The patient is a 58-year-old male who underwent aortic valve replacement and ascending aortic grafting five years ago. Postoperatively, a temporary epicardial pacing wire( TEPW) could not be removed, and was subsequently cut at insertion to the skin and left in situ. Despite ongoing antibiotic therapy, the patient's C-reactive protein (CRP) level remained elevated. An endoscopic examination revealed that the TEPW had migrated and penetrated the esophagus, prompting its endoscopic removal. TEPW can cause fatal complications, so they should be removed whenever possible. In patients with TEPW left in the body, wires should be checked constantly by imaging studies.
The lupus anticoagulant is one of the antiphospholipid antibodies that inhibit the phospholipid-dependent coagulation pathway. Lupus anticoagulant-positive patients are often associated with abnormal blood coagulation, which cause thrombosis or miscarriage. We report two surgical cases of pulmonary nontuberculous mycobacterial disease (M. avium) with the lupus anticoagulant. Both patients were women around 70 years of age with no past history, including thrombosis or miscarriage. Despite treatment, M. avium continued to be cultured from their sputum and eventually blood sputum appeared. They were performed surgical operations and the postoperative courses were uneventful without anticoagulation. Although the report of pulmonary nontuberculous mycobacterial disease with the lupus anticoagulant is extremely rare, the involvement of infection in the pathogenesis of the lupus anticoagulant has been reported. The further research between lupus anticoagulant and pulmonary nontuberculous mycobacterial infection is necessary.
Primary cardiac malignant tumor is rare and is associated with poor survival. We report a case of primary cardiac intimal sarcoma. A 41-year-old man was admitted to our hospital with congestive heart failure. We performed tumor resection under emergency. The pathological diagnosis of the resected tumor was cardiac intimal sarcoma. There have been few reports of cardiac intimal sarcoma, and the frequency of its occurrence and prognosis are unknown. Surgery and postoperative radiation therapy may improve the prognosis.
Non-small cell lung cancer (NSCLC) remains a leading cause of cancer-related mortality worldwide, with high recurrence risk even after curative surgery. Perioperative treatment, including neoadjuvant and adjuvant strategies, has historically relied on platinum-based chemotherapy, which modestly improved survival outcomes. Recent advances have introduced immune checkpoint inhibitors (ICIs) and tyrosine kinase inhibitors (TKIs) as transformative options. Landmark trials, such as CheckMate 816, KEYNOTE-671, ADAURA, and ALINA, demonstrated significant improvements in pathological response, disease-free survival, and, in some cases, overall survival. ICIs have become a standard component for resectable stageⅡ-Ⅲ NSCLC, while osimertinib and alectinib established new standards for EGFR- and ALK-positive tumors, respectively. Remaining challenges include optimal patient selection, integration with surgery, and biomarker development. Future directions point to personalized strategies incorporating circulating tumor deoxyribonucleic acid (ctDNA) monitoring and novel therapies to further enhance prognosis in resectable NSCLC.
We report a case of reoperation for pseudoaneurysm late after Bentall procedure. A 61-year-old man who had undergone Bentall procedure eight years previously was found to have fluid collection around the graft on routine computed tomography (CT) follow-up. Contrast-enhanced CT revealed extravasation of contrast medium, and he was diagnosed with a pseudoaneurysm of the aorta. During surgery, extracorporeal circulation was temporarily stopped prior to resternotomy to avoid massive hemorrhage. The pseudoaneurysm was due to dehiscence of 4/5 circumference of the proximal suture line. The previous composite graft was removed and replaced with a new graft. The patient recovered well and was discharged on postoperative day 12. This case illustrates the importance of regular imaging surveillance after aortic root replacement and careful surgical planning for reoperations to prevent catastrophic bleeding complications.
We report two cases of metastatic cardiac tumors managed surgically. Case 1 involved a 52-year-old man with colorectal cancer and pulmonary metastases who developed respiratory distress during chemoradiotherapy. Imaging revealed a right atrial mass extending into the right ventricle. Mass reduction of the intracardiac tumor was surgically performed to reduce embolic risk and to enable subsequent chemotherapy. Postoperative chemotherapy resulted in complete remission without recurrence. Case 2 involved a 50-year-old woman with cervical cancer who experienced worsening dyspnea during treatment. Positron emission tomography (PET) and echocardiography identified a tumor extending from the right atrium to the pulmonary artery. As complete resection was unfeasible, mass reduction with tricuspid valve replacement was performed, followed by chemotherapy. The patient remains alive. Pathology confirmed metastatic cardiac tumors in both cases. These tumors present variably depending on the primary cancer and metastatic pattern, making diagnosis and treatment challenging. In symptomatic cases, especially with heart failure or embolism, prompt surgical intervention is critical. Mass reduction can relieve symptoms and improve survival. A focused literature review is also included to support clinical decision-making.
A 72-year-old man underwent bronchoscopy for an abnormal shadow on chest imaging, but no definitive diagnosis was made. The lesion was followed for four years as atelectasis, during which time it gradually increased in size. A computed tomography (CT)-guided biopsy suggested mucinous adenocarcinoma; however, a definitive diagnosis remained elusive. Surgical resection was ultimately performed for both diagnostic and therapeutic purposes, and the patient was diagnosed with invasive mucinous adenocarcinoma. Invasive mucinous adenocarcinoma, characterized by abundant mucus components, may be difficult to diagnose through preoperative biopsy. Even when atelectasis is suspected, the possibility of invasive mucinous adenocarcinoma should be considered. Prompt re-evaluation is warranted when an enlarging shadow is observed. In some cases, surgical resection may be necessary as part of the diagnostic strategy.
An eight-day-old boy with the transposition of the great arteries (TGA) with posterior aorta underwent original Jatene procedure. He has been developing well. Cardiac catheterization revealed good coronary artery blood flow at five years of age. At the age of 13 years, he had a critical episode of fainting during excessive physical exertion in the junior high school club activities. Three-dimensional computed tomography (CT) revealed a slit-like stenosis of the left coronary artery orifice. Enlargement of the left coronary orifice was successfully performed. Stretching of the left coronary artery into the enlarged aorta may cause the coronary orifice stenosis. The patient is doing well two years after surgery.
A 76-year-old woman was admitted to our hospital with an abnormal shadow on a chest computed tomography (CT) scan. A chest magnetic resonance imaging (MRI) revealed an anterior mediastinal cyst of 7 cm in diameter with an internal septal-like structure, leading to the differential diagnosis of mediastinal lymphangioma. After administering milk, we performed video-assisted thoracoscopic excision of the lesion. After excision of the cyst, no cloudy fluid leakage was observed from the excised margin. Immunohistochemical analysis showed that the cells lining the cyst walls were stained positive for D2-40, therefore the lesion was diagnosed as a mediastinal lymphangioma. Mediastinal lymphangioma is rare, and postoperative lymphatic leakage is common in surgical cases. In this case, mediastinal lymphangioma was selected as the differential diagnosis based on the preoperative MRI findings, and complete resection was achieved without complications by administering milk before surgery.
In a 77-year-old man, there was difficulty in removing a guidewire that had strayed into the right ventricle during leadless pacemaker insertion. Surgical removal was required. During removal of the wire, the tendon cords of the anterior tricuspid valve were pulled out, resulting in acute severe tricuspid regurgitation. The patient underwent tricuspid valve repair under cardiac arrest. He had a good postoperative course, a permanent pacemaker was implanted on postoperative day 14, and he was discharged on postoperative day 20. Although complications associated with catheter procedures have been increasing in recent years, there have been no reports of cases in which a guidewire became entangled in the tendon cords of the tricuspid valve. We discuss the cause of this case from the viewpoint of preventing recurrence and refer to acute tricuspid regurgitation that occurred during the removal of the catheter.
A 50-year-old male was diagnosed with aortic annulus ectasia (AAE) and aortic valve regurgitation (AR), and was thus referred to our department for surgery. Computed tomography (CT) revealed a Valsalva aneurysm with a maximal diameter of 52 mm. Echocardiography revealed severe AR with left ventricular enlargement [left ventricular internal dimension in diastole (LVDd) 85 mm]. The creatinine (CRE) level was 0.97 mg/dl, and the C-reactive protein (CRP) level was 1.92 mg/dl. David's procedure was initiated as a therapeutic intervention; however, severe adhesion and enlargement of the ascending aorta were observed after it was exposed during cardiopulmonary bypass (CPB). Based on this finding, the patient was suspected of having Takayasu's arteritis, and thus a Bentall procedure, with ascending aorta replacement by selective cerebral perfusion (SCP) and systemic cooling, was performed. Pathological examination revealed an inflammatory reaction from the adventitia to the intima with mononuclear cell infiltration, leading to a histological diagnosis of Takayasu's arteritis. The postoperative course was uneventful, and the patient was discharged on postoperative day 21. Steroids were used to treat Takayasu's arteritis and to prevent its recurrence after discharge.
The patient is an 86-year-old woman. She had ascites and was being treated with diuretics, but developed dyspnea, so a chest computed tomography( CT) scan was performed which revealed right pleural effusion. After aspiration of pleural effusion, abdominal distention due to ascites decreased and video-assisted thoracoscopic surgery was performed on suspicion of pleuroperitoneal communication. The diaphragm was sutured using an automatic suture device because a hole was found in the diaphragm. Insufflation into the abdominal cavity technique was safety and useful for identifying pleuroperitoneal communication.
The patient was a 71-year-old man with a history of hypertension and myocardial infarction. Transthoracic echocardiography revealed a left ventricular ejection fraction of 26% and moderate mitral regurgitation. Computed tomography (CT) showed a wide-ranging aneurysm from the aortic arch to the abdomen. Maximum short diameter of the thoracic aortic aneurysm (TAA) was 54 mm. We planned a two-stage hybrid surgery to avoid a long aortic clamp time. During the first surgery, we performed mitral annuloplasty (MAP) and a total debranching procedure using a three-branch graft from the ascending aorta to the brachiocephalic artery, left common carotid artery, and left axillary artery under cardiopulmonary arrest. Thoracic endovascular aortic repair (TEVAR) was performed 20 days after the first surgery. No complications were encountered and the patient was discharged 31 days after the initial surgery. Hybrid surgery involving MAP and second-stage TEVAR after branch reconstruction was effective in this case of extensive TAA with low cardiac function.
Right atrial thrombus with pulmonary thromboembolism is a fatal condition. A 70-year-old woman was transferred to our hospital after echocardiography revealed a large mass in the right atrium. The patient's vital signs were stable, but blood tests indicated disseminated intravascular coagulation( DIC). Contrast-enhanced computed tomography (CT) revealed thrombi in the bilateral pulmonary arteries, inferior vena cava, and right common iliac vein. A contrast defect in the right atrium was also observed, suggesting a thrombus. Transthoracic echocardiography revealed a 16-×39-mm floating mass in the right atrium. The patient was diagnosed with a giant floating thrombus in the right atrium complicated by pulmonary embolism and underwent emergency surgery to remove the thrombus. Postoperatively, anticoagulant therapy was administered for the pulmonary thromboembolism. The patient's recovery was uneventful, with no complications. Surgical resection was deemed the optimal treatment because of the high risk of secondary embolism and the patient's DIC status.
We report a case of a 50-year-old man with anomalous aortic origin of the right coronary artery (AAORCA) and hypertrophic obstructive cardiomyopathy (HOCM), who was treated with modified unroofing and septal myectomy. The patient presented with exertional syncope. Echocardiography revealed systolic anterior motion (SAM)-associated severe mitral regurgitation (MR) and HOCM. Coronary computed tomography (CT) showed AAORCA with an inter-arterial course and occlusion of the left anterior descending artery (LAD). Intraoperative findings confirmed intramural segment of the anomalous coronary artery was near the commissure of the aortic valve. To preserve native aortic valve function, modified unroofing technique was employed to establish a new right coronary ostium. Septal myectomy was performed to relieve left ventricular outflow tract obstruction, and coronary artery bypass grafting using the left internal thoracic artery was conducted to revascularize the LAD. Postoperatively, myocardial ischemia was resolved, and MR disappeared. The patient was discharged on postoperative day 10 without complications and has remained free of syncope during three years of follow-up.
During surgery for acute aortic dissection, reinforcing anastomoses in the aorta with felt strips is helpful for hemostasis. We had two cases of hemolytic anemia that developed due to inversion of an inner felt strip that was applied at the proximal anastomosis in the ascending aorta. A 78-year-old woman underwent ascending aorta replacement for type A aortic dissection, and over the next 2.5 years, she gradually developed hemolytic anemia and underwent reoperation. A 47-year-old woman also had to undergo reoperation due to hemolytic anemia 17 days after ascending aorta replacement for type A aortic dissection. Based on these experiences, we make suture line in the felt much more proximal, and no further cases of hemolytic anemia have occurred since then.
A 50-year-old woman underwent total arch replacement for Stanford type A acute aortic dissection. Postoperatively, she became delirious and experienced difficulty maintaining rest, so haloperidol was used. Due to persistent high fever and markedly elevated serum levels of creatinine kinase, neuroleptic malignant syndrome was suspected. We discontinued haloperidol and started dantrolene. During the same period, we ruled out infections, central nervous system disorders, and organ ischemia due to dissection. Administration of dantrolene achieved a good outcome, with reduction of fever and improvement of creatinine kinase levels. Neuroleptic malignant syndrome after aortic dissection surgery is very rare and includes numerous differential diagnoses. However, prompt action is important because delays in diagnosis and treatment can lead to deterioration in the general condition of the patient.
We report a case of endovascular stent grafting for a pseudoaneurysm at the brachiocephalic artery anastomosis after acute aortic dissection surgery. A 48-year-old male underwent total arch replacement for Stanford type A acute aortic dissection. One month postoperatively, thoracic endovascular aortic repair (TEVAR) was performed to treat true lumen narrowing due to residual dissection. Two months after the initial surgery, he was emergently admitted with anterior chest pain. Close examination revealed a pseudoaneurysm at the brachiocephalic artery anastomosis, forming a mediastinal hematoma. Endovascular stent grafting was performed after creating a right axillary artery-to-right common carotid artery bypass. The stent graft successfully covered the pseudoaneurysm and the dissected segment of the right common carotid artery. The patient had no neurological complications, and postoperative contrast-enhanced computed tomography (CT) confirmed patency of the bypass and exclusion of the pseudoaneurysm. Endovascular stent grafting is a minimally invasive and effective treatment, achieving both pseudoaneurysm exclusion and entry closure.
A 63-year-old female patient was emergently admitted to our hospital with complaints of dyspnea and leg edema. She had a history of abdominal total hysterectomy and bilateral salpingo-oophorectomy for uterine leiomyoma 11 years ago. Computed tomography (CT) and echocardiography revealed a local recurrent tumor on the right side of the inferior vena cava in the retroperitoneal cavity, which extended to the right ovarian vein, inferior vena cava, and right atrium/ventricle. The patient suffered shock due to the tumor lodging in the tricuspid valve, so we performed an emergency intracardiac tumor resection under cardiopulmonary bypass, and two months later, we removed the locally recurrent tumor and the intravascular tumor below the diaphragm. The tumor in the inferior vena cava was removed entirely under hypothermic circulatory arrest. In cases such as this one, which is associated with hemodynamic instability before surgery, it is desirable to aim for a complete resection with a two-stage surgery.
A 74-year-old male was admitted with acute cholecystitis, during which computed tomography( CT) revealed a 20 cm anterior mediastinal tumor. He developed septic shock requiring tracheostomy and mechanical ventilation, and was referred to our institution. Biopsy under local anesthesia excluded malignant lymphoma and germ cell tumor, leading to planned surgical resection. Due to the tumor's extensive bilateral spread and proximity to the tracheostomy site, clamshell thoracotomy with lower partial sternotomy was performed instead of median full sternotomy. The final diagnosis was well-differentiated liposarcoma. The sternum was closed with wires and plates, and prophylactic negative pressure wound therapy was applied. Postoperatively, there were no sternal complications. Laparoscopic cholecystectomy was later performed, and the tracheostomy cannula was removed successfully. In surgical resection of giant mediastinal tumors, the approach should be selected based on the tumor's location and its extent of invasion into surrounding tissues.
