Kyobu geka. The Japanese journal of thoracic surgery
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In cardiac surgery significant residual lesions increase postoperative morbidity and mortality. To evaluate the usefulness of transesophageal echocardiography (TEE) as a early postoperative monitor in patients immediately after cardiovascular surgery, 500 consecutive patients were studied from April 1990 to December 1994. ⋯ Imaging revealed unsatisfactory operative results that necessitated further surgery in 18 (3.6%) of the 500 patients. These data indicate that early postoperative TEE is useful in assessing immediate operative results and identifying patients with unsatisfactory results who are at increased risk for postoperative complications.
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Tracheobronchial injuries remain uncommon, but they are of great significance, because they can result in death or substantinal functional compromise. Such injuries are mostly from blunt trauma and motor vehicle accidents, but there also is an incidence of penetrating thoracic trauma inclunding iatrogenic accidents. Three cases of iatrogenic injury of tracheobronchial membranous wall were reported. ⋯ Another case was tracheal membranous wall injury during operation at blunt dissection for esophageal carcinoma. We reported the emergent managements for iatrogenic injury of tracheobroncheal membranous wall in differents 3 ways. We should select the best treatment according to the condition of the patients and situation of the injury.
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A 72-year-old woman was admitted to our hospital because of hemosputum. Enhanced CT showed ruptured true aortic arch aneurysm. True aortic arch aneurysm ruptured at distal portion of aneurysm. ⋯ She weaned from respiratory support. True aortic arch aneurysm combined with Stanford type A dissection is very rare. We presented ruptured true aortic arch aneurysm in association with Stanford type A chronic dissection which had an entry in true aneurysm.
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Two cases of bronchogenic carcinoma undergone left upper lobectomy (R 3) with bronchoplasty and sleeve pulmonary arterial resection via mid-sternotomy were reported. Both cases were squamous cell carcinoma originated in the orifice of the left upper lobe. Case 1 was stage IIIB (T2N3M0) bronchogenic carcinoma, its postoperative course was uneventful and died of distant lymphatic metastasis thirty-three months after operation. ⋯ In order to preserve adequate pulmonary function and to maintain reasonable quality of life (QOL) for the patients with impaired pulmonary function, this angioplastic procedure seems to be acceptable. It is still under discussion to perform this procedure for the patients who would be able to withstand undergoing pneumonectomy, therefore we adopt this method only for every patient for whom it is difficult to maintain desirable QOL after pneumonectomy. Namely, for the patient whose predicted one second forced expiratory volume (FEV1.0) after pneumonectomy is less than 900 ml/m2, we'll be likely to try this angioplastic procedure at first.
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Review Case Reports
[Traumatic tricuspid regurgitation: a case report and a review of operated cases in Japan].
A 48-year-old male was admitted with chief complaints of fatigue and palpitation. He had a past history of closed chest trauma without rib fracture due to an automobile accident 7 years ago. He had been complaining of a gradual increase of palpitation since 4 years after the accident. ⋯ The valve was replaced with a 31 mm Carpentier-Edwards bioprosthesis. His post operative course was uneventful. A brief review of the reported surgical cases of traumatic tricuspid regurgitation in Japan is also described in this paper.