Despite improvements in surgical techniques and perioperative management and surgery combined with chemotherapy and/or radiotherapy, the prognosis of esophageal squamous cell carcinoma (SCC) at an advanced stage remains poor. Therefore, for esophageal SCC patients, novel therapies such as small molecule inhibitors of tyrosine kinases (TKIs) and humanized monoclonal antibodies (mAbs) are very much needed.Esophageal SCC shows a relatively high incidence of EGFR (33%) and/or HER2(31%) overexpression. Two categories of anti-HER-family-targeting therapies have been in clinical development: small-molecule, HER-family-related TKIs such as Gefitinib,Erlotinib and Lapatinib, and humanized mAbs against the HER family represented by Cetuximab and Trastuzumab. Although there have been very few clinical trials of antiHER-family targeting drugs in esophageal SCC, some in vitro data suggested that the combination of Cetuximab and Trastuzumab could induce synergistic antiproliferative effects and additional antibody-dependent cellular cytotoxicity (ADCC) activities against esophageal SCC cells. A better understanding of the detailed mechanisms involved in EGFR and/or HER2 may help identify new therapeutic targets in esophageal SCC.

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Purpose: Ventricular assist devices have been used for the treatment of severe heart failure. Recently, many types of blood pumps have been developed to reduce major adverse events. EVAHEART® (Sun Medical Technology Research Corporation, Nagano, Japan) is an implantable centrifugal blood pump. In laboratory animal studies, the pump flow of EVAHEART® increases spontaneously during exercise with no changes in pump control parameters. However, this has not been confirmed clinically. The aim of this study was to analyze EVAHEART® performance during exercise.
Patients and methods: Four male patients were implanted with an EVAHEART®. We evaluated the performance of the EVAHEART® during exercise. Fixed pump speeds were maintained during each test. Measurements during exercise were peak load, peak oxygen consumption (peak VO₂), pre exercise pump flow, and peak velocity.
Results: Pump flow significantly increased from 4.1 ± 0.5 liters per minute (L/min) to 7.2 ± 1.8 L/min during exercise. VO₂ increased from 4.0 ± 0.7 milliliters per kilogram per minute (ml/kg/min) to 14.7 ± 3.3 ml/kg/min.
Conclusion: These results indicate that EVAHEART® may support severe heart failure patients not only under static but also under dynamic conditions. Pump flow spontaneously increased during exercise at a constant pump speed.

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Purpose: We investigated whether mitral annuloplasty (MAP) should be performed for mild ischemic mitral regurgitation (IMR).
Methods: We selected 57 patients with preoperatively mild IMR. Twenty-eight patients who previously had moderate MR or more, underwent MAP (group 1) while 29 patients with persistent mild MR, did not (group 2). We reviewed MR changes and outcomes of these patients. We also investigated other IMR patients with preoperatively moderate or more MR as reference data (group 3).
Results: In group 1, MR was none or trace in 25 patients immediately after operation, however, eleven out of these patients (44%) showed postoperative MR up-grade. The trends of MR changes in group 1 were similar to those of patients in group 3. In group 2, MR was graded mild in 79% of patients in mid-term postoperative stage although 28% of patients were up-graded or down-graded during postoperative follow-up.
Conclusion: MAP is not necessary for patients with persistently mild IMR. Patients with preoperatively mild IMR with episodes of MR exacerbation had better be treated similarly as those with moderate or more IMR and undergo MAP.

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Purpose: To describe the clinical presentation and echocardiographic findings associated with localized tamponade after open-heart surgery.
Methods: Retrospective analysis of a case series with a surgically proven diagnosis.
Results: Among 23 patients with surgically proven localized cardiac tamponade after elective open-heart surgery, 5 patients (22%) died in the ICU from multiorgan failure. At the time of diagnosis (median delay: 2 days; range: 0–8 days), shock was present in 19 patients, 8 of them being hypotensive. Transthoracic echocardiography (TTE) depicted the localized cardiac tamponade in 3 of 4 examined patients, whereas transesophageal echocardiography (TEE) was always conclusive. The right atrium was primarily involved, solely (n = 11) or with the right ventricle (n = 5), whereas the left cardiac cavities were less frequently compressed (left atrium: n = 6, left ventricle: n = 1). The free wall curvature of the involved cardiac chamber was consistently inverted, and blood flow turbulences were depicted in 12 patients. Surgical removal of the compressive hematoma improved the clinical status of 18 patients (78%) who were discharged from the hospital.
Conclusion: Since localized tamponade complicating open-heart surgery has various, non-specific clinical presentations and TTE is not diagnostic, indications of TEE must be liberal in this setting to prompt diagnosis and surgical reoperation.

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Objectives: The benefits of preoperative chemoradiotherapy for advanced nonsmall cell lung cancer (NSCLC) remain controversial. To evaluate prognostic indicators of clinical N2 NSCLC patients treated with concurrent chemotherapy followed by pulmonary resection, we performed a retrospective study.
Methods: We retrospectively investigated 52 patients with pathologically proven N2 NSCLC who underwent concurrent chemoradiotherapy before pulmonary resection. Each received 2 cycles of cisplatin-vinca alkaloid-based chemotherapy every 4 weeks. Radiotherapy, directed at the tumor and mediastinal nodes, was started on day 2 at a median dose of 44 Gy. A thoracotomy was performed 6 to 8 weeks after completion of chemoradiotherapy.
Results: The overall 5-year survival rate for the 52 patients was 38%. Complete pathological response by the tumor was found in 11 (21%). Down-staging of nodal stage occurred in 29 patients, (56%) and overall survival was better in those with lower pathological N status. The 5-year survival rate was 58% for pathological N0-N1 disease and 0% for N2 disease. While the response to induction therapy by the primary tumor was correlated with postoperative nodal stage, multivariate analysis revealed postoperative nodal stage as an independent prognostic factor.
Conclusion: Pathological status of mediastinal lymph nodes in response to preoperative concurrent chemoradiotherapy determined prognosis in our patients.

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A 68 year old man was admitted to our hospital with dysphagia and back pain. Contrasted computed tomography showed “Shaggy aorta” forming a saccular descending aortic aneurysm with edematous esophagus. Low density area in the intramuscular layer of the esophagus suggested the possibility of connection between the esophagus and the aneurysm. The patient underwent endovascular treatment of the aneurysm. The postoperative course was uneventful, and the patient was discharged from the hospital with improvement in his symptoms. Although there are reports suggesting endovascular treatment as a contraindication for shaggy aorta due to risk of embolization, it may be considered as an option for a patient who is in need of surgical treatment.

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Coronary artery aneurysms and fistulas are very rare congenital anomalies. They occur in 0.2%–0.4% of all congenital heart diseases. In this article, we report a case of a 39-year-old girl with a left coronary artery aneurysm and fistula draining into the right atrium. An intervention is successfully achieved by transcatheter occluder embolization using a patent ductus arteriosus (PDA) occluder.

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Adenoid cystic carcinoma (ACC), which is a subtype of the nonpapillary adenocarcinoma of the thymus, is extremely rare. We report a patient with thymic carcinoma with ACC-like features presented with multiple bone and pulmonary metastases that underwent surgery. The present case firstly demonstrated that thymic carcinoma with ACC-like features could have metastatic potential.

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Anomalous origin of the left coronary artery (LCA) from the right coronary artery sinus is a rare congenital coronary anomaly. We report a case of a 48-year-old symptomatic man who was admitted to our clinic with a history of hypertension, type 2 diabetes mellitus, myocardial infarction and hypercholesterolemia. Coronary angiography was performed revealing anomalous left coronary artery from the right coronary artery sinus. In addition, stenosis of RCA and well developed stenotic diagonal artery were detected with coronary angiography. We performed coronary by-pass with left internal mammarian artery to diagonal artery and vena saphena to right coronary artery (RCA). Both coronary angiography and intraoperative view should be evaluated well in patients with anomalous of the coronary artery.

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A 52-year-old man with massive hemoptysis underwent a left upper lobectomy. He suddenly reported a severe headache and lost consciousness on postoperative day 4. Computed tomography of the brain demonstrated a subarachnoid hemorrhage due to right vertebral artery dissection. Fortunately, he recovered well with intensive neurosurgical treatment. Vertebral artery dissection sometimes develops following systemic vascular disease, infection, and even minor neck trauma such as hyperextension or torsion of the neck. We should be aware that vertebral artery dissection may cause postoperative stroke and subarachnoid hemorrhage.

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We would like to discuss this rare case of an orthotopic heart transplantation in a recipient with an unknown history of persistent left superior vena cava.

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A secondary aortoenteric fistula is a relatively rare complication of abdominal aortic reconstruction. The clinical manifestation of aortoenteric fistula is usually upper gastrointestinal bleeding. We report a patient who developed acute aortic occlusion following chronic cellulitis, which is an uncommon finding. A 50-year-old man with a history of aortobifemoral bypass grafting was admitted for tiredness, fever and swelling of his right leg. On the 40th day of admission, he developed acute aortic occlusion. Computed tomography revealed right distal aortic graft occlusion and the presence of gas surrounding the graft. Gastroduodenoscopy showed an underlying Dacron graft consistent with an aortoenteric fistula in the third part of the duodenum. We excised the infected graft and reconstructed the abdominal aorta with a new prosthetic graft in situ, which was wrapped with the vascularized pedicle of the omentum. The duodenal defect was repaired with segmental duodenal resection and end-to-end anastomosis. The patient recovered well after surgical management and has remained in good condition for 2 years without developing any signs of recurrence of infection.

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Pulmonary sequestration is a rare anomaly, which does not have a connection with the bronchial system and gets its blood supply, generally, from the aorta or its branches. Anatomically, two different forms were described: intralobar and extralobar. Although 74% of intralobar pulmonary sequestrations get their blood supply from the descending thoracic aorta, they may get their blood supply from different arteries. Furthermore, there is more than one arterial anomaly in 14.8% of cases. We report an intralobar pulmonary sequestration, in which arterial blood supply is from two different origins (Arcus aorta and celiac trunk). To the best of our knowledge, this is the first case in the literature.

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Management of aorto-esophageal fistula has no consensus, currently. Aorto-esophageal fistula remains a life-threatening condition and has high mortality and morbidity rates. Endovascular therapy is a favorable choice for thoracic aortic disease, in recent years. We present our experience initially managed with endovascular therapy, but there was a re-hemorrhage event with suboptimal results. Aortic bypass surgery and plastic surgery of the esophagus have been performed, subsequently. The aorto-esophageal fistula was finally resolved by surgical management. We conclude that endovascular therapy is a reasonable method for aorto-esophageal fistula in the acute hemorrhagic phase, but early treatment of an erosive esophagus is suggested to avoid further morbidity.

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A 65-year-old woman with exercise-related dyspnea was admitted to our hospital. Transthoracic echocardiography demonstrated a large anomalous papillary muscle that originated from the posterior wall of the left ventricle and severe mitral valve regurgitation in systole. Cleft suture, 5-0 polytetrafluoroethylene sutures from a single papillary muscle to the anterior commissure leaflet (AC), 5-0 polypropylene sutures between AC and A1, and between A1 and A2, the double-orifice technique, and ring plasty with 32-mm semi-rigid ring was performed. Postoperative echocardiography showed an improvement in severe mitral valve regurgitation. At the 2-month follow-up, the patient was in good health. In the present case, the elderly patient with an isolated parachute mitral valve but without any other cardiac anomaly and presenting with mitral valve regurgitation is extremely rare. This case of mitral valvuloplasty for a parachute mitral valve with a single papillary muscle in an elderly woman has not been reported before.

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Aortic pseudoaneurysm is a rare, life-threatening complication after cardiac or aortic surgery. In this article, we report reoperation on an 86-year-old man undergoing total arch replacement and omentoplasty for an infectious aortic aneurysm, 5 years previously. He was transferred to our hospital and fell into shock. Prompt drainage of the right-side pleural cavity manifested 2000 ml of blood. Computed tomography revealed contrast extravasation into a pseudoaneurysm, which arose from the proximal anastomotic site of the ascending aorta. The patient underwent emergent surgery that included an extremely careful dissection of the omentum and pericardial adherences, through the re-sternotomy. The patient recovered without neurological sequelae.

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Cardiac myxoma represents the most common primary cardiac neoplasm, accounting for nearly 75% of benign cardiac tumor. Tumor embolisms occur in 30% to 40% of patients with myxoma, and half of these are cerebral arteries. To our knowledge, this is the first published report of multiregional tumor embolizations except for cerebral artery and Takotsubo cardiomyopathy in patients with left atrial myxoma.

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