General Thoracic and Cardiovascular Surgery Cases最新文献

{"title":"Perioperative management of acute type A aortic dissection using extended half-life factor IX (Alprolix) in a patient with severe hemophilia B: a case report.","authors":"Tessho Kitamura, Yutaro Ryu, Shun Nakaji, Shinichiro Taniguchi","doi":"10.1186/s44215-026-00282-1","DOIUrl":"https://doi.org/10.1186/s44215-026-00282-1","url":null,"abstract":"<p><strong>Background: </strong>Emergency surgery for acute type A aortic dissection (ATAAD) in patients with severe hemophilia B is extremely rare, and perioperative coagulation management is a major challenge.</p><p><strong>Case presentation: </strong>A 63-year-old man with severe hemophilia B (factor IX activity < 1%) was diagnosed with ATAAD and underwent emergency surgery. Replacement therapy with an extended half-life factor IX product (eftrenonacog alfa; Alprolix) was administered targeting a factor IX activity of 80-100%, and total arch replacement was performed. Cardiopulmonary bypass was performed under standard heparinization conditions. Since rapid measurement of factor IX activity was not possible, postoperative replacement therapy was based primarily on the clinical assessment of hemostasis, with serial activated partial thromboplastin time measurements providing supportive information, whereas intraoperative anticoagulation was managed using standard activated clotting time monitoring. Intra- and postoperative bleeding volumes were within ranges comparable to those observed in standard complex aortic surgery, and the postoperative course was uneventful.</p><p><strong>Conclusions: </strong>The use of an extended half-life factor IX product may be a practical option for perioperative coagulation management during emergency aortic surgery in patients with severe hemophilia B.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"5 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Massive enlargement of a previously unrecognized bronchogenic cyst over 8 years with intracystic hemorrhage and complex surgical resection: a case report.","authors":"Shuhei Kobayashi, Eriko Fukui, Hideki Nagata, Kenji Kimura, Toru Kimura, Takashi Kanou, Naoko Ose, Yasushi Shintani","doi":"10.1186/s44215-026-00284-z","DOIUrl":"https://doi.org/10.1186/s44215-026-00284-z","url":null,"abstract":"<p><strong>Background: </strong>Bronchogenic cysts are usually asymptomatic and are often detected incidentally; however, they may become symptomatic due to infection, hemorrhage, or enlargement. We report a case of a previously unrecognized bronchogenic cyst that showed substantial enlargement from 4.8 to 13 cm over an 8-year interval, with intracystic hemorrhage, ultimately requiring partial resection of the esophageal muscularis.</p><p><strong>Case presentation: </strong>A man in his 20s presented with upper abdominal pain and nausea. Computed tomography revealed a 13-cm mass extending from below the tracheal bifurcation to the level of the gastric cardia. A CT scan obtained eight years earlier during the evaluation of abdominal pain had shown a 4.8-cm cystic lesion below the tracheal bifurcation, demonstrating substantial enlargement over the intervening period. Although conservative treatment was attempted, compressive symptoms persisted; therefore, surgical resection was performed for definitive diagnosis and symptom relief. Severe inflammatory adhesions necessitated right open thoracotomy with partial resection of the esophageal muscularis. The cyst contained a large hematoma, and histopathological examination confirmed the diagnosis of a bronchogenic cyst with intracystic hemorrhage.</p><p><strong>Conclusion: </strong>This case demonstrates substantial enlargement of a previously unrecognized bronchogenic cyst from 4.8 to 13 cm over an 8-year interval, with intracystic hemorrhage, symptomatic progression, and technically demanding surgical resection. The potential for substantial enlargement and increasing surgical complexity should be considered when determining the timing of resection for bronchogenic cysts.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"5 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revascularize first, resect second: off-pump excision of giant SVG pseudoaneurysm.","authors":"Aadhya Rakesh, Nishant Saran","doi":"10.1186/s44215-026-00273-2","DOIUrl":"10.1186/s44215-026-00273-2","url":null,"abstract":"<p><strong>Background: </strong>Saphenous vein graft pseudoaneurysm is a rare late complication of coronary artery bypass grafting. Management is particularly challenging when the pseudoaneurysm-bearing graft remains an active source of myocardial perfusion. A 67-year-old man presented 33 years after coronary artery bypass grafting with progressive exertional dyspnea. Echocardiography demonstrated a large mass abutting the right atrium. Computed tomography angiography showed a 10 × 7 × 6 cm partially thrombosed pseudoaneurysm arising from the saphenous vein graft to the right posterior descending artery, with right atrial compression. Coronary angiography demonstrated pseudoaneurysm filling from the graft, chronic native right coronary artery occlusion, patent mammary grafts, and severe proximal graft stenosis. The heart team considered transcatheter exclusion unsuitable because of the distal entry site, calcific graft disease, and ongoing distal right coronary dependence. Redo off-pump saphenous vein grafting to the right posterior descending artery was performed before old-graft ligation. After transit-time flow measurement confirmed new-graft function, the pseudoaneurysm-bearing graft was ligated proximally and distally and excised en bloc. The patient was discharged on postoperative day 5. Three-month computed tomography angiography demonstrated a patent new graft without residual pseudoaneurysm.</p><p><strong>Discussion: </strong>This case highlights that graft patency and myocardial dependence should be defined before exclusion of a saphenous vein graft pseudoaneurysm. In selected patients, revascularization before graft sacrifice can be performed off pump, avoiding cardiopulmonary bypass while preserving myocardial perfusion.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"5 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149208387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Curative-intent lung resection after recovery from fulminant immune checkpoint inhibitor-associated myocarditis during neoadjuvant therapy: a case report.","authors":"Yui Kaburaki, Hiroyuki Ito, Tetsuya Isaka, Takashi Tsunematsu, Kengo Tsukahara, Azusa Hayakawa, Ikki Takada, Ryotaro Matsuyama, Chiaki Kanno, Takuya Nagashima","doi":"10.1186/s44215-026-00278-x","DOIUrl":"10.1186/s44215-026-00278-x","url":null,"abstract":"<p><strong>Background: </strong>Immune checkpoint inhibitor (ICI)-associated myocarditis is a rare but potentially fatal immune-related adverse event (irAE) that may interrupt planned curative treatment for resectable non-small-cell lung cancer. However, the suitability of definitive surgery after recovery from fulminant myocarditis remains unclear.</p><p><strong>Case presentation: </strong>A 53-year-old man with left upper lobe adenocarcinoma and ipsilateral hilar nodal disease was administered four cycles of neoadjuvant cisplatin, pemetrexed, and pembrolizumab, resulting in a partial response. Eighty-six days after the initiation of neoadjuvant chemoimmunotherapy, he developed grade 4 fulminant ICI-associated myocarditis with ventricular fibrillation and cardiac arrest. Endomyocardial biopsy revealed active lymphocytic myocarditis. The patient required intubation, percutaneous cardiopulmonary support, intra-aortic balloon pumping, continuous hemodiafiltration, high-dose corticosteroids, and prolonged rehabilitation. After his cardiac function recovered, tumor regrowth without distant metastasis was identified. Multidisciplinary reassessment supported surgery because the left ventricular ejection fraction had recovered to 71%, no recurrent malignant arrhythmia had been documented, cardiac biomarkers had improved, prednisolone had been tapered to 10 mg/day, and the disease remained technically resectable. Thoracoscopic-assisted thoracotomy with left upper lobe sleeve resection, pulmonary artery reconstruction, and hilar and mediastinal lymph node dissection was performed 144 days after myocarditis onset, corresponding to 230 days after the initiation of neoadjuvant chemoimmunotherapy. R0 resection was achieved. Surveillance computed tomography showed no evidence of recurrence through 3.5 years after surgery, and the patient was alive at the last follow-up 6.3 years after surgery.</p><p><strong>Conclusions: </strong>Fulminant ICI-associated myocarditis does not necessarily preclude subsequent curative-intent lung resection. In highly selected patients, surgery may remain feasible after objective cardiac recovery, multidisciplinary reassessment, and shared decision-making with the patient. This case suggests that the acute management of life-threatening cardiovascular irAEs should be undertaken at centers with continuous on-site cardiology support, multidisciplinary care, and access to emergency mechanical circulatory support. Additionally, planning subsequent curative-intent surgery requires multidisciplinary collaboration, ready access to cardiology expertise, and an appropriate pathway for rapid escalation of cardiovascular care.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"5 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13651155/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149149585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary pulmonary hyalinizing clear cell carcinoma harboring EWSR1::ATF1 fusion: a case report.","authors":"Takashi Teishikata, Mariko Hashiguchi, Kozue Nakahara, Yusuke Okamoto, Masafumi Hiratsuka, Keiji Kamohara","doi":"10.1186/s44215-026-00280-3","DOIUrl":"https://doi.org/10.1186/s44215-026-00280-3","url":null,"abstract":"<p><strong>Background: </strong>Hyalinizing clear cell carcinoma (HCCC) is a rare salivary gland-type tumor that occasionally arises in the lung. As it shows substantial morphological overlap with mucoepidermoid carcinoma (MEC), definitive diagnosis can be challenging. Therefore, molecular testing is essential, as MEC typically harbors CRTC1/3::MAML2 fusions, whereas HCCC is characterized by EWSR1 fusions.</p><p><strong>Case presentation: </strong>A 60-year-old woman presented with persistent cough and hemoptysis. Imaging revealed a 3.0-cm solid nodule in the left lower lobe adjacent to the bronchus. She underwent robot-assisted left lower lobectomy with lymph node dissection. Histologically, the tumor consisted of uniform epithelioid cells with clear-to-pale eosinophilic cytoplasm arranged in nests and cords within prominent hyalinized stroma. Cytologic atypia was minimal. Immunohistochemically, tumor cells were positive for CK7, CK5/6, and p40 and negative for TTF-1. Venous invasion was present without lymph node metastasis. Break-apart fluorescence in situ hybridization revealed rearrangements of EWSR1 and ATF1, strongly supporting the presence of an EWSR1::ATF1 fusion, whereas MAML2 rearrangement was absent. The patient remains recurrence-free 1 year after surgery.</p><p><strong>Conclusion: </strong>Accurately distinguishing primary pulmonary HCCC, which is rare and may mimic MEC, is essential for appropriate pathological classification and prognostic assessment. It is also important for thoracic surgeons to consider HCCC during the differential diagnosis of centrally located or endobronchial pulmonary tumors, particularly when a definitive preoperative diagnosis is challenging. Integrating histopathology with molecular testing for EWSR1 and MAML2 rearrangements is critical for accurate diagnosis.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"5 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful staged anatomic repair for congenitally corrected transposition with both atrioventricular valves' regurgitation: a case report.","authors":"Yuji Fuchigami, Koichi Toda, Akinori Hirano, Ryusuke Hosoda, Yukino Iijima, Takaya Hoashi","doi":"10.1186/s44215-026-00281-2","DOIUrl":"https://doi.org/10.1186/s44215-026-00281-2","url":null,"abstract":"<p><p>A 4-year-old boy with dextrocardia, congenitally corrected transposition of the great arteries, pulmonary valve stenosis, and ventricular septal defect demonstrated progressive hypoxemia and mild-to-moderate mitral and tricuspid regurgitation. Cardiac magnetic resonance imaging revealed insufficient right ventricular volume for Senning-Rastelli type anatomical repair. Given the elevated surgical risk associated with mitral regurgitation and inadequate ventricular volume, an initial palliative approach was undertaken at 2 years of age, consisting of systemic-to-pulmonary shunt placement and mitral valve repair, which improved oxygenation and promoted right ventricular growth, with trivial mitral regurgitation. Subsequent imaging confirmed adequate ventricular development and trivial mitral regurgitation, allowing for definitive anatomic repair at 4 years and 7 months of age. The procedure comprised a Senning atrial switch combined with a Rastelli operation. The postoperative course was uneventful, and imaging demonstrated preserved biventricular function with minimal atrioventricular valve regurgitation and no evidence of outflow or pathway obstruction.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"5 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637420/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inferior vena cava hyperechoic structure in a patient with cardiac myxoma: a surgical case report and literature review.","authors":"Hiroto Yasumura, Tomoyuki Matsuba, Ryusuke Ibi, Shinichi Minagoe, Atsuko Hiramine, Yuki Ogata, Koichiro Shimoishi, Yoshihiro Fukumoto, Goichi Yotsumoto, Yoshiharu Soga","doi":"10.1186/s44215-026-00277-y","DOIUrl":"https://doi.org/10.1186/s44215-026-00277-y","url":null,"abstract":"<p><strong>Background: </strong>IVC hyperechoic structure detected by echocardiography is relatively uncommon and is usually associated with deep vein thrombosis and cancers. In most cases, the etiology can be clarified using computed tomography (CT) and magnetic resonance imaging (MRI). However, we encountered an IVC hyperechoic structure that was not confirmed by multimodality imaging in a patient with cardiac myxoma.</p><p><strong>Case presentation: </strong>A 62-year-old woman presented with sudden-onset left hemiplegia and right homonymous hemianopsia. On arrival, her left arm was cold to the touch. Contrast-enhanced CT demonstrated a left atrial mass, left subclavian artery occlusion, and splenic infarction. Brain MRI revealed an acute infarction in the right occipital lobe. Transthoracic echocardiography (TTE) showed a mobile mass in the left atrium and a 33 mm immobile linear hyperechoic structure with surrounding blood flow in the suprarenal IVC, suggestive of organized thrombus. However, laboratory tests showed no elevation of D-dimer, and cardiac MRI did not confirm any IVC lesion. During surgical planning, there was concern that IVC cannulation via the right atrium for CPB might dislodge a potential thrombus and cause pulmonary embolism. Preoperative transesophageal echocardiography under general anesthesia demonstrated no IVC hyperechoic structure. An IVC cannula was inserted via the right femoral vein under fluoroscopic guidance. Following cardiac arrest and right atriotomy, direct inspection revealed no thrombus or other abnormal structure within the suprarenal IVC. The left atrial tumor was excised via left atriotomy. Histopathological examination confirmed cardiac myxoma. Postoperative TTE showed complete disappearance of the IVC hyperechoic structure.</p><p><strong>Conclusions: </strong>We report a rare case of IVC hyperechoic structure mimicking a true thrombus in a patient with cardiac myxoma. This phenomenon may be related with spontaneous echo contrast and echocardiographic artifacts. Our case highlights an important diagnostic pitfall in echocardiographic assessment of the IVC and emphasizes the importance of integrating findings from multiple imaging modalities.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"5 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13633645/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149121715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robot-assisted thoracoscopic resection of a costal cartilage chondrosarcoma mimicking anterior mediastinal teratoma: a case report.","authors":"Takumi Takemoto, Junichi Murakami, Sota Yoshimine, Toshiki Tanaka, Akihito Mikamo","doi":"10.1186/s44215-026-00279-w","DOIUrl":"https://doi.org/10.1186/s44215-026-00279-w","url":null,"abstract":"<p><strong>Background: </strong>Chondrosarcoma arising from the costal cartilage is extremely rare. When such a tumor extends toward the mediastinum, it may present as a well-defined mass that is difficult to distinguish from a primary anterior mediastinal tumor. We report a case diagnosed preoperatively as a mature teratoma but later proven to be a grade 1 chondrosarcoma of the costal cartilage.</p><p><strong>Case presentation: </strong>A 66-year-old asymptomatic woman was incidentally found to have an abnormal shadow on chest imaging. Contrast-enhanced computed tomography revealed a well-defined, calcified mass measuring 37 × 31 × 21 mm in the anterior mediastinum, adjacent to the left costal arch; bone-window and reformatted images did not clearly demonstrate continuity with the adjacent costal cartilage. Magnetic resonance imaging demonstrated T1-weighted hyperintensity with signal loss on fat-suppressed imaging, consistent with a fatty component, and no invasion of surrounding structures. Positron emission tomography-computed tomography showed low fluorodeoxyglucose uptake and no distant metastasis, and tumor markers were normal. A preoperative diagnosis of mature teratoma was made, and resection was planned. Robot-assisted thoracoscopic surgery was performed via a three-port right-sided approach. Intraoperatively, the tumor lay in the narrow space between the heart and the sternum, with direct continuity with the left sixth costal cartilage suggesting its origin; the tumor-cartilage boundary could not be identified, and the cartilage was divided at the tumor interface. The postoperative course was uneventful. Pathological examination revealed chondrocyte-like tumor cells with mild nuclear atypia, consistent with a grade 1 chondrosarcoma of the costal cartilage; residual tumor could not be excluded (Rx). A multidisciplinary tumor board elected surveillance, and no recurrence has been observed at 18 months postoperatively.</p><p><strong>Conclusions: </strong>Costal cartilage chondrosarcoma belongs in the differential diagnosis of a calcified anterior mediastinal mass because preoperative recognition determines whether a wide or marginal resection is planned, and a minimally invasive approach must not compromise the surgical margin when malignancy is suspected. The right-sided robot-assisted thoracoscopic approach provided favorable visualization and maneuverability in this confined retrosternal location, but its oncological safety cannot be generalized from a single case.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"5 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13628817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physician-modified fenestrated/inner-branched endovascular aortic repair for distal aortic arch aneurysm after stent graft migration: a case report.","authors":"Yutaro Hori, Tsuyoshi Shibata, Shingo Tsushima, Kenta Yoshikawa, Shun Hayasaka, Hirokazu Sugiura, Hajime Maeda, Tomohiro Nakajima, Junji Nakazawa, Ayaka Arihara, Kenichi Kato, Shigeki Komatsu, Masato Yonemori, Yutaka Iba","doi":"10.1186/s44215-026-00272-3","DOIUrl":"10.1186/s44215-026-00272-3","url":null,"abstract":"<p><strong>Backgrounds: </strong>Open surgical repair remains the gold standard for aortic arch aneurysms, and endovascular treatment options are limited in high-risk patients. We report successful treatment of a distal aortic arch aneurysm using physician-modified fenestrated/inner-branched endovascular aortic repair (PM-F/iBEVAR), suggesting its feasibility as an alternative strategy.</p><p><strong>Case presentation: </strong>A 50-year-old man presented with a distal aortic arch aneurysm enlargement after stent graft migration following preemptive thoracic endovascular aortic repair. The patient had significant neurological sequelae with impaired activities of daily living and was considered unsuitable for conventional arch replacement after multidisciplinary discussion. PM-F/iBEVAR was performed, and an inner branch was sutured only to the left subclavian artery in this patient. Although a type II endoleak was detected on postoperative day 3, the type Ia endoleak had resolved, and patency of the arch branch vessels was well maintained. The patient was discharged without any complications. At 6 months, the aneurysm remained stable without enlargement.</p><p><strong>Conclusions: </strong>This case report suggests that PM-F/iBEVAR may be a feasible option for patients at high risk for open surgical repair with anatomically challenging distal aortic arch aneurysms.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"5 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13599197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149027469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In vivo three-dimensional FD-OCT visualization of microvascular structures consistent with vasa vasorum in a conventionally harvested saphenous vein graft.","authors":"Akira Sugaya, Mutsumi Mizoguchi, Masanori Nakamura, Koji Kawahito","doi":"10.1186/s44215-026-00276-z","DOIUrl":"10.1186/s44215-026-00276-z","url":null,"abstract":"<p><strong>Background: </strong>The no-touch (NT) saphenous vein graft (SVG) technique improves long-term graft patency. Proposed mechanisms include maintenance of adventitial and perivascular structures and avoidance of high-pressure distension. Whether adventitial structures consistent with VV remain detectable in carefully harvested conventional SVGs without a thick tissue pedicle remains uncertain.</p><p><strong>Case presentation: </strong>A 75-year-old woman underwent aortic valve replacement and coronary artery bypass grafting. The SVG was harvested using a carefully performed conventional technique that retained an approximately 1-2 mm rim of surrounding adipose tissue and protected the adventitia. Graft dilation was performed using cardiopulmonary bypass arterial-line pressure (approximately 100 mmHg), avoiding manual high-pressure distension. Two weeks postoperatively, frequency-domain optical coherence tomography (FD-OCT) demonstrated low-signal tubular structures within the adventitial layer. Three-dimensional reconstruction showed longitudinal continuity of structures morphologically consistent with vasa vasorum externae.</p><p><strong>Conclusions: </strong>This case demonstrates localized adventitial structures consistent with VV in a carefully harvested conventional SVG. Although functional patency could not be confirmed, the findings are hypothesis-generating and warrant further comparative investigation.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"5 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13576230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148979370","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}