[Multiple Primary Pulmonary Meningiomas].

We report a rare case of multiple primary pulmonary meningiomas in a 52-year-old woman who presented with lung nodules identified on abdominal computed tomography(CT). She had a history of surgery and chemotherapy for an immature ovarian teratoma 33 years prior to presentation. She underwent resection of a mature retroperitoneal teratoma 16 years prior and a peritoneal teratoma 6 months prior to presentation. Chest CT revealed 3 solid nodules in the right S3, right S8, and left S6 lung segments, and we performed thoracoscopic resection. Histopathologically, the 3 tumors were diagnosed as meningiomas. Since these tumors did not have other histological component and magnetic resonance imaging of the central nervous system revealed no meningeal lesion, these tumors were diagnosed as primary pulmonary meningiomas.

[IgG4-related Periaortitis Manifested as Contained Rupture of Penetrating Atherosclerotic Ulcer].

We report a case of IgG4-related periaortitis of the descending aorta manifested as a contained rupture of penetrating atherosclerotic ulcer(PAU). A 67-year-old male was admitted to our hospital complaining about chest pain. Computed tomography(CT) and magnetic resonance imaging revealed PAU with extravasation of the descending aorta and thickening of surrounding tissues. Fluorodeoxyglucose-positron emission tomography (FDG-PET) CT demonstrated abnormal accumulation of FDG at the thickening sites, and serum IgG4 value was abnormally high. The descending aorta replacement was performed and intraoperative findings showed a marked thickening of the mediastinal tissue around the descending aorta and the ulceration of the intima penetrating to the mediastinum. In histopathological examination, the adventitial thickening due to marked fibrosis and the ulceration of the intima accompanying infiltration of IgG4 positive plasma cells were observed. IgG4-related thoracic periaortitis can invade not only to the adventitia but to the intima, and can cause PAU. For aortic diseases with thickening of periaotic tissues, it is necessary to keep in mind the possibility of IgG4-related aortic disease, and serum IgG4 values are useful for diagnosis.

[Redissection of the Aortic Root Three Months after Replacement of the Ascending Aorta for Acute Stanford Type A Dissection;Report of a Case].

We report a case of redissection of the aortic root after graft replacement for acute aortic dissection using BioGlue to approximate the false lumen. A 49-year-old man underwent graft replacement of the ascending aorta for acute aortic dissection. In this operation, BioGlue was applied to the false lumen of the aortic root. Three months later, computed tomography revealed an ulcer-like projection and an intramural hematoma in the aortic root. Aortic root replacement was performed, in which operative findings showed a new intimal tear and a patent false lumen contained with hematomas and a fragment of BioGlue. Histological examination showed no evidence of adhesion between the intimal media and the adventitia of the aorta, or toxic effect of BioGlue. We conclude that care should be taken in applying the BioGlue to a false lumen and that cautious follow-up is mandatory not to overlook redissection.

[Tricuspid Valve Regurgitation and Right Heart Failure due to Perioperative Right Ventricular Myocardial Infarction].

We herein experienced 2 cases of severe tricuspid valve regurgitation (TR) and right heart failure after mitral valve surgery. In these cases, echocardiography showed a marked right ventricular dilatation and severe TR, which ware suspected to result from a right ventricular myocardial infarction at the time of the 1st operation. We considered the cause of right ventricular infarction to be an air embolism of the right coronary artery or inadequate cardioplegic perfusion to the right ventricle. Since these incidences, we have paid more careful attention to the de-airing of the left ventricle and aortic root and provided more frequent and strict delivery of antegrade and retrograde cardioplegic perfusion. Consequently, we have not since experienced any similar complications at our institute.

Short-Term Evaluation of a Novel No-Touch Technique for Harvesting Saphenous Veins With Long-Shafted Ultrasonic Scalpel.

OBJECTIVE: Saphenous vein grafts (SVGs) are widely used as bypass conduits in coronary artery bypass grafting. Compared with the conventional technique, the "no-touch" technique, wherein the saphenous veins are harvested with the surrounding tissue, may improve SVG patency; however, there are concerns regarding wound complications. To address this issue, we describe our novel no-touch technique with separate skin incisions using a long-shafted ultrasonic scalpel and report the clinical outcomes. METHODS: We enrolled 66 male patients who underwent isolated coronary artery bypass grafting between April 2016 and April 2021. There were 30 and 36 patients treated using our no-touch technique and the conventional technique, respectively. The participants underwent coronary angiography before discharge and were followed clinically. SVG samples were taken for pathological examination. RESULTS: SVGs harvested using our no-touch technique displayed preservation of the vessel wall structure and surrounding tissues. Our no-touch technique demonstrated no inferiority in patency compared with the conventional technique, and there was no SVG occlusion in the no-touch group. The frequency of leg wound complications was higher in the no-touch group than the conventional group, but no surgical site infections and severe complications occurred in the no-touch group. CONCLUSIONS: SVGs harvested using our novel no-touch technique had similar pathological characteristics to those harvested using the original no-touch technique reported previously. Our no-touch technique maintained SVG patency and caused no severe wound complications. However, a large-scale, longitudinal study is required to accurately assess the clinical outcomes of our no-touch technique.

A rare case of thymoma with entire-tumor calcification.

A 49-year-old woman presented with cough, and chest X-rays showed an abnormal shadow. Chest computed tomography showed an anterior mediastinal 40-mm mass with massive calcification. The patient underwent mediastinal tumor excision performed using video-assisted thoracoscopic surgery. Pathological findings revealed the tumor to be a type B3 thymoma, with massive calcification occupying almost all of the thymoma. Due to high risk of recurrence, we performed completion thymectomy. Pathological findings revealed no remaining thymoma tissue in the residual thymus. Mediastinal tumor with entire calcification could be a candidate for surgical excision.

[Simultaneous operation for Ebstein's anomaly and lung cancer].

The number of patients with coexisting cardiac disease and lung cancer have been increasing. The issue of performing simultaneous pulmonary resection and cardiac surgery remains controversial. We report a patient who underwent simultaneous surgery for Ebstein's anomaly and lung cancer with a good outcome. The tricuspid valve replacement with bioprothesis and the closure of a foramen ovale for Ebstein's anomaly was 1st performed under cardiopulmonary bypass. The resection of the right upper pulmonary lobe and mediastinal lymph nodes followed. The postoperative course was uneventful.

[Surgical treatment of carcinoid heart disease].

A 70-year-old female with severe tricuspid regurgitation and stenosis was admitted to our institution because of watery diarrhea and peripheral edema. The urinary 5-hydroxyindoleacetic acid (5-HIAA) level was 292.9 mg/l (normal, 0.5-5.0 mg/l). Abdominal computed tomography showed enhanced multiple nodules in the liver. The liver biopsy revealed metastatic carcinoid disease, which was thought as an etiology in severe tricuspid regurgitation and stenosis. We administered long acting somatostatin analog, octreotide to control carcinoid symptoms. After improvement of general condition, she successfully underwent bioprosthetic valve replacement with concomitant octreotide administration. Postoperative course was uneventful. She had been followed up with administration of octreotide at outpatient clinic. Cardiac surgery for carcinoid heart disease is complicated by hemodynamic instability secondary to carcinoid crises which can be provoked pharmacologically by administration of vasoactive medications. Octreotide is an effective tool to manage manifestation of carcinoid activity. We could performed surgical treatment of carcinoid heart disease safely in the perioperative presence of octreotide.

Pulmonary emphysema: histopathologic correlation with minimum intensity projection imaging, high-resolution computed tomography, and pulmonary function test results.

OBJECTIVE: To prospectively evaluate the use of minimum-intensity projection (minIP) imaging, high-resolution (HR) computed tomography (CT), and pulmonary function tests for quantifying emphysema with histopathologic examination. METHODS: MinIP and HRCT imaging data (n = 23) were obtained, and relative areas of the lung with attenuation values below thresholds from -940 to -1000 Hounsfield units (HU) and first to 13th percentiles were calculated for both data. Pulmonary function tests were performed before lung resection. These parameters were compared with mean alveolar perimeters measured on resected samples. RESULTS: Strongest correlations with mean alveolar perimeter were obtained at -990 HU and the fifth percentile by minIP, -1000 HU and the seventh percentile by HRCT, and diffusion capacity. The correlation between the mean alveolar perimeter and relative areas below -990 HU by minIP showed significantly higher extension (0%-51%) than those below -1000 HU by HRCT (1%-21%). CONCLUSIONS: MinIP imaging is more than 2(1/2) times more predictive for quantifying emphysema than HRCT, although diffusion capacity of lung for carbon monoxide is also a valid index.

Skeletonized harvesting improves the early-term and mid-term perfect patency of a radial artery graft.

OBJECTIVE: A radial artery (RA) graft is frequently used for coronary artery bypass grafting (CABG), but little information exists regarding the early- and mid-term patency associated with the harvesting procedure. The objective of this study is to compare the early- and mid-term patency of the RA graft obtained using non-skeletonized and skeletonized harvesting. METHODS: Altogether, 131 patients and 159 anastomoses were studied. In 85 patients the RA was harvested non-skeletonized (group A: procedures between September 2000 and November 2002), whereas in 46 patients the RA was harvested skeletonized (group B: procedures between November 2002 and April 2004). Angiography results were analyzed before discharge [A: postoperative day (POD) 14.7 +/- 2.9, 75 patients, 90 anastomoses; B: POD 13.7 +/- 1.9, 38 patients, 47 anastomoses], and after 1 year (A: POD 386.8 +/- 149.3, 44 patients, 51 anastomoses; B: POD 267.1 +/- 148.7, 11 patients, 13 anastomoses). RESULTS: There was no difference in patency between the two groups (group A vs group B, 96.7% vs 100%, P = not significant [NS], in the early-term, 96.2% vs 100%, P = NS, in the mid-term). However, the perfect patency rates for groups A and B were 86.7% and 98.1%, respectively, in the early-term (P = 0.034) and 77.5% and 100%, respectively, in the mid-term (P = 0.048). The location and severity of the target vessel did not influence the angiographic results. CONCLUSION: The early- and mid-term patency of RA grafts was excellent, and skeletonized harvesting improved the perfect patency rates at both time points.

Giant organized thrombus in the left sinus of valsalva causing intermittent left coronary obstruction: an unusual case of acute myocardial infarction.

A 48-year-old Japanese man was admitted to hospital for acute myocardial infarction associated with a giant organized thrombus occupying the left sinus of Valsalva. Cardiac catheterization revealed no organic stenosis in either coronary artery, but left ventriculography and aortography showed a filling defect above the left coronary cusp. Transesophageal echocardiography was immediately performed and showed a round mass filling the left sinus of Valsalva. A solid, round mass approximately 2.5 cm in diameter was removed during emergency surgery and determined to be a thrombus on the basis of microscopic findings. This is the second report of a giant organized thrombus occupying the entire left sinus of Valsalva, obstructing the ostium of the left coronary artery intermittently, and leading to acute myocardial infarction.