Kyobu geka. The Japanese journal of thoracic surgery
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A 63-year-old man complained of chest pain and back pain 16 months after aortic valve replacement. Computed tomography (CT) showed acute aortic dissection (Stanford A) and we decided to perform operation. ⋯ Under hypothermic circulatory arrest graft replacement of ascending aorta was performed. Postoperative course was uneventful.
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The management of small pulmonary artery in tetralogy of Fallot (TOF) with pulmonary atresia (PA) is complicated. Our strategy is palliative right ventricle outflow tract reconstruction (RVOTR). The aim of this study is to determine whether palliative RVOTR is useful as the first stage operation. ⋯ One patient with TOF, PA, major aorto-pulmonary collateral artery (MAPCA) had corrective surgery after 2 additional operations and interventional catheterization. Five patients of this series already have undergone corrective surgery, whereas 1 is waiting for it. RVOTR is a useful method for pulmonary artery growth in patients with TOF, PA and diminutive pulmonary artery.
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Diffuse malignant mesothelioma with bloody pleural effusion is not rare, but a localized fibrous mesothelioma with bloody pleural effusion is relatively rare. A 45-year-old woman presented with a localized fibrous mesothelioma causing a bloody pleural effusion. Her chief complaint was right-sided lateral chest pain. ⋯ At operation, the tumor seemed to have originated from the right lung parenchyma or had invade the right lower lobe because tumor had penetrated deeply in the lung. Tumor and part of the parietal pleura were resected by right lower lobectomy. Final pathology established that the tumor was adherent to the right lung and was only encapsulated by the lung.
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With recent technical improvements in catheter interventional therapy, percutaneous coronary intervention (PCI) has now become the treatment of first choice for acute coronary syndrome (ACS). The objective of the present study was to evaluate critically the timing of coronary artery bypass grafting (CABG) for severe ACS with preoperative intraaortic balloon pumping (IABP). Since 1994, a total of 70 patients have gone emergency or urgent CABG for ACS. ⋯ In conclusion, for ACS cases, especially UAP cases of LMT, in which symptoms, findings of ischemia and hemodynamics are stabilized by medical intervention including IABP; emergency surgery could be avoided immediately after coronary angiography. Recovery in the ischemic myocardium is intended by IABP, and urgent surgery should be performed after sufficient and precise preoperative examinations. An improvement not only in the perioperative but also long-term results can be expected by performing complete revascularizations.
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Thoracic aortic injury caused by blunt chest trauma is often fatal. Although aortography had been inevitable for thoracic surgery until recently, image of computed tomography (CT) is often superior to aortogram nowadays. We present a case of 64-yaer-old man with blunt chest trauma by traffic accident, who was successfully diagnosed and operated without invasive aortography. ⋯ There found Y-shaped tear at the distal aortic arch, and was replaced with a prosthetic graft. Operation was performed under left heart bypass using heparin-coated circuit and centrifugal pump. We would stress that the enhanced chest CT is sufficiently diagnostic in thoracic aortic trauma like the present case.