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General Thoracic and Cardiovascular Surgery

Mohammed A El-Hag-Aly, Mohamed G Hagag, Heba K Allam
OBJECTIVES: Despite the overgrowth of procedures done by VATS, there are still needs for thoracotomy. Post-thoracotomy pain plays an important role in many post-operative morbidities. Surgeons should make efforts to evolve new techniques to reduce post-thoracotomy pain with its associated morbidities. This trial aimed to study the impact of combining lack of rib retraction with protection of both intercostal nerves on post-operative pain. METHODS: This was a prospective study of 57 patients who had Integrated thoracotomy (I group) which consists of modified French window with Double-Edge closure...
April 16, 2019: General Thoracic and Cardiovascular Surgery
Masaki Goto, Keiju Aokage, Keigo Sekihara, Tomohiro Miyoshi, Kenta Tane, Kohei Yokoi, Masahiro Tsuboi
PURPOSE: The aim of this study was to extract predictive factors of prolonged air leak (PAL) including air flow data as objective parameter by digital drainage system (DDS). METHODS: The 372 patients who underwent lung resection and had continuous log data of air flow by DDS were reviewed. PAL was defined as the air leak which was exceeding 20 ml/min and lasting 5 days or more. The 69 patients (18.5%) showed air leak and were divided into PAL group (n = 21) and non-PAL group (n = 48)...
April 15, 2019: General Thoracic and Cardiovascular Surgery
Koji Kawaguchi, Tetsuo Taniguchi, Takayuki Fukui, Shota Nakamura, Kohei Yokoi
PURPOSE: Metastasis to the lungs arising from biliary tract carcinoma (BTC) is extremely rare, and the patient characteristics and prognosis are not well known. We aimed to identify the imaging findings of pulmonary metastases originating from BTC and the eligible indications for surgical treatment. METHODS: Fifteen patients who underwent pulmonary resection for metastases originating from BTC were retrospectively analyzed. RESULTS: The primary sites included cholangiocarcinoma (n = 12) and gallbladder carcinoma (n = 3), and all cases were histologically diagnosed as well to moderately differentiated adenocarcinomas...
April 12, 2019: General Thoracic and Cardiovascular Surgery
Yo Kawaguchi, Jun Hanaoka, Yasuhiko Ohshio, Keigo Okamoto, Ryosuke Kaku, Kazuki Hayashi, Takuya Shiratori, Makoto Yoden
PURPOSE: Sarcopenia gradually progress with age; hence, it is necessary to define sarcopenia to predict postoperative outcomes in elderly patients with lung cancer. The purpose of this study is to propose a definition of sarcopenia in elderly patients with lung cancer, and to demonstrate the post operative outcomes. METHODS: Using computed tomography scans, the cross-sectional area (cm2 ) of the psoas muscle at the third lumbar vertebral level was measured. The psoas area was normalized for height...
April 10, 2019: General Thoracic and Cardiovascular Surgery
Koji Furukawa, Mitsuhiro Yano, Masanori Nishimura, Eisaku Nakamura, Nozomi Watanabe, Shun Nishino, Kunihide Nakamura
OBJECTIVES: To analyze our surgical experiences with surgical ventricular restoration (SVR) for dilated ischemic cardiomyopathy (ICM) and to determine the significance of preoperative right ventricular (RV) function on outcomes. METHODS AND RESULTS: This study retrospectively analyzed 19 patients who underwent SVR between April 2010 and May 2016. Their mean age and New York Heart Association functional class were 62 ± 11 years and 2.9 ± 0.8, respectively...
April 9, 2019: General Thoracic and Cardiovascular Surgery
Hiroki Ogura, Ryutaro Kimata, Shohei Mitta, Etsuji Umeda, Narihiro Ishida, Katsuya Shimabukuro, Takashi Nakashima, Hiromitsu Kanamori, Masanori Kawasaki, Kiyoshi Doi
Hemorrhagic pericardial effusion is life-threatening and mostly occurs during pericarditis; however, its underlying mechanism is unclear. We report a case of pericardial hematoma with obvious hemorrhage. A 56-year-old man without prior chest trauma presenting with exertional dyspnea and abdominal fullness was treated for idiopathic pericarditis. The echocardiogram showed a thickened pericardium with effusion. Imaging showed extravasation and neovascularization. Following ineffective pharmacotherapy, we performed pericardiectomy...
April 9, 2019: General Thoracic and Cardiovascular Surgery
Tatushi Onzuka, Kojiro Furukawa, Eiki Tayama, Shigeki Morita, Akira Shiose
We herein report a new procedure to prevent type 3 endoleakage (EL3) after open stent graft (OSG) surgery with thoracic endovascular aortic repair (TEVAR) extension. The OSG Dacron graft portion is reversed and folded inside the OSG stent graft portion intraoperatively, filling the crack between the OSG and TEVAR device. We applied this procedure in two patients with no postoperative complications. Our folding procedure may prevent EL3 after OSG surgery if TEVAR extension is needed in the future.
April 9, 2019: General Thoracic and Cardiovascular Surgery
Minoru Matsuhama, Satoshi Arimura, Kenichi Sasaki, Hiroaki Semba, Yuko Kato, Shinya Suzuki, Tokuhisa Uejima, Junji Yajima, Takeshi Yamashita, Takashi Kunihara
OBJECTIVE: Whether mild to moderate and moderate aortic regurgitation should be corrected surgically during other cardiovascular surgeries remains controversial. We evaluated the effectiveness of external suture annuloplasty in such cases. METHODS: Among 95 patients undergoing aortic valve repair between December 2013 and March 2018, five patients with mild to moderate and moderate aortic regurgitation due to aortic annulus dilatation (type Ic lesion) underwent surgery for mitral regurgitation and/or thoracic aortic aneurysm...
April 8, 2019: General Thoracic and Cardiovascular Surgery
Kaoru Hattori, Kazuyuki Daitoku, Satoshi Taniguchi, Ikuo Fukuda
The patient was a 68-year-old woman with a history of multiple cerebral emboli. The patient presented with dysarthria, dysphagia, and left facial paralysis. Emergent MRI demonstrated multiple emboli in the brain stem and left occipital lobe. Echocardiography and chest CT demonstrated floating emboli entrapped in the foramen ovale and pulmonary emboli in both main pulmonary arteries. Emergent pulmonary embolectomy and extraction of the emboli on the foramen ovale were successfully performed without neurological exacerbation...
April 6, 2019: General Thoracic and Cardiovascular Surgery
Yoshito Sakon, Takashi Murakami, Hiromichi Fujii, Yosuke Takahashi, Akimasa Morisaki, Kokoro Yamane, Masahiko Ohsawa, Ayumi Shintani, Toshiko Seki, Toshihiko Shibata
The article New insight into tricuspid valve anatomy from 100 hearts to reappraise annuloplasty methodology.
April 5, 2019: General Thoracic and Cardiovascular Surgery
Yasuhiro Arai, Toru Kimura, Yuki Takahashi, Takashi Hashimoto, Mamoru Arakawa, Homare Okamura
OBJECTIVE: Preoperative frailty affects the progression of cardiac rehabilitation (CR) after cardiovascular surgery. Different frailty assessment measures are available. However, it remains unclear which tool most likely predicts the progress of CR. Our aim was to evaluate preoperative frailty using different methods and to identify the predictors in the progress of postoperative CR. METHODS: Eighty-nine patients underwent elective cardiovascular surgery at our institution between May 2016 and April 2018...
April 5, 2019: General Thoracic and Cardiovascular Surgery
Kenta Nakahashi, Hiroyuki Oizumi, Jun Suzuki, Akira Hamada, Hikaru Watarai, Satoshi Takamori, Mitsuaki Sadahiro
OBJECTIVES: In this study, we aimed to determine conditions associated with the development of air bubbles in the pulmonary veins during lung resection. METHODS: A total of 28 patients who underwent lung resection at our institution between October 2016 and March 2018 were included in the study. An intraoperative transesophageal echocardiography was conducted, and the influx of air bubbles in the orifice of the pulmonary vein leading to the left atrium was observed during lung resection...
April 2, 2019: General Thoracic and Cardiovascular Surgery
Shingo Kunioka, Hiroto Kitahara, Seima Ohira, Yuki Tada, Nobuyuki Akasaka, Hiroyuki Kamiya
A coronary artery fistula (CAF) is an abnormal connection between a coronary artery and a cardiac chamber or a great vessel. CAF draining into the main pulmonary artery, called coronary-to-pulmonary artery fistula (CPAF), is one of the common variations of CAF. Although there is no definitive surgical indication of CPAF, it is treated concomitantly during other cardiac surgeries. Here, we present the case of a patient who underwent surgical closure of multiple CPAFs and coronary artery bypass grafting under cardiopulmonary bypass...
April 1, 2019: General Thoracic and Cardiovascular Surgery
Toshiki Yajima, Kimihiro Shimizu, Akira Mogi, Takayuki Kosaka, Seshiru Nakazawa, Ken Shirabe
The technique of medial-basal segment (S7 )-sparing basal segmentectomy has not previously been reported. Herein we report the technical details of thoracoscopic anatomical basal segmentectomy preserving S7 in patients with B7 ab branching pattern.
April 1, 2019: General Thoracic and Cardiovascular Surgery
Satoshi Shiono, Makoto Endo, Katsuyuki Suzuki, Kazuki Hayasaka
OBJECTIVE: An enhanced recovery after surgery (ERAS) program might be effective for postoperative recovery in elderly patients undergoing thoracic surgery. This study aimed to clarify the impact of ERAS on the post-operative recovery of elderly patients, with regard to shortening hospital stay and reducing complications after open thoracic surgery. METHODS: We used a prospectively collected database and retrospectively accessed the data of patients who underwent lobectomies or segmentectomies for pulmonary malignancies from April 2013 to March 2018 and evaluated outcomes after implementation of ERAS...
March 30, 2019: General Thoracic and Cardiovascular Surgery
Akiisa Omura, Ryu Kanzaki, Akihiro Ike, Go Kanazawa, Takashi Kanou, Naoko Ose, Soichiro Funaki, Masato Minami, Yasushi Shintani
Hepatic hydrothorax refers to significant serous pleural effusion induced by liver cirrhosis, and some reports have suggested that this entity is ascites transferred to the thoracic cavity via a small hole in the diaphragm. There have been a few reports describing radical diaphragmatic repair by suturing the defect. We performed thoracoscopic diaphragmatic repair under abdominal insufflation to clarify the defect points. Air leakage at the diaphragmatic tissue was clearly noted and closed by suturing with polytetrafluoroethylene (PTFE) pledgets...
March 29, 2019: General Thoracic and Cardiovascular Surgery
Yoko Kataoka, Tomoyuki Igarashi, Yasuhiko Ohshio, Takuya Fujita, Jun Hanaoka
OBJECTIVE: The predictive importance of galectin-3 in non-small cell lung cancer (NSCLC) has not been elucidated. We examined whether galectin-3 could serve as a predictor for tumor recurrence in NSCLC. METHODS: In 42 consecutive patients with NSCLC who underwent radical resection, galectin-3 expression in tumor cells was examined by immunohistochemistry. Galectin-3 levels in serum were assessed before surgery and 1 month after surgery by enzyme-linked immunosorbent assays...
March 22, 2019: General Thoracic and Cardiovascular Surgery
Shunsaku Miyauchi, Junichi Soh, Kazuhiko Shien, Masato Tanaka, Hiromasa Yamamoto, Toshifumi Ozaki, Shinichi Toyooka
The prone position is usually not selected for pulmonary resection. The intraoperative body position is an important issue in surgery for non-small cell lung cancer invading the spine because the standard intraoperative body position for a vertebrectomy is a prone position, while that for a pulmonary resection is a lateral decubitus position. Intraoperative changes in body position can cause several complications. Using an O-arm with a navigation system, a partial vertebrectomy was completed with the patient in a prone position thanks to the recognition of accurate surgical margins in the vertebral body; then, without changing the patient's body position, a lobectomy with systemic lymph node dissection was performed via a posterior approach...
March 21, 2019: General Thoracic and Cardiovascular Surgery
Shuhei Iizuka, Akikazu Kawase, Hiroaki Oiwa, Toshinari Ema, Norihiko Shiiya, Kazuhito Funai
OBJECTIVE: This study aimed to construct a simple scoring system for predicting visceral pleural invasion of non-small cell lung cancer (NSCLC) from computed tomography (CT) findings and clinicopathological factors in lesions directly under the pleural membrane. METHODS: Among 376 cases of surgically treated NSCLC, cases in which the tumor was ≤ 7 cm in diameter and in contact with the pleura on the CT image were retrospectively extracted and examined. The CT findings and clinicopathological factors associated with the presence of pathological pleural invasion in each case were examined by Fisher's exact test...
March 19, 2019: General Thoracic and Cardiovascular Surgery
Nobuo Kondo, Kentaro Tamura, Arudo Hiraoka, Toshinori Totsugawa, Genta Chikazawa, Taichi Sakaguchi, Hidenori Yoshitaka
OBJECTIVES: While reports which focus on the outcomes of conservative treatments for acute type A aortic dissection in patients over the age of 80 are worth considering, recently many studies have reported improved outcomes of surgical treatment. Accordingly, we analyzed the outcomes of surgical and conservative treatments for acute type A aortic dissection with patent false lumen in patients over the age of 80. METHODS: We retrospectively investigated 70 patients over 80 years in age out of 248 consecutive patients with acute type A aortic dissection between January, 2010, and May, 2015...
March 19, 2019: General Thoracic and Cardiovascular Surgery
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