Kyobu geka. The Japanese journal of thoracic surgery
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The Japanese Joint Committee of Lung Cancer Registry reported that 1,091 patients( 5.8%) had cerebrovascular diseases as comorbidities in "A report from the Japanese Joint Committee of Lung Cancer Registry;a study of 18,973 surgical cases in 2010;secondary publication". They reported that 24 patients caused cerebral hemorrhage or cerebral infarction within 30 days after surgery. Since the elderly patient surgery is increasing, the incidence their perioperative stroke is increasing too, often leading to severe conditions. ⋯ As most perioperative strokes occur within 3 days after surgery, and the recurrence rate is higher in patients with a history of cerebrovascular diseases, systematic perioperative management should be treated to prevent recurrence in the perioperative period. If patient taking antithrombotic drugs undergo surgery, it is necessary to be informed of the risks such as intraoperative stroke associated with pausing and resuming antithrombotic drugs. Patient with cerebrovascular disease must be diagnosed accurately and promptly, as cerebrovascular disease involves the conditions of ischemia and hemorrhage.
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Mitral regurgitation (MR) in Barlow's disease is complicated because of its mixed pathophysiology, leaflet billowing with/without organic prolapse, and abnormal annular dynamics that causes functional prolapse. Complex repair techniques, including aggressive leaflet resection and implantation of multiple neochords, are conventionally performed;nevertheless, these are technically demanding, especially when performed using a minimally invasive approach. We aimed to standardize the repair technique for Barlow's disease and developed stepwise repair techniques. ⋯ A stepwise repair strategy facilitates mitral valve repair in patients with Barlow's disease and provides excellent outcomes even via a minimally invasive approach.
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An 85-year-old woman with severe aortic stenosis (AS) and coronary artery disease (CAD) was admitted with heart failure 3 times. Direct aorta transcatheter aortic valve replacement( DA-TAVR) and off-pump coronary artery bypass grafting (OPCAB) were performed after percutaneous coronary intervention (PCI), and she was discharged without postoperative complication. ⋯ Recently, PCI or CABG with transcatheter aortic valve replacement(TAVR) has been reported, although there is no standard treatment for concomitant CAD in patients who undergo TAVR. DA-TAVR and OPCAB after PCI is considered as a reasonable treatment for high-risk patients.
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A 52-year-old man with a history of von Recklinghausen's disease presented to our hospital with abrupt onset of right chest and back pain. A contrast-enhanced chest computed tomography (CT) revealed massive right hemothorax, extravasation of the contrast medium at a branch of the right subclavian artery, and a tumor surrounding the second right dorsal rib. Based on findings from emergent angiography, hemothorax secondary to the rupture of an aneurysm of a branch of the right subclavian artery was diagnosed, and transcatheter arterial embolization(TAE) was performed. After hemostasis, intrathoracic hematoma was removed by surgery, and a recurrence of hemothorax did not occur until at least 8 months after the initial TAE procedure.
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Case Reports
[Ectopic Hilar Thymoma Associated with Morvan Syndrome after Extended Thymectomy for Myasthenia Gravis].
Morvan syndrome is a rare autoimmune neurological disease characterized by peripheral nerve hyperexcitability, autonomic dysfunction and encephalopathy. Morvan syndrome is often associated with thymoma as a paraneoplastic condition. Here we present a rare case of Morvan syndrome with ectopic hilar thymoma after extended thymectomy for myasthenia gravis.