[Initial experience with real-time three-dimensional transesophageal echocardiography (3D-TEE) in cardiac surgery].

Recently, real-time 3-dimensional transesophageal echocardiography (3D-TEE) was introduced to allow online acquisition, rendering, and provision of accurate information on cardiac structures. We report our initial experience of this modality. The 1st patient had mitral valve insufficiency; mitral valve prolapse of the P2 segment was clearly visualized by preoperative 3D-TEE. The 2nd patient had severe aortic stenosis, in whom 3D-TEE demonstrated fusion of the non- and right-coronary cusps. The 3rd patient had ventricular septal defect (perimembranous type), and 3D-TEE precisely demonstrated the size, shape, and location of the defect. The diagnoses were confirmed intraoperatively in all the patients. In conclusion, real-time 3D-TEE was useful for assessing the anatomical features of heart structures, enabling us to perform safer operations.

[A new technique of aortic occlusion in patient with severe aortic calcification].

A 63-year-old woman with severe aortic valve insufficiency and bilateral subclavian artery occlusion underwent ascending aorta-to-biaxillary artery bypass and aortic valve replacement, simultaneously. Because of severe aortic calcification, a hand-made aortic occluder was utilized to prevent embolic stroke. We believe that the new technique of aortic occllusion might be very useful for patients with severe aortic calcification.

[Bronchioloalveolar carcinoma illustrating difficulties in diagnosis and determination of operative management; report of a case].

A 56-year-old male was admitted to our hospital to treat for an abnormal lung shadow. Computed tomography (CT) revealed the shadow with ground-glass opacity that was 30 mm in diameter at left S6 lesion. Although transbronchial lung biopsy had been performed, histological diagnosis could not be made. We had expected the tumor could not be resected completely with a partial lung resection. Additionally, he refused being done a lower lobectomy without a histological diagnosis. So we performed a S6+S* segmentectomy with No. 7-12 lymph node dissection. Although the intraoperative frozen section diagnosis was an atypical adenomatous hyperplasia, the tumor was finally diagnosed as bronchioloalveolar carcinoma (BAC) because of its nuclear atypia. We did not resect the residual part of left lower lobe because he refused the additional operation and might have histopathologically no residual tumor and lymph node metastasis. At present, he is alive without any evidence of recurrence.