Kyobu geka. The Japanese journal of thoracic surgery
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Case Reports
[Reoperation of Blalock-Taussig shunt for double outlet right ventricle and pulmonary atresia in an adult].
A 36-year-old man was admitted to our hospital due to dyspnea and pneumonia. He had undergone left classical Blalock-Taussig shunt at 5 years old and right modified Blalock-Taussig shunt at 16 years old, because he was judged as no indication for any radical operation. Since the last surgery, he had stopped visiting hospital. ⋯ After pneumonia was improved by antibiotic treatment, he underwent reoperation of the right modified Blalock-Taussig shunt using 8 mm knitted Dacron graft. Postoperative course was uneventful and dyspnea and cyanosys were improved. We successfully treated a complicated case of an adult congenital heart disease by reoperation of the right modified Blalock-Taussig shunt.
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Spontaneous esophageal rupture is a comparatively rare disease, and thought to be a severe emergency disease clinically. Most patients of spontaneous esophageal rupture complained of chest pain after vomiting, which required an appropriate diagnosis. ⋯ To prevent post-operative empyema and mediastinal abscess formation, insertion of a conventional thoracic drainage tube and another fixed drainage tube from the posterior diaphragm to the lateral border of the vertebral column along the thoracic descending aorta seemed effective. The patients with spontaneous esophageal rupture underwent continuous irrigation and suction via these drainage tubes after the operation.
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We used percutaneous cardiopulmonary support (PCPS) to resuscitate a 54-year-old man who had stabbed himself in the left anterior chest with a chopstick. Chest computed tomography showed that the chopstick had penetrated the heart. ⋯ After cardiopulmonary bypass was established through a median sternotomy replacing PCPS, the chopstick was removed and the stab wounds were closed by mattress sutures. The postoperative course was uneventful.
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We report a resected case of malignant lymphoma with hypersensitivity pneumonitis. A 62-year-old woman, who presented with fever, wheeze and dry cough was referred to our department under the diagnosis of malignant B cell lymphoma in lower lobe of the left lung and hypersensitivity pneumonitis. She underwent left lower lobectomy as a therapy for malignant lymphoma. ⋯ Post operative course was uneventful and no sign of acute exacerbation was seen. It is rare that lung with hypersensitivity pneumonitis is observed as a macroscopical specimen. Hypersensitivity pneumonitis differs from idiopathic pulmonary fibrosis, but we have to take care of post operative course because post operative acute exacerbation was reported.
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A 67-year-old female was operated upon because of transthoracic echocardiograms revealing a 13 x 8 mm mass in right atrium. However, there was no mass and was prominent crista terminalis (CT) instead. CT is the largest and strongest fibromuscular bundle in the right atrium, which separates primitive right atrium from the venous sinus. ⋯ It was difficult to make a differential diagnosis because prominent CT formed a bridge-like shape in this case. To obtain certain diagnosis, transesophageal echocardiography (TEE) is necessary, and prevalence of three-dimensional (3D)-TEE is expected to improve the accuracy of diagnosis. We report this case as a pitfall of the diagnosis for the right atrial mass.