胸部外科

The patient is a 58-year-old male who underwent aortic valve replacement and ascending aortic grafting five years ago. Postoperatively, a temporary epicardial pacing wire( TEPW) could not be removed, and was subsequently cut at insertion to the skin and left in situ. Despite ongoing antibiotic therapy, the patient’s C-reactive protein (CRP) level remained elevated. An endoscopic examination revealed that the TEPW had migrated and penetrated the esophagus, prompting its endoscopic removal. TEPW can cause fatal complications, so they should be removed whenever possible. In patients with TEPW left in the body, wires should be checked constantly by imaging studies.

An eight-day-old boy with the transposition of the great arteries (TGA) with posterior aorta underwent original Jatene procedure. He has been developing well. Cardiac catheterization revealed good coronary artery blood flow at five years of age. At the age of 13 years, he had a critical episode of fainting during excessive physical exertion in the junior high school club activities. Three-dimensional computed tomography (CT) revealed a slit-like stenosis of the left coronary artery orifice. Enlargement of the left coronary orifice was successfully performed. Stretching of the left coronary artery into the enlarged aorta may cause the coronary orifice stenosis. The patient is doing well two years after surgery.

The patient is an 86-year-old woman. She had ascites and was being treated with diuretics, but developed dyspnea, so a chest computed tomography( CT) scan was performed which revealed right pleural effusion. After aspiration of pleural effusion, abdominal distention due to ascites decreased and video-assisted thoracoscopic surgery was performed on suspicion of pleuroperitoneal communication. The diaphragm was sutured using an automatic suture device because a hole was found in the diaphragm. Insufflation into the abdominal cavity technique was safety and useful for identifying pleuroperitoneal communication.

We report two cases of metastatic cardiac tumors managed surgically. Case 1 involved a 52-year-old man with colorectal cancer and pulmonary metastases who developed respiratory distress during chemoradiotherapy. Imaging revealed a right atrial mass extending into the right ventricle. Mass reduction of the intracardiac tumor was surgically performed to reduce embolic risk and to enable subsequent chemotherapy. Postoperative chemotherapy resulted in complete remission without recurrence. Case 2 involved a 50-year-old woman with cervical cancer who experienced worsening dyspnea during treatment. Positron emission tomography (PET) and echocardiography identified a tumor extending from the right atrium to the pulmonary artery. As complete resection was unfeasible, mass reduction with tricuspid valve replacement was performed, followed by chemotherapy. The patient remains alive. Pathology confirmed metastatic cardiac tumors in both cases. These tumors present variably depending on the primary cancer and metastatic pattern, making diagnosis and treatment challenging. In symptomatic cases, especially with heart failure or embolism, prompt surgical intervention is critical. Mass reduction can relieve symptoms and improve survival. A focused literature review is also included to support clinical decision-making.

The lupus anticoagulant is one of the antiphospholipid antibodies that inhibit the phospholipid-dependent coagulation pathway. Lupus anticoagulant-positive patients are often associated with abnormal blood coagulation, which cause thrombosis or miscarriage. We report two surgical cases of pulmonary nontuberculous mycobacterial disease (M. avium) with the lupus anticoagulant. Both patients were women around 70 years of age with no past history, including thrombosis or miscarriage. Despite treatment, M. avium continued to be cultured from their sputum and eventually blood sputum appeared. They were performed surgical operations and the postoperative courses were uneventful without anticoagulation. Although the report of pulmonary nontuberculous mycobacterial disease with the lupus anticoagulant is extremely rare, the involvement of infection in the pathogenesis of the lupus anticoagulant has been reported. The further research between lupus anticoagulant and pulmonary nontuberculous mycobacterial infection is necessary.