[Giant Thrombus in the Left Atrium Showing a Rapid Growth:Report of a Case].

A 74-year-old woman had been on hemodialysis for about 2 months using a short-term indwelling dialysis catheter due to chronic kidney disease. A 20 mm-diameter left atrial neoplastic lesion was noted during a screening echocardiogram performed at the time of induction of hemodialysis. The lesion rapidly increased to 30 mm 2 months later and was referred to our hospital for surgical resection. Under cardiopulmonary bypass and cardiac arrest, tumor resection was performed. Although the lesion was myxomatous with a thin stalk on the left atrial ceiling, the pathological diagnosis was thrombus. After the initiation of anticoagulation, the patient was discharged.

Closure of open window thoracostomy due to MRSA pyothorax by EWS bronchial occlusion and modified extraperiosteal air plombage: a case report.

BACKGROUND: Refractory pyothorax caused by methicillin-resistant Staphylococcus aureus (MRSA) is a challenging clinical condition; complications such as bronchopleural fistulae can further hinder its treatment. To avoid a fatal state caused by aspirating pneumonia, open window thoracotomy is not only sometimes performed, but subsequent closure of the window can also be difficult. In this report, we describe the case of a patient with MRSA pyothorax with bronchopleural fistula in whom a successful closure of window thoracostomy was achieved by utilizing Endobronchial Watanabe Spigot　(EWS; Novatech, La Ciotat, France) bronchial occlusion and a modified extraperiosteal air plombage technique. CASE PRESENTATION: A 66-year-old man underwent an open window thoracotomy for pyothorax with bronchopleural fistula with MRSA infection at the age of 59. After 7 years, he was referred to our department for the closure of the window. Initially, we occluded the right B6a + b by EWS under bronchoscopy. Subsequently, we dissected the intercostal muscles between the 3rd, 4th, 5th, and 6th ribs to collapse the pyothorax cavity and ensure the coverage of the fistula of lung including the hypertrophied parietal pleura and soft tissues of the chest wall. We filled the extrapleosteal space with a pedicled anterior serratus muscle flap to compress the parietal pleura. Postoperatively, lung expansion was satisfactory, and there has been no recurrence for 6 years since the window closure surgery. CONCLUSIONS: We were able to achieve closure and healing in a patient who underwent open window thoracostomy for MRSA bronchopleural fistula by applying EWS and modified extraperiosteal air plombage technique.

[Requiring Differential Diagnosis of Pulmonary Arteriovenous Fistula and Pulmonary Venous Aneurysm: Report of a Case].

A pulmonary arteriovenous fistula (PAVF) is a direct abnormal connection between the pulmonary artery and pulmonary vein, lacking capillary tissue. On the other hand, a pulmonary venous aneurysm (PVA) is a localized dilation and aneurysmal formation in the pulmonary vein without reflux issues. Treatment approaches for PAVF and PVA differ, considering surgery or catheter embolization for PAVF due to the risk of cerebral infarction or rupture caused by the abnormal shunt. PVA cases, being rare in rupture and embolism, are usually recommended for observation. Therefore, distinguishing between these two conditions is crucial. This article presents a case where both PVA and PAVF were present, necessitating a differential diagnosis.

[Staged Hybrid Repair Including Abdominal Branches Bypass Grafting for Crawford Typeâ ¡ Thoracoabdominal Aortic Aneurysm:Report of a Case].

A 64-year-old female with a diagnosis of Crawford typeⅡ thoracoabdominal aortic aneurysm( TAAA) including enlargement of the ascending aorta underwent a staged hybrid repair including visceral artery debranching thoracic endovascular aortic repair( TEVAR). First, total arch replacement with elephant trunk method was performed, followed by TEVAR for the descending thoracic aorta, and finally visceral artery debranching TEVAR for the thoracoabdominal aorta. Complications such as spinal cord infarction did not occur throughout the procedure. Surgical repair of Crawford typeⅡ TAAA involves a wide range of treatment and is highly invasive, requiring ingenuity in terms of preventing complications such as spinal cord infarction. Hybrid repair including visceral artery debranching TEVAR may be an effective treatment modality for complex aortic lesions including TAAA, but requires careful follow-up including remote complications.

Malignant Pleural Mesothelioma (MPM) Presenting as Hydropneumothorax.

An 86-year-old man presented with bilateral lower limb edema and was found to have hydropneumothorax on chest radiography. CT revealed a substantial pleural effusion and plaques. The patient had a history of working in a stone workshop, but the extent of asbestos exposure remained unknown. Thoracic drainage and subsequent thoracoscopic surgery confirmed the presence of biphasic malignant mesothelioma through pathological examination. Hydropneumothorax as a presentation of malignant pleural mesothelioma (MPM) is rare, with only a few similar cases reported. Remarkably, despite the coexistence of plural effusion and pneumothorax, the patient did not experience dyspnea. The examination also revealed tumor rupture and disruption of the pleura. Considering the possibility of MPM in patients with asymptomatic hydropneumothorax is essential for early diagnosis and appropriate management.

[Total Arch Replacement using the Frozen Elephant Trunk for Kommerell Diverticulum with Right Aortic Arch:Report of a Case].

A 42-year-old woman with dysphagia was referred to our hospital. Computed tomography (CT) revealed Kommerell diverticulum( KD) associated with right aortic arch( RAA) and aberrant left subclavian artery (ALSCA). We performed total arch replacement (TAR) using a frozen elephant trunk (FET) technique. We ligated ALSCA at the distal portion of the KD after perfusing from a 8 mm tubular graft from left axillar artery. We inserted a FET from the ascending aorta to avoid locating the nonstented portion at the steep-angled site of RAA. Postoperatively dysphagia disappeared and CT scan showed complete exclusion of KD without leakage of the stent graft and successful reconstruction of the arch. The TAR and FET technique is an effective procedure for KD with RAA and ALSCA.

[Comparison of Three Methods of Sternal Closure after Open Heart Surgery:Analysis of 722 Cases for 11 Years].

722 patients who returned to the intensive care unit( ICU) after completing the cardiac surgery and closing the median sternotomy from Jan 2010 to Feb 2021 at our hospital were divided into 3 groups according to the different sternal closures. Sternum was fixed with 6 wires alone in group A (n=333), with 2 absorbable plates and 6 wires in group B( n=259) or with 3 titanium plates with 20 screws and 4 wires in group C (n=130). Background characteristics were not different between the 3 groups. Total number of 3 complications (postsurgical bleeding, mediastinitis and delayed cardiac tamponade) was significantly less in group B and C than group A. Among them postsurgical bleeding needed hemostasis surgery was significantly less in group C than in group A. Surgical nor hospital mortality were not significantly different in 3 groups. Postsurgical complications were significantly less when the sternum closure was fixed with plates( absorbable, not absorbable).

[Repeated Rupture of Infective Thoracic Aortic Aneurysm:Report of a Case].

A 79-year-old man was diagnosed with rupture of infective thoracic aortic aneurysm following septicemia caused by infective cholangitis. He underwent emergent endovascular aortic repair and discontinued antibiotics. Graft infection occurred and was treated 29 days after the first operation. He underwent emergent resection of the abscess with graft coverage using pedicled intercostal muscle flaps. Aortic re-rupture was found and treated 183 days after the second operation. He underwent emergency additional thoracic endovascular aortic repair and continued to take antibiotics again. We should continue a careful follow up.

[Comparative Study of Elephant Trunk and Frozen Elephant Trunk Techniques].

Twenty-six patients underwent total arch replacement for Stanford type A aortic dissection, including that with elephant trunk technique (ET group, n=10) or with frozen elephant trunk technique (FET group, n=16). We compared preoperative and intraoperative findings, postoperative results and distal aortic arch remodeling between the two groups. In FET group, anesthesia time, operation time, cardiopulmonary bypass time, cardiac arrest time and circulatory arrest time were significantly shorter than ET group. Also, intra-operative blood transfusion amount was significantly smaller than ET group. In FET group, the ratio of true lumen area and thrombosis rate of false lumen at the distal arch level were significantly higher than ET group. Other postoperative results were almost similar between the two groups.

[Aortic Para-annular Abscess Following Infective Endocarditis Requiring Three Times of Operation:Report of a Case].

A 45-year-old man was diagnosed with active aortic valve endocarditis accompanied by massive aortic regurgitation, complete atrioventricular block, para-annular abscess and a mobile large vegetation. He underwent emergency resection of the aortic valve, direct closure of the abscess with an autologous pericardium patch and mechanical valve replacement. Acquired communication between the left ventricle and the right atrium was closed simultaneously. Then, adjacent mitral para-annular abscess and another vegetation were revealed by echocardiography, and treated surgically 20 days after the first operation. He underwent mitral valve replacement and closure of the annular abscess. Twenty-one days after the second operation, aortic annular false aneurysm was detected by echocardiography, and closure of the false aneurysm and aortic valve re-replacement were performed successfully.

[Simple Evaluation of Left Hand Function after Thoracic Endovascular Aortic Repair with Obstruction of Left Subclavian Artery].

We evaluated left hand function with or without obstruction of left subclavian artery for 29 cases of thoracic endovascular aortic repair (TEVAR). 18 cases of distal true aortic aneurysm were undergone surgery with simple direct closure of left subclavian artery (LSCA). The other 11 cases of true arch aneurysm were revascularized by axilla-carotid-axilla bypass grafting with TEVAR. Later 26 cases were evaluated by blood pressure, maximal grasping power, persisting duration of 60% maximal grasping power, circumferential length of upper and forearms, and simple test for evaluating hand function (STEF). Left hand blood pressure was significantly reduced than right side in obstruction group. But left hand function was not reduced in any other test. We concluded that no relationship between the obstruction of LSCA and the left hand function, and the influence of late survival and mobidity.

[Multiple mitral valve aneurysms, mycotic arterial embolism and aneurysms with infective endocarditis].

A 30-year-old woman with a more than 6-month history of fever, weight loss, general fatigue and dysesthesia of lower extremities was admitted to our hospital with a diagnosis of infective endocarditis. Blood cultures revealed Staphylococcus oralis. Echocardiography revealed severe mitral and moderate tricuspid regurgitation, as well as massive vegetations and aneurysms on the mitral valve. Computed tomography revealed an abdominal aortic aneurysm, left common and external iliac arterial aneurysms, and occlusion of the left common iliac, the deep femoral arteries and the bilateral tibioperoneal trunk. The ankle brachial pressure indices (ABI) were 0.94 (right) and 0.61 (left). She initially underwent mitral valve replacement and tricuspid annuloplasty. On postoperative day 24, the affected segments of the arteries were replaced with a woven Dacron bifurcated graft after resection of the mycotic abdominal and the iliac arterial aneurysms. We could not obtain a sufficient amount of omental pedicle to wrap the prosthesis. Her postoperative course was uneventful and mycotic arterial embolism and aneurysm did not recur.

Coexistence of primary pulmonary Hodgkin lymphoma and gastric MALT lymphoma associated with Epstein-Barr virus infection: a case report.

We describe a 66-year-old woman with Epstein-Barr virus-associated lymphoproliferative disorder with lung and gastric tumors. We identified two lung tumors measuring 13 and 20 mm in diameter that consisted of CD30-, CD15-, and CD20-positive Hodgkin- and Reed-Sternberg-like cells and heterogeneous cellular infiltrates in a pronounced nodular pattern, with necrosis and vasculitis, diagnosed as nodular sclerosis classical Hodgkin lymphoma. A gastric tumor showed low-grade extranodal marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue type. Neoplastic cells in all tumors expressed Epstein-Barr virus-encoded RNA based on in situ hybridization. The present case is a rare composite lymphoma arising from different extranodal organs, associated with EBV infection. Her medical history included gamma-knife therapy for clinical diagnosis with a suspicion of cerebral lymphoma.

Squamous cell carcinoma of the lung in association with sarcoidosis.

A 76-year-old man who was known to have sarcoidosis, developed a lung tumor. He had previously undergone cardiac and abdominal vascular surgery, at which sarcoidosis was confirmed by lymph node biopsy. A right lower lobectomy was carried out. Postoperative pathology showed limited disease, but cancer recurred 1 year later. Issues regarding the combination of sarcoidosis and a malignant tumor are discussed.

Posttraumatic tricuspid insufficiency successfully repaired by conventional technique.

A 22-year-old man developed exertional dyspnea 2 years after blunt chest trauma due to a horse kick. Preoperative echocardiography showed severe tricuspid insufficiency (TI) caused by chordal rupture and prolapse of the anterior leaflet. A novel repair technique, the "clover technique," was applied, but was unsuccessful in this case. The valve was then repaired successfully using conventional techniques, that is, insertion of an artificial chordae, plication of the prolapsing leaflet, and DeVega's annuloplasty. We present here a brief review of posttraumatic TI, and discuss effective and less expensive techniques for repair.

Rupture of a smoldering mycotic aneurysm of the thoracic aorta into the lung.

A 65-year-old man was a diagnosed with meningitis and bacteremia, as Streptococcus pneumoniae was isolated from spinal fluid and blood cultures. After three weeks of antibiotic therapy, computed tomography revealed a ruptured aneurysm of the descending thoracic aorta. The aneurysm had appeared during the first episode of meningitis but had remained silent for two years. The patient underwent in situ Dacron graft replacement and his postoperative course was uneventful with no infectious complication.