Annals of Thoracic and Cardiovascular Surgery
Online ISSN : 2186-1005
Print ISSN : 1341-1098
ISSN-L : 1341-1098
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Displaying 1-47 of 47 articles from this issue
  • Tomohiro Nakajima, Yutaka Iba, Syuichi Naraoka, Tsuyoshi Shibata, Shin ...
    Article ID: cr.22-00044
    Published: 2022
    Advance online publication: May 19, 2022
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    We present a case report of a 30-year-old Marfan syndrome patient who underwent a David procedure for severe aortic valve insufficiency and Valsalva aneurysm. Harvested aortic walls were examined by pathologists. Although the tunica media of the ascending aorta contained aligned elastic fibers, the aortic root media lacked aligned elastic fibers.

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  • Ikki Takada, Ryosuke Amemiya, Shotaro Ono, Keni Kou, Yukio Morishita, ...
    Article ID: cr.22-00026
    Published: 2022
    Advance online publication: May 10, 2022
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    Castleman’s disease with calcification of the chest wall is very rare, and there have been few reports of such cases to date. A 57-year-old woman was referred to our hospital for a tumor with calcification on her left lateral chest wall, which was detected on chest computed tomography. Findings of her chest magnetic resonance imaging suggested schwannoma or a solitary fibrous tumor, and therefore, we performed surgery for diagnostic and therapeutic purposes. Pathologically, the tumor with calcification was diagnosed as Castleman’s disease of the hyaline-vascular type. After the surgery, the patient has had no obvious symptoms and continues to undergo regular follow-up examinations.

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  • Takeshi Uzuka, Masanori Nakamura, Hirotaro Sugiyama, Mayo Kondo, Junic ...
    Article ID: oa.21-00093
    Published: 2022
    Advance online publication: May 10, 2022
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    Purpose: This study focused on clarifying the durability of bioprosthetic valves in current practice.

    Methods: A total of 238 consecutive patients who underwent aortic valve replacement at a single institution from 2011 to 2020 were reviewed. We evaluated valve-related outcomes such as structural valve deterioration (SVD), especially in dialysis patients who received bioprosthetic valve.

    Results: Among the tissue valves implanted in 212 patients, 5 SVDs were recorded and 3 valves were replaced. All early valve failures occurred in relatively young dialysis patients and were recorded 3 to 5 years after the initial operation. Freedom from SVD at 6 years was 49.9% in patients on dialysis, compared with 100% in non-dialysis patients. Predictors of better survival in dialysis patients were better preoperative functional class and larger prosthetic valve size.

    Conclusions: The durability of bioprosthetic valves in the aortic position was suboptimal in dialysis patients. Mechanical valves can be an option for young, healthy dialysis patients with a large aortic valve annulus.

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  • Kuniyo Sueyoshi, Kosuke Otsubo, Shinya Hirota, Fumitsugu Kojima, Toru ...
    Article ID: cr.22-00042
    Published: 2022
    Advance online publication: May 09, 2022
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    Ingested sharp foreign bodies rarely migrate extraluminally into adjacent organs such as the pharynx, lungs, and liver. Herein, we report a case of fish bone ingestion where the foreign body followed a unique migration trajectory. Computed tomography revealed a fish bone extraluminally located in the aortopulmonary space in the left mediastinum and peri-esophageal pneumomediastinum. Endoscopic examination indicated no injury to the esophageal mucosa but showed mucosal lacerations in the left hypopharynx. Accordingly, we reasoned that the fish bone penetrated the laryngopharynx and then descended in the mediastinum.

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  • Yohei Yamamoto, Hidetoshi Uchiyama, Masahiro Oonuki
    Article ID: oa.21-00258
    Published: 2022
    Advance online publication: April 07, 2022
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    Purpose: To analyze our contemporary experience in open abdominal aortic aneurysm (AAA) repair. We focused on the effects of suprarenal (SR) aortic cross-clamping and adjunctive renal reconstruction (RR) on postoperative outcomes.

    Methods: We retrospectively reviewed our institutional data of 141 consecutive patients who received elective open AAA repair between January 2014 and December 2020.

    Results: Seventy-five procedures were performed with SR aortic cross-clamping, 20 of which required an adjunctive RR. Patients in the SR group had a higher incidence of postoperative acute kidney injury (AKI) (18.7% vs. 7.6%, P = 0.045). There were no significant between-group differences in other major complications. The 30-day mortality rate in the infrarenal (IR) and SR groups was 0% and 1.3%, respectively. After a median follow-up of 33 months, the rates of chronic renal decline in the IR (18.2%) and SR (21.3%) groups were similar. All reconstructed renal arteries were patent without reintervention. The 5-year overall survival rate in the IR and SR groups was 88.8% and 83.2%, respectively.

    Conclusions: SR aortic cross-clamping was associated with postoperative AKI but neither SR aortic cross-clamping nor RR affected the long-term renal function or mortality. Open repair remains an essential option for patients with AAA, especially those with complex anatomy.

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  • Katsutoshi Seto, Rika Nohara, Yusuke Sugita, Hironori Ishibashi, Kenic ...
    Article ID: cr.22-00035
    Published: 2022
    Advance online publication: April 06, 2022
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    Pulmonary mucormycosis is an extremely rare disease. It often occurs in immunocompromised patients, such as patients with diabetes and those on long-term steroid use. The prognosis of the disease is poor despite the administration of antifungal agents and removal of the necrotic tissue. Herein, we present a successfully treated case of pulmonary mucormycosis in a patient with type 2 diabetes who underwent left pneumonectomy because of the involvement of the left main pulmonary artery and the left main bronchus. Irrespective of the infected organ, complete debridement of the infected tissue and treatment with antifungal agents are essential for treating mucormycosis.

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  • Naoshi Minamidate, Noriyuki Takashima, Takeshi Kinoshita, Tomoaki Suzu ...
    Article ID: oa.21-00255
    Published: 2022
    Advance online publication: April 05, 2022
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Purpose: Transit-time flow measurement (TTFM), consisting of pulsatility index (PI), mean graft flow, and diastolic filling, is mainly used as a bypass assessment for coronary artery disease (CAD). However, little was known about TTFM in the case of coronary malperfusion (CMP). This study aimed to clarify the difference in the results of TTFM between two different diseases.

    Methods: Between 2010 and 2020, 138 patients underwent aortic surgery and coronary artery bypass grafting (CABG) with vein grafts. Patients were divided into two groups: CMP (n = 26) and CAD (n = 27). Their results were compared. The primary endpoints were the results of TTFM. Secondary endpoints were the relation between TTFM and mortality, morbidity, and short-term patency in each group.

    Results: The PI in the CMP group was significantly higher than the other group (4.7 ± 2.9 vs. 3.4 ± 1.9, p = 0.04). There was no statistical significance in the other two elements. In both groups, the short-term graft patency, mortality, and morbidity but for cardiac tamponade did not significantly change depending on the TTFM results.

    Conclusions: Patients with CMP tended to have a higher PI than those with CAD. With additional CABG for aortic dissection, insufficient TTFM results did not necessarily mean poor short-term graft patency, complications, or case mortality.

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  • Masahide Komagamine, Kan Nawata, Shota Kita, Kiyoshi Chiba, Shingo Kuw ...
    Article ID: cr.22-00002
    Published: 2022
    Advance online publication: March 26, 2022
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    From April 2018 to February 2021, 150 patients underwent MitraClip implantation for severe functional mitral regurgitation (MR) at our hospital. Two of our patients, an 85-year-old man and an 84-year-old woman, developed a single leaflet device attachment in the acute phase after the implantation and had severe residual MR requiring surgical correction. The recurrent MR was first pointed out on day 5 and day 4, and the duration between MitraClip implantation and surgery was 13 and 55 days, respectively. Due to strong adhesions with the clips and severe valve damage after MitraClip implantation, both cases underwent mitral valve replacement with a good postoperative course. In patients with a high-risk baseline profile, surgical mitral valve replacement after failed MitraClip implantation should be considered at an optimal timing, and a detailed echocardiographic follow-up is required.

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  • Ryosuke Amemiya, Ikki Takada, Taisuke Matsubara, Shotaro Ono, Yukio Mo ...
    Article ID: cr.22-00009
    Published: 2022
    Advance online publication: March 25, 2022
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    Supplementary material

    A 51-year-old man who noticed discomfort in the pharynx was found to have a tracheal tumor on physical examination. He was diagnosed as having adenoid cystic carcinoma by a transbronchial biopsy and underwent tracheal segmental resection via a collar incision. He was additionally treated with radiation therapy owing to a positive surgical margin, and he subsequently developed anastomotic tracheal stenosis. Silicon stent placement to open the airway was performed for the tracheal stenosis. One year after stent placement, the trachea was dilated, so the stent was removed, and he is still under follow-up without recurrence free 1.5 years after stent replacement.

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  • Takuma Mikami, Hiroki Uchiyama, Toshiyuki Maeda, Shinji Nakashima, Mur ...
    Article ID: cr.21-00269
    Published: 2022
    Advance online publication: March 23, 2022
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    A 56-year-old man with a history of left nephrectomy for Wilms’ tumor on chronic hemodialysis underwent aortic valve neocuspidization using autologous pericardium (Ozaki procedure) for aortic stenosis (AS) due to a bicuspid aortic valve 6 years ago. The AS gradually progressed and a decrease in the left ventricular ejection fraction was observed. Because of this, we decided to perform reoperative aortic valve replacement using a mechanical valve. Intraoperative findings showed severe calcification at the site where the autologous pericardium was sutured to the annulus. However, the degeneration of the valve leaflets themselves was mild. While excellent mid-term results have been reported for the Ozaki procedure, the long-term results are still unclear. In this case, the annulus was severely calcified, which reduced the mobility of the leaflet. We report the first case of AS progression requiring reoperation in the long-term period after the Ozaki procedure.

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  • Atsushi Kamigaichi, Hiroaki Harada, Satoshi Shibata
    Article ID: oa.21-00274
    Published: 2022
    Advance online publication: March 16, 2022
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    Supplementary material

    Purpose: This study investigated the impact of skeletal muscle quality on the outcomes of patients undergoing surgery for early-stage non–small-cell lung cancer (NSCLC).

    Methods: A total of 98 patients with pathological stage I–II NSCLC who underwent lobectomy or segmentectomy were retrospectively analyzed. Along with skeletal muscle quantity, muscle quality was evaluated by intramuscular adipose tissue content (IMAC) at the first lumbar vertebral level; a higher IMAC indicates lower skeletal muscle quality. Patients were divided into two groups according to the gender-specific quartiles of IMAC, and the prognostic impact of IMAC was investigated.

    Results: No significant differences in the body and skeletal mass indices, which indicate skeletal muscle quantity, were observed between patients with high and those with normal IMAC. Patients with high IMAC (n = 23) showed a significantly poorer prognosis in overall and disease-specific survivals than those with normal IMAC (n = 75; P <0.001 and P = 0.048, respectively). In a bivariate analysis that included other clinicopathological factors, a high IMAC was independently associated with worse overall survival.

    Conclusion: The skeletal muscle quality evaluated by IMAC could be used to predict survival risk after surgery for early-stage NSCLC.

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  • Riki Sumiyoshi, Hideki Morita, Sho Kusadokoro, Kento Fujii, Hiroyuki K ...
    Article ID: cr.21-00214
    Published: 2022
    Advance online publication: March 10, 2022
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Werner’s syndrome (WS) is a genetic disorder presenting with premature senility. In the present study, we performed minimally invasive cardiac surgery (MICS)-aortic valve replacement (AVR) on a patient with Werner’s syndrome who presented with aortic stenosis. The patient, a 49-year-old Japanese man, was brought to the emergency room with dyspnea during exercise. On echocardiography, severe aortic stenosis was found and surgery was planned. He had poorly controlled diabetes mellitus and underwent MICS-AVR to avoid the risk of sternal osteomyelitis, which resulted in a good outcome. The aortic valve had sclerotic changes and a genetic disease was suspected based on the onset of aortic stenosis at a young age, characteristic appearance, and various signs of aging. Genetic testing led to the diagnosis of WS.

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  • Josef Vodička, Jan Geiger, Alexandra Židková, Pavel Andrle, Hynek Mírk ...
    Article ID: oa.21-00147
    Published: 2022
    Advance online publication: March 08, 2022
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Purpose: The aims of this work were the retrospective analysis of a cohort of patients with acute mediastinitis treated at the authors’ worksite over a 15-year period and the identification of factors that significantly affect the outcomes of the therapy.

    Methods: During the period 2006–2020, 80 patients with acute mediastinitis were treated. Within the cohort, the following were observed: the causes and the type of acute mediastinitis, length of anamnesis, comorbidities, diagnostic methods, time from the diagnosis to surgery, types and number of surgical procedures, results of microbiological tests, complications, and outcomes of the treatment.

    Results: The most common type of acute mediastinitis was descending mediastinitis (48.75%). A total of 116 surgical procedures were performed. Ten patients in the cohort died (12.5%). Patients older than 60 years were at a 6.8 times higher risk of death. Patients with more than two comorbidities were at a 14.3 times higher risk of death. The presence of yeasts in the culture material increased the risk of death by 4.4 times.

    Conclusion: Early diagnosis, removal of the cause of mediastinitis, sufficient mediastinal debridement, and multiple drainage thereof with the possibility of continual postoperative lavage are essential for the successful treatment of acute mediastinitis.

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  • Zhao An, Yang-Yong Sun, Rui-Xin Fan, Shi-Qiang Yu, Jun-Ming Zhu, Qing- ...
    Article ID: oa.21-00261
    Published: 2022
    Advance online publication: February 26, 2022
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    Supplementary material

    Purpose: In this study, we compared the early results between the extensive arch repair with a novel two-branched stent graft (TSG) and the traditional technique.

    Methods: Between 2013 July and 2015 March, 63 acute type A aortic dissection (ATAAD) patients from four cardiac centers with indications for extensive arch repair were included in this study. Finally, 28 patients were involved in the traditional procedure (TP) group (23 males with the age of 49.75 ± 9.26 years) and 35 patients were involved in the TSG group (29 males with the age of 53.82 ± 8.17 years).

    Results: The operation was successful in all patients. The selective cerebral perfusion time, total operation time, and chest drainage within 24 hours after the operation in the TSG group were significantly less than those in the TP group (P ≤0.05). The mean follow-up time was 11.17 ± 1.74 months in the TP group and 11.94 ± 4.29 months in the TSG group. No statistical differences were found in aortic diameter, false lumen diameter, and true lumen diameter at the diaphragmatic level during the follow-up.

    Conclusion: Our technique with a novel TSG simplified the extensive arch repair procedure and was an effective way for the treatment of ATAAD.

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  • Francis P. Cheung, Cheng He, Philippa R. Eaton, Jim Dimitriou, Andrew ...
    Article ID: oa.21-00170
    Published: 2022
    Advance online publication: February 09, 2022
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Background: Concomitant mitral regurgitation (MR) is frequently seen in patients undergoing surgical aortic valve replacement (AVR) for severe aortic stenosis (AS). When the severity of MR is moderate or less, the decision to undertake simultaneous mitral valve intervention can be challenging.

    Methods: A systematic search of Medline, PubMed (NCBI), Embase and Cochrane Library was conducted to qualitatively assess the current evidence for concomitant mitral valve intervention for MR in patients with AS undergoing AVR. The primary outcome for this systematic review was the postoperative change in the severity of MR and other outcomes of interest included factors that predict improvement or persistence of MR and long-term impacts of residual MR.

    Results: A total of 17 studies were included. The percentage of patients demonstrating improvement in MR severity following AVR ranged from 17.2% to 72%; the studies that exclusively included patients with moderate functional MR and reported longer term echocardiographic follow-up of greater than 12 months demonstrated an improvement in MR severity of 45% to 72%.

    Conclusion: This systematic review demonstrates that a proportion of patients can exhibit an improvement in MR following isolated surgical AVR, but whether this confers any long-term morbidity and mortality benefit remains unclear.

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  • Ryumon Matsumoto, Toshiki Fujiyoshi, Kentaro Kamiya, Jun Matsubayashi, ...
    Article ID: cr.21-00226
    Published: 2022
    Advance online publication: January 29, 2022
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    A patient underwent surgical resection twice for primary and metastatic dedifferentiated liposarcomas. Computed tomography revealed a tumor mass at the cavoatrial junction. Prompt surgical resection of the tumor with thrombectomy was successfully performed using cardiopulmonary bypass with hypothermic circulatory arrest. Despite the poor prognosis of metastatic or recurrent liposarcoma, the patient has survived for 8 years since the first tumor resection.

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  • Tomohiro Fujita, Shigeyuki Morino, Akihiro Nakamura
    Article ID: oa.21-00216
    Published: 2022
    Advance online publication: January 29, 2022
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Purpose: The surgical approach for anatomical lung resection includes open thoracotomy, video-assisted thoracoscopic surgery, and robot-assisted thoracoscopic surgery. We evaluated the short-term outcomes and the learning curve wherein a thoracic resident doctor consecutively performed video-assisted thoracoscopic anatomical lung resection for lung cancer.

    Methods: We retrospectively reviewed 91 cases of consecutive video-assisted thoracoscopic anatomical lung resections for lung cancer performed by a thoracic resident doctor between November 2017 and March 2020. The thoracic resident doctor had no previous experience performing video-assisted thoracoscopic or open anatomical lung resection.

    Results: Lobectomy was performed in 80 cases. Simple segmentectomy was performed in 11 cases. No cases required intraoperative conversion to open thoracotomy. The median operative time and blood loss were 148 min and 10 ml, respectively. There were no serious postoperative complications or deaths 30 days after surgery. The learning curve was examined using the cumulative sum method with operative time as a factor, and it took 21 cases to attain experience.

    Conclusion: Our resident doctor safely performed video-assisted thoracoscopic anatomical lung resections and it took 21 cases to stabilize the surgical technique. The surgical technique was possibly stabilized earlier than previously reported, although this was a study of a single resident doctor.

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  • Hirotoshi Suzuki, Shota Kita, Masahide Komagamine, Daijun Tomimoto, Ki ...
    Article ID: cr.21-00193
    Published: 2022
    Advance online publication: January 25, 2022
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    The patient was a 69-year-old man who underwent emergency surgery for acute aortic dissection that developed 5 months after coronary artery bypass grafting. The left internal thoracic artery (LITA) graft anastomosed to the left descending artery was not affected by the aortic dissection, and during the ascending aortic replacement, the artery was not identified for clamping. Although fully sufficient cardioplegia was not achieved due to the patent LITA graft, the patient’s postoperative cardiac function was good. The two anastomotic sites of the vein grafts to the ascending aorta were excised along with a remnant of the aortic wall in an island fashion and were reimplanted onto the artificial graft. Based on the site of intimal tear, we speculated that partial clamping during the previous surgery had caused the dissection.

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  • Toshiaki Fukutomi, Yusuke Taniyama, Chiaki Sato, Hiroshi Okamoto, Hiro ...
    Article ID: cr.21-00203
    Published: 2022
    Advance online publication: January 25, 2022
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Purpose: With de novo cancer, esophagectomy after lung transplantation (LTx) can be challenging because of intrathoracic adhesions, delayed wound healing, and postoperative pulmonary complications, which might be lethal.

    Case Presentation: A 52-year-old woman with esophageal cancer had undergone bilateral LTx for end-stage diffuse panbronchiolitis at 50 years of age. Thoracoscopic esophagectomy was performed. Bilateral bronchial arteries and subcarinal and bilateral bronchial lymph nodes were preserved to maintain blood supply to the transplanted bronchi. No ischemic changes were observed in either bronchi. The patient’s postoperative course was uneventful. Although she underwent chemoradiation therapy for recurrence at the left cervical paraesophageal lymph node, she remains alive with good disease control and well-maintained respiratory function.

    Conclusion: Minimally invasive surgery with careful attention to blood supply to the transplanted bronchi was useful for treating esophageal cancer after LTx.

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  • Kambiz Hassan, Tabea Brüning, Michael Caspary, Peter Wohlmuth, Holger ...
    Article ID: oa.21-00154
    Published: 2022
    Advance online publication: January 20, 2022
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Objective: To analyze the results of hemoadsorption in patients with cardiac surgery to thoracic aortic surgery, who had been loaded beforehand with either Factor Xa inhibitor rivaroxaban or P2Y12 receptor antagonist ticagrelor.

    Methods: We investigated 21 of 171 consecutive patients (median age 71 [interquartile range 62, 76] years) who underwent emergency cardiac operations for acute type A aortic dissection between 2014 and 2020. These patients were pretreated with rivaroxaban (n = 9) or ticagrelor (n = 12). In ten of 21 cases (since 2017), we installed a hemoadsorber into the heart–lung machine and compared the results to eleven patients done without hemoadsorber before that time.

    Results: The operation time was significantly shorter in the adsorber group (286 ± 40 min vs. 348 ± 79 min; p = 0.045). The postoperative 24-hour drainage volume was significantly lower after adsorption (p <0.001; 482 ± 122 ml vs. 907 ± 427 ml) and no rethoracotomy had to be performed (compared to two rethoracotomies [18.9%] among patients without adsorber use). Also, patients without hemoadsorption required significantly more platelet transfusions (p = 0.049).

    Conclusions: In patients with acute type A aortic dissection who were pretreated with rivaroxaban and ticagrelor, the intraoperative use of CytoSorb hemoadsorption during cardiopulmonary bypass is reported for the first time. The method was found to be effective to prevent from bleeding and to improve the outcome in aortic dissection.

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  • Philip Dueppers, Lorenz Meuli, Benedikt Reutersberg, Michael Hofmann, ...
    Article ID: oa.21-00206
    Published: 2021
    Advance online publication: December 22, 2021
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    Supplementary material

    Purpose: To compare open versus endovascular left subclavian artery debranching for thoracic endovascular aortic repair of thoracic aortic pathologies.

    Methods: This is a retrospective study of patients receiving left subclavian artery debranching in our institution from October 2009 to January 2020. The primary outcome was freedom from aortic reintervention. Secondary outcomes were type I endoleaks, left subclavian artery (LSA) debranching failure, stroke, technical or clinical success, procedure-related reintervention, as well as 30-day or overall all-cause and aorta-related mortality.

    Results: Forty-eight patients received parallel graft-based (n = 24, ENDO; median age 75 years [70–80 years]) or open (n = 24, OPEN; median age 71 years [59–75 years]) debranching for type B aortic dissection (n = 25), degenerative aneurysm (n = 12), type IA endoleak (n = 6), suture-associated (n = 3) or ostial LSA aneurysm (n = 1), or penetrating aortic ulcer (n = 1). The median follow-up was 36 months (13–61 months). After 16 months, aortic reintervention-free survival in groups OPEN and ENDO was 91% (95% confidence interval [CI]: 79 to 100%) and 86% (73 to 100%) (p = 0.71), respectively. After 36 months, all-cause survival in groups OPEN and ENDO was 74% (95% CI: 55 to 99%) and 79% (95% CI: 64 to 97%) (p = 0.74), respectively; freedom from aorta-related mortality was 81% (95% CI: 62 to 100%) and 91% (95% CI: 80 to 100%) (p = 0.78), respectively. Group OPEN presented less type I endoleaks (OPEN/ENDO = 3/19, p <0.001) and higher technical (OPEN/ENDO = 81/36%, p = 0.003) and clinical success rates (OPEN/ENDO = 67/36%, p = 0.047). No statistical differences were found for other outcomes.

    Conclusion: Both strategies achieved comparable reintervention and mortality rates, but open debranching should be preferred due to its higher technical and clinical success and less type I endoleaks.

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  • Gregory A. Nuttall, Mark M. Smith, Bradford B. Smith, Jon M. Christens ...
    Article ID: oa.21-00222
    Published: 2021
    Advance online publication: December 22, 2021
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    Supplementary material

    Purpose: High-dose heparin has been suggested to reduce consumption coagulopathy.

    Materials and Methods: In a randomized, blinded, prospective trial of patients undergoing elective, complex cardiac surgery with cardiopulmonary bypass, patients were randomized to one of three groups: 1) high-dose heparin (HH) receiving an initial heparin dose of 450 u/kg, 2) heparin concentration monitoring (HC) with Hepcon Hemostasis Management System (HMS; Medtronic, Minneapolis, MN, USA) monitoring, or 3) a control group (C) receiving a standard heparin dose of 300 u/kg. Primary outcome measures were blood loss and transfusion requirements.

    Results: There were 269 patients block randomized based on primary versus redo sternotomy to one of the three groups from August 2001 to August 2003. There was no difference in operative bleeding between the groups. Chest tube drainage did not differ between treatment groups at 8 hours (median [25th percentile, 75th percentile] for control group was 321 [211, 490] compared to 340 [210, 443] and 327 [250, 545], p = 0.998 and p = 0.540, for HH and HC treatment groups, respectively). The percentage of patients receiving transfusion was not different among the groups.

    Conclusion: Higher heparin dosing accomplished by either activated clot time or HC monitoring did not reduce 24-hour intensive care unit blood loss or transfusion requirements.

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  • Takashi Yamauchi
    Article ID: nm.21-00228
    Published: 2021
    Advance online publication: December 16, 2021
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Intraoperative bleeding from the distal anastomotic site during graft replacement of the arch to distal arch via median sternotomy to treat an aortic aneurysm is sometimes difficult to control because of the limited distal view. I herein report a case in which I addressed this uncontrollable bleeding using a commercialized frozen elephant trunk.

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  • Shenhai Wei, Bingqun Wu, Jintao Tian, Xiaoping Song
    Article ID: cr.21-00213
    Published: 2021
    Advance online publication: December 13, 2021
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Purpose: Reconstruction of the esophagus with sternohyoid muscle after enucleation of the cervical esophageal leiomyosarcoma (ELS) was rarely reported.

    Methods: A case of 55-year-old female with a large leiomyosarcoma in the cervical esophagus was reported. The tumor was enucleated, and the defect of the esophagus was patched with left sternohyoid muscle flap.

    Results: The patient recovered uneventfully after surgery. She has not had any discomfort with swallowing since surgery, and nowadays, there is not any recurrence and metastasis being detected.

    Conclusion: It is minimal invasive and simple to enucleate the cervical ELS and patch the defect of esophagus with sternohyoid muscle flap. For some selected patients, this method may be a promising surgical procedure to achieve both good swallowing function and satisfying prognosis.

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  • Mitsuharu Hosono, Hiroshi Yasumoto, Shintaro Kuwauchi, Yoshino Mitsuna ...
    Article ID: oa.21-00131
    Published: 2021
    Advance online publication: December 07, 2021
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Purpose: The effect of our comprehensive strategy to reduce pain after minimally invasive mitral valve repair through a right mini-thoracotomy was assessed retrospectively.

    Methods: Our comprehensive strategy constituted the following: planned rib cutting to avoid rib injury, sufficient intercostal muscle division to mobilize the cut rib, limiting the number of intercostal ports, avoiding nerve entrapment, continuous extra-pleural intercostal nerve block, and regular use of oral non-steroidal anti-inflammatory drugs. We compared patients treated with this comprehensive strategy (Group S, n = 13) and patients before this strategy was implemented (Group C, n = 13). We used a numerical rating scale (NRS) as a pain scale during the first 3 days postoperatively.

    Results: The average NRS was significantly lower in Group S (0.82 ± 0.49) than in Group C (2.40 ± 1.46) (P <0.01). The maximum NRS was also significantly lower in Group S (3.23 ± 1.17) than in Group C (5.69 ± 2.43) (P <0.01). The number of patients using additional single-dose analgesic were significantly less in Group S (23.1%) than in Group C (84.6%) (P <0.01).

    Conclusion: Our comprehensive pain control strategy effectively reduced postoperative pain in minimally invasive mitral valve repair.

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  • Ryohei Sasamori, Satoru Motoyama, Yusuke Sato, Akiyuki Wakita, Yushi N ...
    Article ID: cr.21-00175
    Published: 2021
    Advance online publication: December 03, 2021
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    The advantages of salvage esophagectomy through robotic-assisted surgery for patients with clinically diagnosed tumor invasion of adjacent vital organs (cT4b) or patients with scar tissue from definitive chemoradiotherapy (dCRT) are still only rarely reported. A man in his 60s with middle thoracic esophageal cancer (cT4b [left main bronchus] N1 M0 cStage IIIC) received dCRT (60 Gy). After the chemoradiotherapy, upper gastrointestinal endoscopy revealed a residual primary tumor, and we performed robotic-assisted thoracoscopic subtotal esophagectomy and gastric tube reconstruction via a retrosternal route with three-field lymphadenectomy. Although it was difficult to dissect the tumor from adjacent organs, especially the left main bronchus and left inferior pulmonary vein, due to loss of the dissecting layer and scarring, R0 surgery was achieved. With robot-assisted thoracoscopic surgery, the high-magnification, high-resolution, and three-dimensional images; the stable surgical field with full countertraction made with the robotic arm forceps, which were readily adjusted; and the stable motion of the robotic arm without physiological tremor are considerable advantages for salvage esophagectomy for cT4b tumors. It goes without saying that sufficient experience with robot-assisted surgery and sufficient understanding and surgical skill in esophageal cancer surgery under suitable surgical indications and timing are required to make use of these advantages.

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  • Mikito Suzuki, Hirotoshi Horio, Azusa Yamada, Reiko Shimizu, Toshiyuki ...
    Article ID: cr.21-00198
    Published: 2021
    Advance online publication: December 03, 2021
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Cholesterol granulomas of the thymus are extremely rare benign entities. Herein, we describe a case of cholesterol granuloma in a 45-year-old man who presented with multifocal anterior mediastinal lesions on computed tomography (CT). Positron emission tomography (PET)–CT revealed increased fluorodeoxyglucose uptake, with a maximum standardized uptake value of 8.3. Diffusion-weighted magnetic resonance imaging (MRI) revealed extreme hypointensity. He underwent total thymectomy by median sternotomy for presumed multiple thymoma. On histopathological analysis, cholesterol granuloma of the thymus was confirmed, and the patient had an uneventful postoperative course without recurrence for 28 months. Cholesterol granuloma of the thymus is a PET–CT-positive benign tumor with unique histological findings. The MRI findings were indicative of hypocellularity associated with a benign entity, whereas the PET–CT findings corresponded to granulomatous inflammation. Therefore, concurrent use of PET–CT and MRI can be helpful in distinguishing between benign cholesterol granulomas and malignant anterior mediastinal tumors.

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  • Yonghua Bi, Hongmei Chen, Wenguang Zhang, Xinwei Han, Jianzhuang Ren
    Article ID: cr.21-00120
    Published: 2021
    Advance online publication: November 03, 2021
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    We report the use of the guidewire lasso technique for the removal of an embedded esophageal self-expanding metal stent (SEMS), following a failure of distal to proximal invagination by removal hook caused by stent incorporation. During a removal procedure of an embedded SEMS using the hook retrieval device, the strut fractured and the stent retained. Attempts to pull up the retained stent using hook were not effective. Thus, the lasso technique with a guidewire over the retained stent was performed and successfully removed with no procedure-related complications. The patient is alive without dysphagia after 3 months follow-up.

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  • Shunsuke Eba, Shuhei Nishiyama, Hirotsugu Notsuda, Hisashi Oishi, Masa ...
    Article ID: cr.21-00144
    Published: 2021
    Advance online publication: October 23, 2021
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Neurological paraneoplastic syndrome is a relatively rare condition in patients with malignant tumors. Recently, it has been reported that anti-Aquaporin 4 (AQP4) antibody is highly specific for neuromyelitis optica. The patient was a 76-year-old man. He underwent right upper lobectomy for squamous cell carcinoma of the lung. Although the immediate postoperative course was uneventful, neurological symptoms became apparent from postoperative day (POD) 4. Magnetic resonance imaging showed longitudinally extended edematous lesions in the spinal cord, and a cerebrospinal fluid examination was positive for anti-AQP4 antibody, leading to the diagnosis of paraneoplastic neuromyelitis optica. Despite multiple rounds of steroid pulse therapy and plasma exchange, the neurological symptoms worsened and the patient died on POD 46. The development of neuromyelitis optica in the early postoperative period could be related to the influence of surgical stress or epidural anesthesia.

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  • Nobuki Ishioka, Takashi Suzuki, Satoshi Yajima, Kentaro Murakami, Yu O ...
    Article ID: oa.21-00195
    Published: 2021
    Advance online publication: October 23, 2021
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    Supplementary material

    Purpose: The prognostic significance of pretreatment serum C-terminus of cytokeratin 19 (CYFRA21-1, CYFRA) status was evaluated in the patients with surgically treated esophageal squamous cell carcinoma.

    Methods: A total of 1047 patients with surgically treated esophageal cancer were enrolled in a multi-institutional study promoted by the Japanese Esophageal Society. This study included an up-front surgery group (n = 412), a neoadjuvant chemotherapy (NAC) group (n = 486), and a neoadjuvant chemoradiation/radiation therapy (NACRT/RT) group (n = 149). The pretreatment CYFRA status was analyzed to assess prognostic significance using multivariate analysis according to treatment modalities.

    Results: The CYFRA-positive group was significantly associated with deep tumor. Univariate analysis showed that the overall survival of the CYFRA-positive group was significantly worse than that of the CYFRA-negative group, but the difference was not significant in the multivariate analysis. CYFRA was an independent risk factor for poor prognosis just in the NACRT/RT group.

    Conclusions: The CYFRA-positive group was associated with deep tumor and poor survival. Pretreatment CYFRA was not an independent risk factor for poor prognosis in the up-front surgery group or NAC group. It was an independent risk factor for poor prognosis just in the NACRT/RT group.

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  • Sami Akbulut, Tevfik Tolga Sahin
    Article ID: lte.21-00031
    Published: 2021
    Advance online publication: September 16, 2021
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
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  • Miho Akabane, Masayuki Urabe, Yu Ohkura, Shusuke Haruta, Masaki Ueno, ...
    Article ID: cr.21-00149
    Published: 2021
    Advance online publication: September 07, 2021
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    A 72-year-old woman with past medical history of rectal cancer resection (adenocarcinoma, pT3N1aM0) presented with a 2-month history of dysphagia. Imaging studies found a thoracic esophageal cancer, for which subtotal esophagectomy with gastric conduit reconstruction via retrosternal route followed by chemoradiotherapy were performed (squamous cell carcinoma, pT4N1M0, RM1). Seven months after the esophagectomy, a contrast-enhanced computed tomography (CT) demonstrated a new asymptomatic mass inside the right atrium. A thrombus or a tumorous lesion was suspected. Positron emission tomography (PET)/CT showed abnormal uptake in the mass. After a thorough discussion by a multidisciplinary oncology group, we performed 1-week anticoagulant therapy first, resulting in mass enlargement. Then tumorectomy was carried out. The final pathological findings revealed that the mass was squamous cell carcinoma, yielding the diagnosis of cardiac metastasis from esophageal cancer. The patient’s postoperative course was unremarkable. PET/CT may help to estimate malignancy and to omit invasive heart surgery.

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  • Xiaoyi Dai, Shengjun Wu
    Article ID: cr.21-00161
    Published: 2021
    Advance online publication: August 26, 2021
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    Supplementary material

    Background: Esophageal foreign body (FB) is usually seen in children, prisoners, or patients with psychiatric disorders, most of which can be removed with endoscope.

    Case Presentation: We herein report a mentally normal adult inadvertently swallowing a needle, which pierced through the esophagus into the adventitia of pulmonary artery. Computed tomography angiography confirmed its specific location, and urgently, surgical removal was performed after the endoscopic attempt. The patient recovered well and was discharged without any complication of the esophageal perforation.

    Conclusion: Surgical treatment should be carried out aggressively if the esophageal FB is out of reach for endoscopic removal or if complications cannot be resolved endoscopically.

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  • Akihiro Sasaki, Tatsuya Kato, Hideki Ujiie, Satoru Wakasa, Setsuyuki O ...
    Article ID: cr.21-00052
    Published: 2021
    Advance online publication: July 16, 2021
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Introduction: Stiff-person syndrome (SPS) is a rare autoimmune neurological disorder. Paraneoplastic SPS associated with malignant tumors such as thymoma occurs in approximately 5% of all SPS cases. We present a rare case of thymoma accompanied by SPS successfully treated using surgery.

    Presentation of Case: A 26-year-old woman presented with lower limbs convulsions and gait disturbance and complained of leg pain. Cerebrospinal fluid and blood test results showed a high level of anti-glutamic acid decarboxylase (GAD) antibodies. Computed tomography showed anterior mediastinal tumor suggestive of a thymoma. She underwent extended thymectomy, and her symptoms gradually improved after surgery. No evidence of recurrent thymoma and SPS has been observed over 44 months.

    Conclusion: Surgical treatment would be effective for patients with SPS and thymoma.

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  • Jin Shiraishi, Takaki Akamine, Seiya Kato, Naoko Miura, Takuro Kometan ...
    Article ID: cr.21-00005
    Published: 2021
    Advance online publication: May 12, 2021
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    Supplementary material

    We report a 33-year-old man who presented with recurrent right pneumothorax. Computed tomography (CT) showed the presence of a large bulla with a maximum diameter of 8 cm in the right middle lobe; he subsequently underwent bullectomy. Histopathology revealed that pulmonary parenchyma adjacent to the bulla represented nodular proliferation of clear cells characterized by a papillary structure resembling placental chorionic villi. Immunohistochemically, clear cells were positive for CD10, suggesting placental transmogrification of the lung (PTL). We reviewed 36 surgical cases of PTL, and only 2 cases (5.6%), including our case, were operated for spontaneous pneumothorax. Bullous lesions secondary to PTL tend to appear as unilateral large cystic masses in non-upper lobes, which is atypical for primary spontaneous pneumothorax (PSP). Although PTL is considered a very rare cause of secondary pneumothorax, we must carefully differentiate this condition.

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  • Boris Duchemann, Ana Maria Portela, Pascal Joudiou, Olivia Freynet, La ...
    Article ID: cr.20-00271
    Published: 2021
    Advance online publication: May 08, 2021
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    In locally advanced non-small-cell lung cancer (NSCLC), mediastinal staging is the cornerstone of the therapeutic decision and echoendoscopy is the most practiced exam to assess the lymph node involvement. We describe a rare case of endobronchial involvement by cells originating from a metastatic lymph node after endobronchial ultrasound (EBUS). A 64-year-old man was diagnosed with a squamous cell lung cancer with mediastinal nodal involvement proven by EBUS. The patient received neoadjuvant chemotherapy with partial response and was scheduled for a lobectomy. Before surgery, a fibroscopy was performed which demonstrated a 1-cm polypoid lesion settled on the internal face of the main right bronchus corresponding to the EBUS puncture site. The histological analysis confirmed tumoral cell in this lesion. The patient was rejected for surgery and undergo chemoradiation. This case highlights the need for a careful endoscopic control before surgical resection in case of prior positive EBUS followed by an interval of time.

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  • Takeo Togo, Jun Atsumi, Miyako Hiramatsu, Kiyomi Shimoda, Kozo Morimot ...
    Article ID: cr.21-00010
    Published: 2021
    Advance online publication: May 08, 2021
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    A 48-year-old woman with extensive clarithromycin-resistant Mycobacterium avium complex pulmonary disease (MAC-PD) was successfully treated by left lower lobectomy and lingulectomy following combination treatment of intravenous/inhaled amikacin plus bronchial occlusion by Endobronchial Watanabe Spigots (EWSs). A left pneumonectomy was initially indicated for removing all the lesions, but the procedure would have been barely tolerated by the patient. However, her preoperative combination treatment sufficiently reduced the lesions requiring resection to allow surgical preservation of the left upper division. This novel approach might be promising for patients with Mycobacterium avium complex lung disease whose pulmonary reserve will not allow an extensive parenchymal resection.

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  • Suguru Mitsui, Yugo Tanaka, Kenji Kimura, Naoe Jimbo, Norio Chihara, Y ...
    Article ID: cr.20-00354
    Published: 2021
    Advance online publication: April 27, 2021
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune inflammatory disease, occasionally accompanied by malignant tumors. Immunosuppressive therapy is the mainstay treatment for idiopathic NMOSD; no guidelines have been published for paraneoplastic NMOSD because it is rarely reported in the literature. We report a rare case of a 67-year-old man with paraneoplastic NMOSD associated with thymic carcinoid whose cells expressed aquaporin-4 antibody. After surgical resection, the patient’s symptoms improved, and serum aquaporin-4 autoantibody turned negative. We believe that radiographic examination for mediastinal tumors in patients with NMOSD is necessary because thymic epithelial tumors could have a role in the pathogenesis of paraneoplastic NMOSD. After mediastinal tumor has been detected, they should be surgically resected to improve neurological symptoms.

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  • Masayuki Urabe, Masaki Ueno, Akikazu Yago, Hayato Shimoyama, Yu Ohkura ...
    Article ID: cr.20-00361
    Published: 2021
    Advance online publication: April 27, 2021
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    We sought to evaluate the feasibility of esophageal carcinoma (EC) surgery in cases requiring dialysis. Among 250 consecutive patients undergoing surgical resection for EC, three on maintenance dialysis were identified. We retrospectively analyzed their clinical characteristics. The three dialyzed patients were all males, 39–77 years old at EC surgery. The operations were thoracoscopic esophagectomy with nodal clearance (Case 1), cervical esophageal resection without thoracic procedures (Case 2), and thoracoscopic esophagectomy without reconstruction, emergently conducted for tumor bleeding (Case 3). Reoperation had been required for postoperative abdominal hematoma in Case 1. Postoperative tracheostomy had been performed due to severe pneumonia in Case 2. EC surgery for dialyzed patients, despite appearing to be feasible, might be associated with a high risk of life-threatening morbidities. To minimize surgical risk, therapeutic decision-making for such cases should be based on the balance between radicality and safety.

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  • Takashi Sakai, Yoko Azuma, Atsushi Sano, Sota Sadamoto, Naobumi Tochig ...
    Article ID: cr.20-00257
    Published: 2021
    Advance online publication: January 20, 2021
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    A 74-year-old man was admitted with lung cancer, and preoperative blood test showed abnormal activated partial thromboplastin time (APTT). Coagulation factor screening and APTT mixing test achieved a diagnosis of acquired hemophilia A (AHA). Bypassing agent therapy was indicated and lobectomy was successfully performed without bleeding complications. APTT returned to normal after the operation without any additional treatment for AHA. The pathogenesis of AHA is still unknown and there is no evidence for hemostatic strategy for AHA patients requiring surgery. This study supports the importance of hemostatic therapy and suggests that malignancy might cause AHA.

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  • Keisuke Yokota, Katsuhiro Okuda, Ichiro Fukai, Ryoichi Nakanishi
    Article ID: cr.20-00215
    Published: 2020
    Advance online publication: November 03, 2020
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    We report a case of extended bronchoplasty in which anastomosis between the left main and the superior segmental bronchi with resection of the left upper lobe and basal segment was required to avoid pneumonectomy for locally advanced lung cancer. The main tumor located at the left upper lobe invaded the basal segment, and involved both the basal pulmonary artery and left secondary carina. Regarding anastomosis, the bronchi were cut in a deep wedge shape and a wall flap was made by part of the lower lobar bronchus. The patient’s postoperative course was uneventful and he has been alive without recurrence for more than 3 years after surgery.

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  • Haruhiko Shiiya, Masaaki Sato, Aya Shinozaki-Ushiku, Chihiro Konoeda, ...
    Article ID: cr.20-00230
    Published: 2020
    Advance online publication: November 03, 2020
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    A 40-year-old woman with idiopathic pleuroparenchymal fibroelastosis (IPPFE) and flat chest underwent left single lung transplantation (SLT). Although she had developed over-systemic pulmonary arterial pressure (PAP) at transplantation, it was alleviated. However, her PAP gradually increased again. Her transplanted lung was well-inflated, but progression of fibrosis in her right native lung appeared to have caused a mediastinal shift, and her flat chest caused obstruction of the outflow tract of the pulmonary vein. She died of heart failure and associated infection 1.5 years after transplantation. An autopsy confirmed irreversible pulmonary arterial and venous changes in the transplanted lung, suggestive of chronic pressure overload. The flat chest associated with IPPFE can affect pulmonary circulation after SLT.

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  • Michiko Ueda, Fumihiro Shoji, Yuka Kozuma, Gouji Toyokawa, Koji Yamaza ...
    Article ID: cr.20-00162
    Published: 2020
    Advance online publication: October 16, 2020
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    We describe a rare case of newly discovered pulmonary metastases and surgical confirmation 12 years after initial surgery for a pheochromocytoma. A 61-year-old asymptomatic man was referred because of an abnormal shadow in the right lung field upon chest radiography. Computed tomography (CT) showed two well-demarcated tumors in the basal segment of the right lung. Twelve years previously, he underwent right adrenalectomy and was pathologically diagnosed as having a benign pheochromocytoma. Thereafter, he received a medical check-up annually. To confirm the diagnosis of two pulmonary tumors, video-assisted thoracic surgery was done and wedge resection of the right lower lobe completed. Pathology studies revealed these tumors as pulmonary metastases from the pheochromocytoma, which indicated that the true diagnosis was a malignant pheochromocytoma. Patients with a benign pheochromocytoma should continue to undergo careful monitoring for a long time after the initial surgical procedure. Thoracic surgeons should be aware of the possibility of pulmonary metastases even if >10 years have passed since initial resection of a benign pheochromocytoma.

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  • Masahiro Kitada, Yoshinobu Ohsaki, Shunsuke Yasuda, Masahiro Abe, Nana ...
    Article ID: oa.20-00014
    Published: 2020
    Advance online publication: June 10, 2020
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
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  • Tomoki Nishida, Naoko Isogai, Rai Shimoyama, Jun Kawachi, Toshitaka Ts ...
    Article ID: cr.19-00302
    Published: 2020
    Advance online publication: May 18, 2020
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    We report a surgical case of bronchial artery aneurysm (BAA) that directly connected to a pulmonary artery and a pulmonary vein through an abnormal vessel. It was complicated by racemose hemangioma. This is a rare vascular malformation. An 82-year-old female had a large BAA that was found incidentally. First, we consider treating the BAA with embolization by interventional radiology (IVR). However, because of strong meandering of the bronchial artery, we could not advance a microcatheter into the BAA. Therefore, a surgical operation was performed through a standard posterior lateral thoracotomy. The BAA was located between the upper and lower lobes and directly connected to the pulmonary artery. Some bronchial artery branches that provided inflow to the aneurysm were ligated, and the abnormal vessel that connected the BAA to the upper pulmonary vein was ligated easily. A fistula between the BAA and pulmonary artery was sutured by the cardiovascular surgeon using an artificial cardiopulmonary device, with permissive stenosis of A2b (ascending A2).

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  • Yuki Ono, Gouji Toyokawa, Tetsuzo Tagawa, Kayo Ijichi, Yoshinao Oda, M ...
    Article ID: cr.19-00244
    Published: 2020
    Advance online publication: February 27, 2020
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION

    Immunoglobulin G4-related disease (IgG4-RD) is a fibroinflammatory condition which involves various organs. This is a very rare case of IgG4-related lung disease (IgG4-RLD) with the invasion into diaphragm. The patient was a 71-year-old man with a long-term exposure to asbestos who had a mass shadow in the left lower lung lobe, which was suspected to invade the left diaphragm on computed tomography (CT). Positron emission tomography (PET)/CT also presented an avid intake of fluorodeoxyglucose in the mass, which suspected lung cancer. Although bronchoscopic biopsy could not lead to the definite diagnosis, we performed left lower lobectomy combined with the resection of left diaphragm. The specimen showed the features of IgG4-RLD on pathology: the vein stenosis and fibrosis around the vein, the infiltration of IgG4-positive cells, and IgG cells to IgG4 cells ratio of 40%. Furthermore, there were inflammatory cells infiltrating to the diaphragm.

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  • Hideki Ujiie, Daisuke Okada, Yuki Nakajima, Naoyuki Yoshino, Hirohiko ...
    Article ID: cr.11.01745
    Published: November 30, 2011
    Advance online publication: November 30, 2011
    JOURNAL OPEN ACCESS ADVANCE PUBLICATION
    The article was withdrawn because of the authors' decison.
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