Kyobu Geka. The Japanese Journal Of Thoracic Surgery[JOURNAL]
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200 papers
[Invasive Mucinous Adenocarcinoma Diagnosed During the Follow-up of Atelectasis:Report of a Case].
Sakata S, Imanaka D, Nozaki F … +2 more , Tsujino I, Sakurai H
Kyobu Geka · 2025 Dec · PMID 41361986
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 s...
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.
[Surgical Treatment of Primary Cardiac Intimal Sarcoma:Report of a Case].
Ikeda Y, Yoshikawa Y, Morimoto K … +2 more , Saiki M, Miyasaka S
Kyobu Geka · 2025 Dec · PMID 41361985
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 performe...
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.
[Reoperation for Pseudoaneurysm Late After Bentall Procedure:Report of a Case].
Yamada H, Onuki Y, Kamikawa Y … +1 more , Shimada N
Kyobu Geka · 2025 Dec · PMID 41361984
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...
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.
[Two-stage Hybrid Repair for Extensive Thoracic Aortic Aneurysm with Ischemic Mitral Regurgitation:Report of a Case].
Hotta A, Midorikawa H, Takinami G … +4 more , Ueno K, Niitsuma K, Kanno M, Takano T
Kyobu Geka · 2025 Dec · PMID 41361983
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...
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.
[Annuloaortic Ectasia Induced by Takayasu's Arteritis:Report of a Case].
Yu Z, Murata K, Watanabe S … +2 more , Kurose A, Minakawa M
Kyobu Geka · 2025 Dec · PMID 41361982
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 ma...
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.
[Guidewire Migration into the Right Ventricle During Leadless Pacemaker Insertion, Requiring Surgical Removal of the Guidewire and Tricuspid Valve Repair:Report of a Case].
Nishimura T, Enomoto M, Takashima N … +1 more , Suzuki T
Kyobu Geka · 2025 Dec · PMID 41361981
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 cord...
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.
[Perioperative Treatment of Lung Cancer:Historical Developments, Current Evidence, and Future Perspectives].
Aokage K
Kyobu Geka · 2025 Dec · PMID 41361980
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 strateg...
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.
[Two Surgical Cases of Pulmonary Nontuberculous Mycobacterial Disease with the Lupus Anticoagulant].
Kawakami T, Nanami H, Shimoda K … +2 more , Hiramatsu M, Shiraishi Y
Kyobu Geka · 2025 Dec · PMID 41361979
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, w...
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.
[Surgical Resection of Metastatic Cardiac Tumors].
Nishiyama M, Okada T, Uetsuki T … +6 more , Jinzai Y, Matsuda Y, Nakamura K, Kuwauchi S, Morikage N, Koyama T
Kyobu Geka · 2025 Dec · PMID 41361978
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...
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.
[Usefulness of Insufflation into the Abdominal Cavity for Repair of Pleuroperitoneal Communication].
Onda T, Kita H, Yoshida T
Kyobu Geka · 2025 Dec · PMID 41361977
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 aspira...
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.
[Left Coronary Artery Stenosis Long-term After Original Jatene Procedure].
Yoshida T, Aoki M, Motono S … +7 more , Nagao K, Toritsuka D, Nagura S, Yamashita S, Doi T, Fukahara K, Yoshimura N
Kyobu Geka · 2025 Dec · PMID 41361976
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 f...
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.
[Esophageal Perforation from a Migrated Temporary Pacing Wire Undetected for Five Years After Cardiac Surgery].
Sone K, Koide M, Kunii Y … +6 more , Yashima M, Takahashi D, Maeda T, Cao Y, Tsukada Y, Nishiyama S
Kyobu Geka · 2025 Dec · PMID 41361975
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...
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.
[Diaphragmatic Eventration Treated with Abdominal Organ Fixation by a Combination of Thoracoscopy and Laparoscopy:Report of a Case].
Ishida J, Katsuya R, Sato K
Kyobu Geka · 2025 Oct · PMID 41253338
We report a case of diaphragmatic eventration treated by a combination of thoracoscopy and laparoscopy. A 49-year-old man was taken by ambulance to our hospital for emergency with a chief complaint of epigastric tightnes...
We report a case of diaphragmatic eventration treated by a combination of thoracoscopy and laparoscopy. A 49-year-old man was taken by ambulance to our hospital for emergency with a chief complaint of epigastric tightness and left-sided abdominal distention. A chest X-ray showed elevation of the left diaphragm, and diaphragmatic eventration was suspected, resulting in an initial visit to our department. A computed tomography (CT) of the thorax and abdomen showed that part of the liver, stomach, spleen, and colon splenic flexure were highly displaced cephalad, and the above symptoms were diagnosed as being caused by diaphragmatic eventration, and surgery was indicated because of the strong symptoms. The surgery was performed laparoscopically first because of the strong gastrointestinal symptoms and for safe thoracic manipulation, the stomach was suture-fixed to the diaphragmatic leg and the splenic flexure of the colon to the lateral abdomen. Next, thoracoscopic surgery was performed. The entire diaphragm was highly relaxed. The diaphragm was repaired first by resection with a stapler, followed by additional plication. The postoperative course was good, and the above symptoms disappeared completely.
[Thoracoscopic Wedge Resection of Pulmonary Carcinoma with Myelofibrosis while Managing Thrombocytopenia:Report of a Case].
Doi T, Takahashi T, Isono T … +1 more , Ito R
Kyobu Geka · 2025 Oct · PMID 41253337
The case is a woman in her 70s. She was scheduled to receive a hematopoietic stem cell transplant for myelofibrosis with thrombocytopenia. Chest computed tomography (CT) examination showed a part solid lesion in the lowe...
The case is a woman in her 70s. She was scheduled to receive a hematopoietic stem cell transplant for myelofibrosis with thrombocytopenia. Chest computed tomography (CT) examination showed a part solid lesion in the lower lobe of the left lung, raising suspicion of pulmonary microinvasive adenocarcinoma. Following preoperative platelet transfusion, the count increased up to 11.1×104/μl, and she underwent thoracoscopic wedge resection of the lung lesion. Pathological examination revealed in situ adenocarcinoma. The chest tube was removed 3 days later at a platelet count of 5.1×104/μl and she was discharged on postoperative day 6. The count returned to baseline as early as postoperative 5 or 6 day. We require predictive strategies for the perioperative management of thrombocytopenia because patients with bone marrow failure have a shorter platelet lifespan.
[Bulla Appearing and Rupturing after Right Upper Lobectomy, Causing a Significant Pulmonary Fistula:Report of a Case].
Kimura K, Kuza I
Kyobu Geka · 2025 Oct · PMID 41253336
A 78-year-old man underwent thoracoscopic right upper lobectomy for lung adenocarcinoma in the right upper lobe. During surgery, a leak test did not reveal any air leakage, but after extubation, the patient coughed and a...
A 78-year-old man underwent thoracoscopic right upper lobectomy for lung adenocarcinoma in the right upper lobe. During surgery, a leak test did not reveal any air leakage, but after extubation, the patient coughed and air leaks appeared. After observation, the air leakage did not improve and subcutaneous emphysema was significant, so reoperation was performed the next day. During the reoperation, a bulla not seen the previous time was found in S6, and a hole was formed in the bulla, through which air leaked. The lesion was partially resected, and the absence of air leakage was confirmed, and the operation was completed. Thereafter he had air leaks again and underwent pleurodesis twice. The chest drain was removed on the 12th day after the second operation, and the patient was discharged on the 22nd day.
[Spontaneous Esophageal Rupture Diagnosed as Pneumothorax at First:Report of a Case].
Nakajima T, Kimura B, Kobayashi Y … +7 more , Matsumoto M, Miyazawa K, Toda T, Shinseki K, Wakata M, Nakamoto T, Takahashi M
Kyobu Geka · 2025 Oct · PMID 41253335
We experienced a case of idiopathic esophageal rupture, which can easily become severe. The patient was a 63-year-old man. At the initial visit, he was diagnosed with pneumothorax, but computed tomography(CT) showed medi...
We experienced a case of idiopathic esophageal rupture, which can easily become severe. The patient was a 63-year-old man. At the initial visit, he was diagnosed with pneumothorax, but computed tomography(CT) showed mediastinal emphysema and esophagography showed perforation, which led to the diagnosis of the above disease. Surgery was performed more than 24 hours after the initial diagnosis. The perforation was closed with sutures and covered with mediastinal pleura. An enterostomy was added at the same time. Postoperatively, pneumonia and pleural effusion were observed, but the patient was discharged from the hospital without serious complications due to systemic management including measures against sepsis and respiratory complications and nutritional management. In the postoperative management of this disease, it is important to pay attention to systemic management such as nutritional management as well as countermeasures against infection and respiratory complications.
[Giant Floating Thrombus in the Right Atrium:Report of a Case].
Miura T, Yokota S, Yanagihara K … +5 more , Sumiya A, Kishimoto N, Bitou Y, Sakaguchi M, Aoyama T
Kyobu Geka · 2025 Oct · PMID 41253334
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 w...
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.
[Left Internal Thoracic Artery Injury due to Lead Perforation After Pacemaker Implantation:Report of a Case].
Echie Y, Morimoto H, Harada T … +3 more , Futagami D, Katayama K, Mukai S
Kyobu Geka · 2025 Oct · PMID 41253333
Perforation of a pacemaker lead is a serious life-threatening complication. Most cases involve the heart alone and rarely involve adjacent organs. The day after the pacemaker was implanted, the patient suddenly became hy...
Perforation of a pacemaker lead is a serious life-threatening complication. Most cases involve the heart alone and rarely involve adjacent organs. The day after the pacemaker was implanted, the patient suddenly became hypotensive and went into shock, and a computed tomography (CT) scan showed an anterior mediastinal hematoma due to bleeding from the left internal thoracic artery. We report a case in which emergency surgery was performed to save the patient's life after assuming that the hemorrhage was caused by a lead leading hemorrhage.
[Pericardial-peritoneal Window After Pericardiectomy:Report of a Case].
Uemura T, Matsumoto K, Kanda H … +7 more , Terazono K, Toyokawa K, Shiramomo Y, Nagatomi S, Kawazu H, Mukaihara K, Soga Y
Kyobu Geka · 2025 Oct · PMID 41253332
A 55-year-old male patient, who was diagnosed as having constrictive pericarditis. He was transferred to our hospital for surgical treatment because of uncontrollable heart failure requiring catecholamine, which was unco...
A 55-year-old male patient, who was diagnosed as having constrictive pericarditis. He was transferred to our hospital for surgical treatment because of uncontrollable heart failure requiring catecholamine, which was uncontrollable by medical treatment. Postoperative drainage from the pericardial drain tube did not decrease, diuretics and anti-inflammatory drugs were not effective, so a pericardioperative peritoneal window was opened on 34 days after surgery. Postoperatively, it could be controlled with diuretics within two weeks after the window opening. He was discharged from the hospital 37 days after the window opening. Refractory pericardial effusions that do not improve with drug therapy require drainage, but if the drainage volume does not decrease, window opening into the abdominal or thoracic cavity may be an option.
[Uterine Intravenous Leiomyomatosis with Right Ventricular Extension:Report of a Case].
Hiki H, Horikoshi R, Akutsu H … +2 more , Muraoka A, Kawahito K
Kyobu Geka · 2025 Oct · PMID 41253331
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 1...
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.
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