterior mitral strip annuloplasty for moderately severe to severe MR were evaluated in this study. The strip annuloplasty (SA) consisted of the use of the newly-designed strip and the suture of the supra-annular atrial wall of 5.0 mm width and the posterior annulus. In addition to SA, six patients (20.0%) with tethered posterior leaflets required posterior leaflet augmentation. Improvement in MR and hemodynamic parameters of the valve with the fixed strip were assessed.
Results: After SA, all patients exhibited little or no MR, with no individual exhibiting signs of exacerbation during the follow-up period. A stable coaptation occurred below the strip and the posterior annulus due to forward movement and lifting of the posterior annulus without significant reduction of intercommissural dimension. During the cardiac cycle, the intercommissural dimensions showed considerable changes, which meant a dynamic motion of the anterior leaflet and the commissures.
Conclusions: Formation of a stable leaflet coaptation was associated with a dynamic change of the intercommissural dimension during the cardiac cycle and resulted in a reliable, annuloplasty strip, representing a new concept in annuloplasty.
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Taijiro Sueda, Naomichi Uchida, Taiichi Takasaki, Shinya Takahashi, Ta ...
2012 Volume 18 Issue 2 Pages
101-108
Published: April 20, 2012
Released on J-STAGE: April 21, 2012
Advance online publication: November 15, 2011
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Background: We hypothesized that chronic atrial fibrillation (AF) originated from the pulmonary veins, and was maintained by irregular activations of the posterior left atrium. We had performed the box pulmonary vein isolation procedure for the elimination of chronic AF associated with solitary mitral valve disease from 1999 to 2004. This paper evaluated the long-term results of this procedure over more than 6 years, and discussed the role of the pulmonary veins and posterior left atrium in maintaining AF.
Methods: Fifty-three patients were examined after box pulmonary vein isolation procedure concomitant with solitary mitral valve surgery retrospectively. We divided the patients into two groups with or without the elimination of AF (AF group and non-AF group). The disappearance of AF was determined by electrocardiography, and atrial function was evaluated by transthoracic echocardiography. The elimination of chronic AF and the recovery of atrial systolic function after surgery were evaluated over more than 6 years of follow-up.
Results: In a total of 462.8 patient years of follow-up (range 6.3 to 11.5 years, mean: 8.9 ± 2.7 years), AF disappeared in 77.3% of the patients (41/53) at 3 months and in 70.6% (36/51) of the patients at 6 years after the box pulmonary vein isolation, respectively. Among the preoperative variables, a long duration of AF and a large diameter of the left atrium were the predictive factors for recurrences of AF (
p <0.05). There was no left atrial tachycardia even though we did not perform ablation towards the mitral valve annulus.
Conclusions: The box pulmonary vein isolation procedure can terminate chronic AF associated with solitary mitral valve disease, and maintain a sinus rhythm for more than 6 years in 70% of chronic AF patients. This study implicates the pulmonary veins and posterior left atrium in maintaining chronic AF associated with mitral valve disease.
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Sezai Celik, Muharrem Celik, Bulent Aydemir, Cemalettin Tunckaya, Tame ...
2012 Volume 18 Issue 2 Pages
109-114
Published: April 20, 2012
Released on J-STAGE: April 21, 2012
Advance online publication: September 29, 2011
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Purpose: To evaluate long-term results of decortications in patients with symptomatic restrictive pleurisy and trapped lung after coronary bypass grafting.
Methods: Twenty consecutive patients undergoing lung decortications for trapped lung after coronary bypass grafting were prospectively evaluated. Pulmonary function tests were used as objective criteria, and quality of life was assessed by the Medical Research Council dyspnea scale. A p value <0.05 was considered significant.
Results: Twenty patients, 3 women and 17 men, with a median age of 59 years were evaluated. The median time interval between coronary bypass grafting and decortications was 9.3 months. The mean preoperative forced expiratory volume in one second and forced vital capacity were 63.8% ± 7.4% and 50.5% ± 6.6% of the predicted value, respectively, and the improvement rates after decortications were 14.97% ± 6.3% and 17.62% ± 6.38%, respectively. Dyspnea scores improved after decortications (p <0.05). The median follow-up was 25 months. After surgery, 3 patients developed superficial wound infections, and out of 7 patients with prolonged air leaks, 2 underwent re-operation. After surgery, one patient died on day 34 and another, after 3 years.
Conclusion: Lung decortications, re-expanding the affected lung, ensures symptom remission and improves quality of life of patients with trapped lung after coronary bypass grafting in the long-term.
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Mitsuhiro Yano, Kunihide Nakamura, Hiroyuki Nagahama, Masakazu Matsuya ...
2012 Volume 18 Issue 2 Pages
115-120
Published: April 20, 2012
Released on J-STAGE: April 21, 2012
Advance online publication: January 31, 2012
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Purpose: The purpose of this study was to clarify the most suitable method to measure the aortic annulus diameter.
Patients and Methods: Fifty-five patients, who had undergone aortic valve replacement at Miyazaki University Hospital between April 2008 and May 2011, were included in this study. The maximum diameter of the sizing tool that could be inserted into the left ventricle through the annulus had been predicted, based on the diameter measured by each modality. Agreement with surgery and each imaging modality, namely transthoracic echocardiography, multidetector computed tomography and contrast angiography, were compared using Bland-Altman analysis.
Results: The predicted aortic annulus diameter, based on the diameter measured by transthoracic echocardiography, multidetector computed tomography and contrast angiography, was 20.3 ± 2.50, 23.9 ± 3.19, and 23.5 ± 3.55 mm, respectively, whereas, the diameter measured at surgery was 23.7 ± 2.99 mm. Predicted aortic annulus diameter measured by multidetector computed tomography best agreed with that measured at surgery.
Conclusion: We conclude that the aortic annulus diameter, measured by multidetector computed tomography, is the best modality to measure the aortic annulus diameter.
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Taichiro Goto, Arafumi Maeshima, Kumi Akanabe, Reo Hamaguchi, Misa Wak ...
2012 Volume 18 Issue 2 Pages
121-124
Published: April 20, 2012
Released on J-STAGE: April 21, 2012
Advance online publication: September 29, 2011
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A 44-year-old woman was found to have an abnormal shadow on a chest X-ray during a regular health checkup, and visited our department. Chest computed tomography showed multiple nodular shadows in both lungs. The patient had no history of neoplasm except for myomectomy for uterine leiomyoma 6 years previously. Eighteen months later, the nodules showed a gradual increase in size, and video-assisted thoracoscopic biopsy of a nodule was performed. Histopathologically, the pulmonary nodule was composed of benign smooth muscle cells proliferating in fascicles, consistent with the diagnosis of benign metastasizing leiomyoma. Benign metastasizing leiomyoma is defined as a histologically benign uterine smooth muscle tumor that acts in a somewhat malignant fashion and produces benign metastases. Although it is a rare condition, it should be considered in asymptomatic women of reproductive age with a history of uterine leiomyoma, who present with solitary or multiple pulmonary nodules. Herein, we report a case of pulmonary benign metastasizing leiomyoma.
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Takashi Nakayama, Takashi Ohtsuka, Akio Kazama, Ken-ichi Watanabe
2012 Volume 18 Issue 2 Pages
125-127
Published: April 20, 2012
Released on J-STAGE: April 21, 2012
Advance online publication: October 17, 2011
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We report a rare case of classic pulmonary blastema (CPB) without recurrence for 3 years after the operation. A 70-year-old man presented with cough and sputum for a month. Chest computed tomography (CT) showed a 5cm-sized mass in the right middle lobe. Bronchoscopic examination was performed, and the mass was suspected as adenocarcinoma of the lung. Right middle lobectomy and lymph node dissection were performed. The pathologic histology diagnosis was classic pulmonary blastoma, a subtype of biphasic pulmonary blastoma.
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Taichiro Goto, Reo Hamaguchi, Arafumi Maeshima, Yoshitaka Oyamada, Ryo ...
2012 Volume 18 Issue 2 Pages
128-131
Published: April 20, 2012
Released on J-STAGE: April 21, 2012
Advance online publication: October 17, 2011
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Mycobacterium chelonae lung infection is rare and has long been recognized as an enigmatic infection resistant to medical therapy. Recently, we encountered a patient who underwent pulmonary resection for
Mycobacterium chelonae infection. A 46-year-old man with no medical history was found to have an abnormal shadow in the left upper lung field on chest X-ray. Computed tomography showed a nodular shadow in the left upper lobe and disseminated shadows around it.
Mycobacterium chelonae was detected from cultures of the sputum, bronchial washings, bronchoscopic biopsy specimens, and gastric fluid, and pulmonary infection with
Mycobacterium chelonae was diagnosed. The shadow did not decrease in size despite antibiotic treatment. Since the lesion was confined to the left upper segment, we judged that a complete resection was possible, and performed left upper division segmentectomy. After surgery, no new foci of infection were observed in the lung. No effective therapy for
Mycobacterium chelonae lung infection has been established to date, and reported cases of pulmonary resection for the treatment of
Mycobacterium chelonae infection are extremely rare. However, surgery should be considered in patients in whom complete resection is deemed possible.
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Jonathan O. Nwiloh
2012 Volume 18 Issue 2 Pages
132-135
Published: April 20, 2012
Released on J-STAGE: April 21, 2012
Advance online publication: September 29, 2011
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Severe primary tricuspid regurgitation is a rare entity, with most cases of tricuspid regurgitation being functional and secondary to pulmonary hypertension from left heart pathologies. We report an unusual case of a female patient with a history of left pneumonectomy and chronic atrial fibrillation many years earlier, and who subsequently developed tricuspid annular dilatation, resulting in severe isolated primary tricuspid regurgitation despite normal pulmonary artery pressures and left ventricular systolic function. She required multiple hospitalizations for right heart failure and continued to be NYHA class IV despite receiving maximal medical management. She finally underwent an isolated tricuspid valve ring annuloplasty, which gave her symptomatic relief. Postoperatively, she improved to NYHA class 1-II still with chronic atrial fibrillation and mild to moderate tricuspid regurgitation at the time of her death 9 years later from pneumonia.
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Tomoyuki Nakano, Shunsuke Endo, Tetsuya Endo, Tsuyoshi Hasegawa, Masay ...
2012 Volume 18 Issue 2 Pages
136-139
Published: April 20, 2012
Released on J-STAGE: April 21, 2012
Advance online publication: October 17, 2011
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We report on a 68-year-old male with a multistation mediastinal lymph node adenocarcinoma, who had no primary lesions occurring within 48 months. After diagnosis by lymph node biopsy via right-sided thoracoscopy, the bilateral mediastinal lymphadenopathy responded to platinum-based chemotherapy. At 30 months after completion of chemotherapy, left mediastinal lymphadenopathy recurred. Left anterior mediastinal dissection via left-sided thoracoscopy was successful. After surgery, the patient did well with no primary lesions for more than a year. The etiology of mediastinal lymph node carcinoma of unknown origin is discussed.
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Takashi Iwata, Takuya Miura, Kazushige Inoue, Shoji Hanada, Hidetoshi ...
2012 Volume 18 Issue 2 Pages
140-143
Published: April 20, 2012
Released on J-STAGE: April 21, 2012
Advance online publication: October 28, 2011
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A 66-year-old man presented with a one month history of hoarseness. Left recurrent nerve palsy and a left upper mediastinal mass were observed by an otorhinolaryngologist who referred the patient to our department. Chest computed tomography showed a superior mediastinal mass, which seemed to involve the left common carotid and left subclavian arteries from the greater curvature of the aortic arch. The innominate vein was compressed, and collateral circulation was well developed. The left upper lobe of the lung was also seemed involved. A mediastinal biopsy conducted via left thoracoscopy revealed a malignant spindle cell tumor. The mediastinum was irradiated (40 Gy), and surgical extirpation was subsequently undertaken 3 weeks later. The tumor was successfully removed without the use of extracorporeal circulation. Because only smooth muscle actin was focally but strongly expressed immunohistochemically, leiomyosarcoma was confirmed. The patient was discharged on day 14. A solitary left pleural metastasis was observed and resected 12 months after the surgery and the patient is well without further recurrence 16 months after the initial surgery.
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Susumu Isoda, Motohiko Osako, Tamizo Kimura, Yuji Mashiko, Nozomu Yama ...
2012 Volume 18 Issue 2 Pages
144-147
Published: April 20, 2012
Released on J-STAGE: April 21, 2012
Advance online publication: November 30, 2011
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A 24-year-old man presented with chest pain. He was diagnosed as having a type A acute aortic dissection and an annulo-aortic aneurysm. After emergency surgery for an aortic root replacement, his electrocardiogram showed ST-segment depression and T-wave inversion. Echocardiography showed asynergy of the left ventricle without coronary ostial pathology. Heart catheterization revealed no coronary stenosis, but the true lumen of the residual ascending aorta had extreme diastolic narrowing due to flap suffocation. This resulted in coronary malperfusion. The pullback pressure curve confirmed the mechanism. The patient underwent a surgical re-intervention for a total arch repair, which diminished the coronary malperfusion. At a follow-up appointment four years and four months later, the patient was doing well.
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Tadashi Omoto, Takeo Tedoriya, Masaya Oi, Naoko Nagano, Tadamasa Miyau ...
2012 Volume 18 Issue 2 Pages
148-150
Published: April 20, 2012
Released on J-STAGE: April 21, 2012
Advance online publication: October 17, 2011
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We report on a successful mitral valve (MV) repair and modified Cox maze procedure in a 35-year-old male patient with acromegaly, associated with severe mitral regurgitation and atrial fibrillation. He underwent a transsphenoidal adenomectomy, 7 months after the cardiac operation, and IGF-I level was normalized postoperatively. Valvular disease in patients with acromegaly is associated with hormonal activity, and control of growth hormone and insulin-like growth factor I excesses is important in the long-term durability of mitral valve repair.
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Erhan Kansiz, Ali Can Hatemi, Aybala Tongut, Sadettin Cohcen, Ahmet Yi ...
2012 Volume 18 Issue 2 Pages
151-155
Published: April 20, 2012
Released on J-STAGE: April 21, 2012
Advance online publication: October 17, 2011
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Introduction: Left ventricular pseudoaneurysm caused by a transmural myocardial infarction is a fatal complication. Reliable diagnosis and on-time surgical intervention are significant for the patient’s survival.
Methods/Results: A 70-year-old diabetic man with a two-month earlier history of successful stent implantation on the proximal right coronary artery because of total occlusion was admitted to our institution with symptoms of congestive heart failure. Transthoracic echocardiogram showed severely decreased overall LV systolic function and a large aneurismal sac attached to the inferior surface of the left ventricle, moderate tricuspid regurgitation and severe mitral insufficiency. On transesophageal echocardiography examination and cardiac magnetic resonance imaging, the aneurismal cavity appeared to be entirely surrounded by thrombi. During the operation, a left ventricular postero-inferior pseudoaneurysm was observed to extend to the mitral annulus. Purse string suturing was used to reduce left ventricular volume, and the hole was closed with a Dacron patch. The patient was weaned from the CPB without any difficulty. The patient’s postoperative period was uneventful, and his physical condition appeared to be very healthy (NYHA class I-II) after the first year.
Conclusion: Following a myocardial infarction, a careful preoperative examination and proper way to diagnose are essential on patients with nonspecific complains or asymptomatic. Despite the risk of high mortality, patients may survive when they are diagnosed and undergo surgery at the right time.
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Mehmet Guler, Birol Yamak
2012 Volume 18 Issue 2 Pages
156-157
Published: April 20, 2012
Released on J-STAGE: April 21, 2012
Advance online publication: October 28, 2011
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A 54-year old man underwent coronary artery bypass graft for occlusion of three coronary arteries. There was no hematological abnormality detected preoperatively and the patient had normal coagulation tests and platelet count before the operation. During the first 24 hours after the operation, hemorrhagic drainage from the chest tubes was 700 ml ,and on postoperative day 1, he underwent reoperation. There was no further drainage from the chest tubes after re-operation but hematocrit level continued to fall. After having ruled out the thoracic source of bleeding, abdominal computed tomography was performed and confirmed intraperitoneal fluid accumulation and determined splenic rupture. The patient underwent emergent splenectomy and discharged from hospital on the sixth postoperative day with recovery.
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Kosuke Narita, Koichi Akutsu, Takeshi Yamamoto, Naoki Sato, Satoru Mur ...
2012 Volume 18 Issue 2 Pages
158-161
Published: April 20, 2012
Released on J-STAGE: April 21, 2012
Advance online publication: October 28, 2011
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Stanford type B acute aortic dissection is sometimes complicated with compressed true lumen of the descending aorta (Dynamic obstruction) and stenosis of a major aortic branch (Static obstruction), which cause organ malperfusion. In such a case, medical therapy alone is usually not effective and endovascular treatments are required including stent implantation and balloon fenestration. However, it is difficult to determine which strategy should be selected, that is, only stent implantation at dissected branch or simultaneous fenestration with stent implantation. We report a case of a 54-year-old man with lower leg ischemia due to type B aortic dissection, who was successfully treated with stent implantation plus balloon fenestration. This case suggests that balloon fenestration plus stent implantation should be considered when static obstruction in the aortic branches is accompanied by dynamic obstruction in the descending aorta.
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Toshinobu Kazui, Hiroyuki Niinuma, Manabu Yamasaki, Kohei Abe, Sunao W ...
2012 Volume 18 Issue 2 Pages
162-165
Published: April 20, 2012
Released on J-STAGE: April 21, 2012
Advance online publication: October 28, 2011
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Septal hyper-contractility is thought to be the principal cause of significant left ventricular outflow tract obstruction (LVOT) and systolic anterior motion (SAM) of the mitral valve by making the distance between the mitral valve and papillary muscle shorter. A seven-year-old patient with severe hypertrophic obstructive cardiomyopathy underwent direct interventricular septal myectomy/myotomy using the resection/crush method to modify hyper-contractility. The procedure successfully reduced the pressure gradient from 180 mmHg to 7.6 mmHg, and systolic anterior movement of the mitral leaflet disappeared. Mitral regurgitation improved from grade 2 to grade 0. Postoperative echocardiographic vector velocity imaging (VVI) study revealed a reduced twist angle, depicting attenuated ventricular contraction power from a maximum twist 17.9° to 7.9°. Perioperative VVI revealed that interventricular septal myectomy/myotomy is useful, not only in reducing LVOT obstruction, but also in reducing hyper-contractility, which increases the distance from the mitral valve to the papillary muscle and relieves SAM.
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Tadashi Akiba, Hideki Marushima, Hiroko Nogi, Noriki Kamiya, Satoki Ki ...
2012 Volume 18 Issue 2 Pages
166-169
Published: April 20, 2012
Released on J-STAGE: April 21, 2012
Advance online publication: October 28, 2011
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Purpose: This study aimed to evaluate the clinical outcomes of chest wall reconstruction using a relatively new expanded polytetrafluoroethylene prosthesis Gore-Tex
® dual mesh.
Methods: We reviewed charts of 11 patients who underwent bony chest wall resection from April 2006 to January 2011.
Results: Six patients underwent three ribs resection, three patients underwent two ribs resection, and the other two patients underwent sternal resection. Of six patients after three ribs resection, three underwent reconstruction using 2 mm Gore-Tex
® dual mesh, one using Gore-Tex
®, one using Bard composite E/X, and the remaining one used no prosthesis. Three patients who underwent two ribs resection underwent no chest wall reconstruction using prosthesis. Two patients who underwent sternal resection underwent chest wall reconstruction using dual mesh with or without a vascularized musculocutaneous pedicle flap. Immediate postoperative extubation was performed in all patients, except one who was extubated the following day. No postoperative deaths or cases with paradoxical respiration occurred.
Conclusion: Chest wall reconstruction using Gore-Tex
® dual mesh demonstrated acceptable durability.
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