Kyobu geka. The Japanese journal of thoracic surgery
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Recently, an increasing number of patients have been treated with the Nuss procedure for pectus excavatum. One of the merits is that this surgical procedure is less invasive and leads to good cosmetic results compared with the former traditional procedures such as sternal turn over. We have repaired 60 cases of pectus excavatum using the Nuss procedure at our institute since July 1999. We have experienced the removal of a steel bar, which was the first case of Nuss procedure at our institute.
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Tetralogy of Fallot with absent pulmonary valve has been classified to a few groups. The most severe one is characterized by symptomatic onset immediately after birth. The others are no or slightly symptomatic at least during their neonatal period. ⋯ Generally, to diminish the massive pulmonary regurgitation in early lifetime period could reduce a progressive airway obstruction and minimize pulmonary tissue damage. However, even after the total correction in this case, considerable peripheral segmental pulmonary obstructive lesions were persistent according to the perfusion lung scanning with 99mTc macroaggregated albumin and 99mTechnegas ventilation lung scanning studies. This persistent, supposed to be innate, pulmonary obstructive lesions might prevent ordinal recovery after cardiac radical repair for this most severe subtype of absent pulmonary valve syndrome.
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We experienced a case of operation for acute type A aortic dissection using transapical aortic cannulation (TAC). A 62-year-old male with chest and back pain admitted to our hospital. ⋯ The reason why we use TAC is that retrograde perfusion by femoral artery has a high-risk of malperfusion and cerebral embolism because of atheromatous change in aorta, and the use of the axillary artery can be troublesome because of the vessel's small diameter. We considered that in cases of acute aortic dissection, TAC is much safer and simpler than femoral or axillary cannulation.
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Aberrant subclavian artery (ASA) is the most frequently encountered congenital anomaly of aortic arch. The ASA aneurysms are rare but potentially lethal disease, it has been recognized that the presence of an aneurysm of an ASA itself is an indication for surgery. We experienced 4 cases with ASA during the past 23 years. ⋯ Three patients had a right-sided aortic arch. Among the 4 patients, only 1 underwent total arch replacement, but the other 3 patients could be followed conservatively for 1, 7 and 23 years, respectively. We reviewed the problem of the diagnosis and treatment of the ASA including surgical indication.
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Case Reports
[Stenting for postoperative airway stenosis due to traumatic tracheobronchial rupture].
A 43-year-old man underwent repair for the broken trachea, left main bronchus and right main brouchus due to trauma. Twenty-seven months after the initial surgery, he developed dyspnea and required ventilatory support. Computed tomography showed severe stenosis of the left main bronchus, tracheomalasia and bronchomalasia of right main bronchus. ⋯ SEMS developed granulatory and cicatricial stenosis of the airway, which caused severe dyspnea. Replacement of SEMS with Dumon stents was successfully done and dyspnea was disappeared. A silicon stent should be used for treating postreconstructive airway stenosis including tracheobronchomalasia.