Kyobu Geka. The Japanese Journal Of Thoracic Surgery[JOURNAL]
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200 papers
[Ruptured Ascending Aortic Aneurysm:Report of a Case].
Otani A, Takagi H
Kyobu Geka · 2025 May · PMID 40589043
A 62-year-old man was transferred to our hospital for consciousness loss, and contrast-enhanced computed tomography( CT) scans showed a 50-mm ascending thoracic aortic aneurysm( ATAA) with a little pericardial effusion....
A 62-year-old man was transferred to our hospital for consciousness loss, and contrast-enhanced computed tomography( CT) scans showed a 50-mm ascending thoracic aortic aneurysm( ATAA) with a little pericardial effusion. The patient became stable and was admitted for observation without any invasive treatments in the department of cardiology. On the 5th hospital day, however, repeated CT scans revealed increased pericardial effusion. Bloody fluid was drained in pericardiocentesis, and the patient was referred to our department. Ruptured ATAA was diagnosed, and emergency surgery was conducted. Although there was no bleeding after removing intrapericardial hematoma, bleeding from a pinhole of the aortic right side adjacent to the right atrium was recognized when the dilated proximal ascending aorta was raised to the left. Aortic root and ascending aortic replacement were performed because the aneurysm reached the ostium of the right coronary artery. Postoperative course was uneventful, and the patient was discharged on postoperative day 29.
[Cardiac Angiosarcoma with Cardiac Tamponade due to Ruptured Right Atrium:Report of a Case].
Kawakami A, Kobayashi Y, Osawa I … +4 more , Sunada M, Uchino G, Kitaoka S, Uchida N
Kyobu Geka · 2025 May · PMID 40589042
Primary angiosarcoma of the heart is extremely rare with poor prognosis. A 39-year-old man presented to his physician for evaluation of fever and pericardial pain and was referred to our department for further management...
Primary angiosarcoma of the heart is extremely rare with poor prognosis. A 39-year-old man presented to his physician for evaluation of fever and pericardial pain and was referred to our department for further management. The patient's condition stabilized after pericardiocentesis;however, the cause of cardiac tamponade remained undetermined on admission. Transesophageal echocardiography and electrocardiography-synchronized contrast-enhanced computed tomography (CT) revealed a suspected source of bleeding in the right atrium, necessitating open chest surgery. Preoperative imaging showed no evidence of a tumor;however, intraoperatively, we observed a suspected right atrial tumor, which was resected, followed by repair using a bovine pericardial patch. Histopathological examination confirmed diagnosis of angiosarcoma. Angiosarcoma is often diagnostically challenging in the early stages, and multiple examinations are important for early diagnosis and treatment.
[Postoperative Pneumothorax Induced by Temporary Epicardial Pacing Wire Placed in Minimally Invasive Cardiac Surgery:Report of a Case].
Niki T, Fukunaga N, Wakami T … +4 more , Shimoji A, Mori O, Yoshizawa K, Tamura N
Kyobu Geka · 2025 May · PMID 40589041
We report a case of pneumothorax induced by the temporary epicardial pacing wire placement during minimally invasive atrium septum defect closure via right mini-thoracotomy. Temporary epicardial pacing wires are commonly...
We report a case of pneumothorax induced by the temporary epicardial pacing wire placement during minimally invasive atrium septum defect closure via right mini-thoracotomy. Temporary epicardial pacing wires are commonly employed in cardiac surgery with complications being rare. In this case, the wire sutured on the right surface of the right atrium directly contacted the right lung, resulting in pneumothorax, as the pericardium, harvested for atrium septum defect closure, was not sutured. Since conservative treatment was not effective, the patient underwent video assisted lung repair surgery. The postoperative course was otherwise uneventful, and the patient was discharged on the 10th postoperative day. Preventive measures such as positioning the wire on the anterior surface of the right atrium, should be considered to mitigate this risk.
[Study of 11 Cases of Surgical Treatment for Pulmonary Sequestration].
Hirayama K, Matsuno M, Suzuki K
Kyobu Geka · 2025 May · PMID 40589040
Pulmonary sequestration was first described by Pryce in 1946. It is a developmental abnormality of the lung, in which a portion of lung tissue is isolated from the normal lung and receives blood supply from an anomalous...
Pulmonary sequestration was first described by Pryce in 1946. It is a developmental abnormality of the lung, in which a portion of lung tissue is isolated from the normal lung and receives blood supply from an anomalous artery branching off the body's circulatory system. In recent years, advances in diagnostic imaging, particularly computed tomography (CT), have made the preoperative diagnosis of pulmonary sequestration more straightforward. Thoracoscopic surgery has increasingly been used for treatment;however, there is still no definitive evidence regarding the extent of resection or the use of automatic suturing devices for the dissection of abnormal arteries. In this report, we summarize the cases of pulmonary sequestration treated surgically at our hospital and discuss the clinical presentation and surgical techniques.
[Cardiac Surgery Using Low-dose Heparin Combined with Nafamostat Mesilate in an Acute Hemorrhagic Stroke].
Koga T, Nishijima S, Mochizuki N … +3 more , Kawashima T, Ohtani N, Ueda T
Kyobu Geka · 2025 May · PMID 40589039
A 66-year-old man presented to our hospital complaining palpitation and fatigue. He was diagnosed with heart failure secondary to mitral regurgitation, left ventricular thrombus, and hemorrhagic stroke in right cerebral...
A 66-year-old man presented to our hospital complaining palpitation and fatigue. He was diagnosed with heart failure secondary to mitral regurgitation, left ventricular thrombus, and hemorrhagic stroke in right cerebral hemisphere. Cardiac surgery under cardiopulmonary bypass during acute phase of stroke or cerebral hemorrhage carries significant risk, including exacerbation of neurological complications due to intraoperative anticoagulation. To mitigate this risk, we employed a low-dose heparin regimen combined with nafamostat mesilate continuous infusion during surgery. The patient successfully underwent mitral valve plasty and left ventricular thrombectomy, with a favorable postoperative course and no new neurological deficits.
[Total Arch Replacement via Right Hemicollar Incision and Mediansternotomy for an Arch Aneurysm with an Aberrant Right Subclavian Artery].
Tanaka Y, Kusakizako M, Nakagawa T … +5 more , Yokawa K, Higuma T, Yoshida K, Obo H, Wakiyama H
Kyobu Geka · 2025 May · PMID 40589038
The patient was 72-year-old-woman. Computed tomography( CT) revealed an arch aneurysm with an aberrant right subclavian artery (ARSA). We performed total arch replacement via right hemicollar incision and median sternoto...
The patient was 72-year-old-woman. Computed tomography( CT) revealed an arch aneurysm with an aberrant right subclavian artery (ARSA). We performed total arch replacement via right hemicollar incision and median sternotomy. Arch replacement and right subclavian artery reconstruction were performed under hypothermic circulatory arrest with selective cerebral perfusion. This approach allowed selective perfusion and reconstruction of the ARSA in the same field of view as total arch replacement. Because the right side was non-recurrent laryngeal nerve, we were able to perform the surgery without concern for bilateral recurrent nerve palsy. The patient had no cerebral complication and her postoperative course was uneventful.
[Upper J Partial Sternotomy during Re-do Surgery for a Giant Ascending Aortic Aneurysm].
Miyatake T, Minamida T, Kato N … +1 more , Yoshida I
Kyobu Geka · 2025 May · PMID 40589037
A 79-year-old woman with a history of aortic valve replacement using a mechanical valve was referred to our hospital due to a giant ascending aortic aneurysm just beneath the sternum. As the initial step of the surgery,...
A 79-year-old woman with a history of aortic valve replacement using a mechanical valve was referred to our hospital due to a giant ascending aortic aneurysm just beneath the sternum. As the initial step of the surgery, the upper sternum was partially divided in J shape under cardiopulmonary bypass with cannulae in the femoral artery and vein. After securing the distal portion of the ascending aorta, full sternotomy was performed, and the ascending aorta was replaced with a vascular prosthesis. Given the sefety of these procedures, we believe that securing the distal portion of the ascending aorta through an upper partial sternotomy at an early stage may be beneficial during surgery for giant ascending aortic aneurysm, as it could help avoid serious bleeding and reduce the risk of invasive strategies, such as deep hypothermia, circulatory arrest, or prolonged cardiopulmonary bypass.
[Coronary Air Embolism after Computed Tomography( CT)-guided Lung Biopsy].
Kimura K, Itou N, Yoshimura M
Kyobu Geka · 2025 May · PMID 40589036
The patient was a 61-year-old man who was diagnosed with an abnormal chest shadow during a medical examination. A computed tomography (CT) scan revealed a nodular shadow in the left upper lobe, so a lung biopsy was perfo...
The patient was a 61-year-old man who was diagnosed with an abnormal chest shadow during a medical examination. A computed tomography (CT) scan revealed a nodular shadow in the left upper lobe, so a lung biopsy was performed for diagnostic purposes. Immediately after the biopsy, the patient experienced chest discomfort and a drop in pulse rate. An electrocardiogram showed ST elevation in Ⅱ, Ⅲ, aVf, and V1-V5. Chest CT revealed air in the right coronary artery and left ventricle, and the patient was diagnosed with air embolism. Morphine hydrochloride hydrate, nitroglycerin, and oxygen were administered. The chest pain improved the next morning. Chest CT performed the day after the examination showed that the air had disappeared. The patient's condition improved, and he was discharged two days after the examination. Coronary artery air embolism occurred after the CT-guided biopsy, but he recovered without serious sequelae.
[Incising the Anterior Wall of the Right Ventricular Outflow Tract for Reoperation of the Aortic Root].
Inoue T, Masuyama S, Ichihara T
Kyobu Geka · 2025 May · PMID 40589035
A 32-year-old man underwent the 3rd aortic root reoperation with incising the anterior wall of the right ventricular outflow tract. He has been doing well. To this day,aortic root reoperation remains challenging. This di...
A 32-year-old man underwent the 3rd aortic root reoperation with incising the anterior wall of the right ventricular outflow tract. He has been doing well. To this day,aortic root reoperation remains challenging. This difficulty may stem from issues securing a physical space and a clear visual field for surgery, in addition to adhesions around the aortic root. In such complex cases, we incise the anterior wall of the right ventricular outflow tract. We have successfully treated seven patients using this method, demonstrating that it can secure physical space and improve the visual field for surgery.
[Sympathetic Nerve Trunk Preserved by Intracapsular and Transcapsular Resection in a Patient with Superior Mediastinal Schwannoma].
Mizutani E, Morita R, Yamamoto S … +3 more , Okochi Y, Kodama M, Abe K
Kyobu Geka · 2025 May · PMID 40589034
A 52-year-old man was referred to our hospital because of an abnormal shadow on a chest X-ray. He was asymptomatic. Computed tomography (CT) revealed a smooth 32 mm right superior mediastinal mass at the level of the fir...
A 52-year-old man was referred to our hospital because of an abnormal shadow on a chest X-ray. He was asymptomatic. Computed tomography (CT) revealed a smooth 32 mm right superior mediastinal mass at the level of the first to third thoracic vertebrae. T2 magnetic resonance imaging (MRI)revealed a cystic mass with a fluid level. Foregut cysts were initially considered. After three years, the mass had enlarged to 39 mm. Thoracoscopic surgery was performed, and the mass was originated from a sympathetic trunk and removed via intracapsular and transcapsular resection. A histological examination confirmed a diagnosis of schwannoma. The patient experienced no postoperative neurological complications. Intracapsular and transcapsular resection of schwannomas is useful for preventing nerve and vascular injuries.
[Broncholithiasis Who Underwent Lung Resection:Report of a Case].
Suzuki K, Machida Y, Tomioka Y … +4 more , Inoue T, Kawasaki N, Terasaki Y, Usuda J
Kyobu Geka · 2025 Jun · PMID 40589030
A 42-year-old woman presented with bloody sputum. Her chest computed tomography (CT) scan revealed a 21 mm nodular shadow with 5 mm of calcification in the right S8 area. She was referred to our department for further ex...
A 42-year-old woman presented with bloody sputum. Her chest computed tomography (CT) scan revealed a 21 mm nodular shadow with 5 mm of calcification in the right S8 area. She was referred to our department for further examination and treatment, and underwent thoracoscopic partial resection of the right lower lobe. Pathological examination identified a 5 mm stone surrounded by lymphoid follicle formation and plasma cell infiltration. The diagnosis was broncholithiasis associated with an Aspergillus infection. Broncholithiasis is a relatively rare disease, and a review of the literature is provided.
[Cholesterol Granuloma Arising in the Thymus:Report of a Case].
Kimura K, Itou N, Yoshimura M … +2 more , Kuza I, Sakuma T
Kyobu Geka · 2025 Jun · PMID 40589029
The patient was a 64-year-old man who was found to have an abnormal shadow in the anterior mediastinum on a chest computed tomography( CT) scan during a health check. He was admitted for diagnosis and treatment, and unde...
The patient was a 64-year-old man who was found to have an abnormal shadow in the anterior mediastinum on a chest computed tomography( CT) scan during a health check. He was admitted for diagnosis and treatment, and underwent thoracoscopic thymic and thymic tumor removal. The postoperative course was uneventful, and the patient was discharged on the 4th postoperative day. Histopathological examination revealed numerous foreign body giant cells and cholesterol crystals in the thymus tissue, and the patient was diagnosed with cholesterol granuloma. One cause of cholesterol granuloma is trauma. Trauma was suspected as the cause in this case because the patient had bruised his chest in a traffic accident eight years ago. It is difficult to diagnose cholesterol granuloma from image findings, and surgical resection is necessary for diagnosis and treatment to differentiate it from malignant diseases.
[Bilateral Peripheral Pulmonary Artery Aneurysms:Report of a Case].
Takayama Y, Matsumoto I, Kakegawa S … +4 more , Nishikawa S, Wada T, Saito D, Tanaka N
Kyobu Geka · 2025 Jun · PMID 40589028
Pulmonary artery aneurysms are extremely rare and can be fatal if ruptured. We report the case of a 72-year-old man who underwent coil embolization of bilateral peripheral pulmonary artery aneurysms. Ten years ago, a lef...
Pulmonary artery aneurysms are extremely rare and can be fatal if ruptured. We report the case of a 72-year-old man who underwent coil embolization of bilateral peripheral pulmonary artery aneurysms. Ten years ago, a left upper lobe nodule was incidentally noted on a chest computed tomography (CT). The nodule was suspected as a benign tumor and followed up. As it gradually enlarged, the patient referred to our hospital. Chest CT showed a 2.0-cm nodule in S1+2 of the left lung and a 0.6-cm nodule in S10 of the right lung. Contrast-enhanced CT showed that each nodule had the same contrast enhancement as the pulmonary artery. The left upper lobe nodule and the right lower lobe nodule were connected by a shunt with A1+2b and A10. They were diagnosed as pulmonary artery aneurysms, and coil embolization was performed. Eighteen months later, no enlargement of the pulmonary artery aneurysms or new lesions were observed.
[Successful Emergent Open Stent Grafting for a Ruptured Aortic Arch Aneurysm:Report of a Case].
Hioki I, Urata Y, Sato T … +1 more , Yuasa U
Kyobu Geka · 2025 Jun · PMID 40589027
The classical surgical procedure ruptured thoracic aortic aneurysm is associated with mortality rates of up to 50% and prolonged intensive care hospitalization. We present an emergent case of procedure of open stent graf...
The classical surgical procedure ruptured thoracic aortic aneurysm is associated with mortality rates of up to 50% and prolonged intensive care hospitalization. We present an emergent case of procedure of open stent grafting. A 80-year-old man was brought to the emergency department in our hospital with loss of consciousness. Chest computed tomography( CT) revealed a saccular-shaped aortic aneurysm in the aortic arch with diameter of 56 mm. The chest was opened via midsternotomy. After a circulatory arrest was induced at 30 ℃ with cerebral perfusion, the anterior surface of the arch was incised in a hemi-circumferencial mannar at the level of left subclavian artery. The stent graft was inserted into the aortic arch and was deployed. The proximal side of the graft was then trimmed, and the posterior aortic wall and the graft were continuously anastomosis, the aortic incision and anterior side of the graft were continuously closed. The patient's postoperative course was uneventful and he was discharged on postoperative day 14. An open stent grafting via an aortotomy was useful in the surgery for a ruptured aortic arch aneurysm.
[Thoracic Descending Aorta Mural Thrombus Treated with Stent Graft:Report of a Case].
Tokuda T, Yamada Y
Kyobu Geka · 2025 Jun · PMID 40589026
A 43-year-old male patient was admitted to our hospital with chest oppression and received percutaneous coronary intervention with a diagnosis of myocardial infarction. Two months after the event, he was referred to our...
A 43-year-old male patient was admitted to our hospital with chest oppression and received percutaneous coronary intervention with a diagnosis of myocardial infarction. Two months after the event, he was referred to our department because the enhanced computed tomography (CT) image revealed a low-density area on the descending aorta, which was suspicious of a mobile plaque. He had no symptoms and there were no other signs suggesting embolization or metastatic tumor in CT image. Enhanced magnetic resonance imaging (MRI) or positron emission tomography (PET) image revealed no enhancement in the lesion and we diagnosed it as mural thrombosis on the descending aorta. We performed thoracic endovascular aortic repair( TEVAR) to compress the intra-aortic thrombus. He had no complication such as thromboembolism in the procedure and also had a good course for two years after the procedure.
[Surgery for Right Coronary Artery Ostium Thrombus Occlusion:Report of a Case].
Sakamoto K, Ohno N, Nagasawa A … +2 more , Wada Y, Marui A
Kyobu Geka · 2025 Jun · PMID 40589025
We experienced a rare thrombus occlusion at the orifice of the right coronary artery in a patient with chronic atrial fibrillation and a history of cancer treatment. The thrombus plugged the right coronary artery, orific...
We experienced a rare thrombus occlusion at the orifice of the right coronary artery in a patient with chronic atrial fibrillation and a history of cancer treatment. The thrombus plugged the right coronary artery, orifice accompanying protrusion into the aorta. There was a risk of a systemic embolism if it scattered. By utilizing computed tomography (CT) scan, we were able to avoid subsequent systemic embolism and make the diagnosis. We selected thrombectomy by open heart surgery to avoid subsequent embolism. We report this case with a review of the literature.
[Giant Left Atrium Thrombus after Left Atrial Appendectomy:Report of a Case].
Yanase Y, Sumino S, Komuro K
Kyobu Geka · 2025 Jun · PMID 40589024
A 78-years-old woman was admitted to our hospital due to recurrence of cerebral infarction. She had history of chronic atrial fibrillation, so we performed left atrium appendectomy for prevention of cardiogenic brain emb...
A 78-years-old woman was admitted to our hospital due to recurrence of cerebral infarction. She had history of chronic atrial fibrillation, so we performed left atrium appendectomy for prevention of cardiogenic brain embolism. But a giant left atrium thrombus appeared in spite of left atrial appendage closure and anticoagulant therapy. Echo cardiogram showed severe spontaneous echo contrast in the large left atrium. The criteria of mitral valve stenosis were not met, but restriction of the mitral valve opening was suspected. So, we performed removal of left atrium thrombus and mitral valve replacement. The left atrium thrombus did not attach at the stump of the left atrial appendage, but at the junction of left pulmonary vein and left atrium. She was transferred without recurrence of left atrium thrombus. Severe left atrial blood stasis may cause thrombus in spite of left atrium appendectomy.
[Perigraft Seroma after Ascending Aorta Replacement with Symptom of Chest Oppression:Report of a Case].
Ozu Y, Hirano K, Inoue K
Kyobu Geka · 2025 Jun · PMID 40589023
A 75-year-old man underwent redo sternotomy for the management of a perigraft seroma four years after ascending aorta replacement. Three months postoperatively, a subcutaneous effusion at the median sternotomy site neces...
A 75-year-old man underwent redo sternotomy for the management of a perigraft seroma four years after ascending aorta replacement. Three months postoperatively, a subcutaneous effusion at the median sternotomy site necessitated serous fluid drainage. The patient exhibited no significant inflammatory changes. He was referred to our hospital for evaluation of chest oppression. Follow-up computed tomography (CT) revealed a low-density fluid collection surrounding the prosthetic graft. Surgical intervention was performed to evacuate the fluid, with no evidence of active bleeding. The prosthetic graft was subsequently covered with fibrin glue to mitigate serum leakage and reinforced with a bovine xenopericardial sheet. To facilitate effusion drainage, the adjacent right pleura was widely opened. The postoperative course was uneventful. Bacterial culture, laboratory analysis, and histological examination confirmed the diagnosis of perigraft seroma. No recurrence or symptoms were observed during the two-year follow-up period.
[Left Ventriculoplasty for Ventricular Septal Rupture and Left Ventricular Aneurysm Following Acute Myocardial Infarction:Report of a Case].
Watabe Y, Sato K, Ito T … +1 more , Wakasa S
Kyobu Geka · 2025 Jun · PMID 40589022
A 70-year-old man with acute myocardial infarction underwent percutaneous coronary intervention (PCI) for the diagonal branch. Eight days after PCI, the patient presented worsening heart failure. Transthoracic echocardio...
A 70-year-old man with acute myocardial infarction underwent percutaneous coronary intervention (PCI) for the diagonal branch. Eight days after PCI, the patient presented worsening heart failure. Transthoracic echocardiography( TTE) and enhanced computed tomography( CT) revealed ventricular septal rupture( VSR) and left ventricular aneurysm( LVA). After establishing cardiopulmonary bypass, the LVA was longitudinally excised along the left anterior descending artery( LAD). A septal anterior ventricular exclusion( SAVE) procedure was performed using a bovine pericardial patch to exclude the LVA and VSR. The VSR was directly closed with pledgeted sutures. Additionally, coronary artery bypass grafting was performed to the LAD using the left internal thoracic artery. The patient was discharged without any complications.
[Pulmonary Enteric Adenocarcinoma Congenital Pericardial Defect Incidentally Discovered During Lung Cancer Surgery].
Hirayama K, Matsuno M, Suzuki K
Kyobu Geka · 2025 Jun · PMID 40589021
Pulmonary enteric adenocarcinoma is a rare subtype of adenocarcinoma that was introduced in the 2015 World Health Organization( WHO) Histological Classification and Lung Cancer Treatment Protocol (8th Edition). Distingui...
Pulmonary enteric adenocarcinoma is a rare subtype of adenocarcinoma that was introduced in the 2015 World Health Organization( WHO) Histological Classification and Lung Cancer Treatment Protocol (8th Edition). Distinguishing it from lung metastases of colorectal cancer poses a significant clinical challenge. We report three cases of pulmonary enteric adenocarcinoma with distinct computed tomography(CT) findings. Pulmonary enteric adenocarcinoma typically presents as a large mass, often characterized as substantial and lacking a significant ground glass shadow. However, in the first case, a partially filled nodular shadow was observed;in the second case, a well-difined cystic-like mass shadow was identified;and in the third case, a nodular shadow with an internal cavity was noted.
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