General Thoracic and Cardiovascular Surgery Cases最新文献

{"title":"Early biological reactions to a novel hybrid knit fabric inducing autologous tissue ingrowth implanted in a small infant.","authors":"Takashi Kido, Shintaro Nemoto, Jun Narita, Hidekazu Ishida, Ryo Ishii, Takayoshi Ueno, Shigeru Miyagawa","doi":"10.1186/s44215-026-00275-0","DOIUrl":"10.1186/s44215-026-00275-0","url":null,"abstract":"<p><strong>Back ground: </strong>Patch augmentation of the right ventricular outflow tract (RVOT) is frequently required in pediatric patients with stenosis or atresia affecting the right ventricle-to-pulmonary artery continuity. However there have been no ideal patch materials for pediatric patients.</p><p><strong>Case presentation: </strong>A 1-month-old infant with pulmonary atresia with an intact ventricular septum underwent surgical pulmonary valvotomy and RVOT reconstruction using a novel hybrid wrap-knitted patch designed for autologous tissue ingrowth. Ten months postoperatively, for recurrent severe pulmonary valve stenosis, the patient underwent repeat RVOT reconstruction. Histological examination of the excised hybrid patch revealed that both surfaces were covered with regenerated tissue composed of smooth muscle cells, blood vessels, and collagen fibers. Transmission electron microscopy confirmed that the regenerated tissue contained feature mature fibroblasts and capillaries, demonstrating sufficient development of regenerated tissue.</p><p><strong>Conclusions: </strong>Histological findings of the hybrid wrap-knit fabric patch excised in redo surgery 10 months after the initial surgery showed potential macrophage-fibroblast interaction, promoting tissue remodeling in the new fabric.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"5 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13555954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914974","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":"Esophageal adenosquamous carcinoma with mucinous carcinoma-predominant lymph node metastases: a case report.","authors":"Natsumi Maeda, Miho Yamamoto, Rie Nakashima, Kohei Tajima, Takatoshi Seki, Mika Ogimi, Kohei Kanamori, Yamato Ninomiya, Akihito Kazuno, Yoshiaki Shoji, Hiroshi Kajiwara, Masaki Mori, Kazuo Koyanagi","doi":"10.1186/s44215-026-00269-y","DOIUrl":"10.1186/s44215-026-00269-y","url":null,"abstract":"<p><strong>Background: </strong>Esophageal adenosquamous carcinoma is a rare histological subtype of esophageal cancer characterized by the coexistence of squamous cell carcinoma and adenocarcinoma components. Preoperative diagnosis is challenging because biopsy specimens often contain only the squamous component.</p><p><strong>Case presentation: </strong>A 75-year-old man presented with dysphagia. Esophagogastroduodenoscopy revealed a type 3 tumor in the middle thoracic esophagus. Histopathological examination of the biopsy specimens demonstrated predominantly squamous cell carcinoma with a minor mucin-producing adenocarcinoma component, raising suspicion of adenosquamous carcinoma. Given the patient's history of myocardial infarction and poor cardiac function, neoadjuvant chemotherapy was considered unsuitable. The patient underwent thoracoscopic esophagectomy with lymph node dissection. Pathological examination confirmed adenosquamous carcinoma, with the superficial portion composed predominantly of moderately differentiated squamous cell carcinoma, whereas the deeper layers contained mucinous carcinoma and signet-ring cells. Extensive lymph node metastases were identified in the cervical, thoracic, and abdominal regions, the majority of which predominantly comprised mucinous carcinoma. At seven months postoperatively, mediastinal lymph node recurrence was detected. Due to the patient's deteriorating general condition, systemic chemotherapy was contraindicated, and the patient died 11 months postoperatively.</p><p><strong>Conclusions: </strong>We report a rare case of esophageal adenosquamous carcinoma with mucinous carcinoma-predominant lymph node metastases. The predominance of mucinous carcinoma in metastatic lesions may reflect the aggressive biological behavior of the adenocarcinoma component and could be associated with poor clinical outcomes. Although esophageal adenosquamous carcinoma is generally managed using surgery-based multidisciplinary strategies based on the treatment principles for esophageal squamous cell carcinoma, no standard chemotherapy regimen has been established for esophageal adenosquamous carcinoma. Further accumulation of cases is needed to determine the optimal treatment strategies for this rare disease.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"5 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13504769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820895","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":"Late intrathoracic migration of a retained temporary epicardial pacing wire associated with middle lobe atelectasis and hemoptysis 15 years after aortic valve replacement: a case report.","authors":"Shiro Kaneda, So Miyahara, Shohei Mitsumata, Jyun-Ichi Wakahara, Kensuke Midorikawa, Yuichiro Ueda, Toshihiko Sato","doi":"10.1186/s44215-026-00274-1","DOIUrl":"10.1186/s44215-026-00274-1","url":null,"abstract":"<p><strong>Background: </strong>Temporary epicardial pacing wires (TEPWs) are routinely placed after cardiac surgery for temporary rhythm management and are typically removed within a few days. Although retained wires are uncommon, late migration may lead to serious complications.</p><p><strong>Case presentation: </strong>An 80-year-old man who had undergone aortic valve replacement 15 years earlier was referred for evaluation of right middle lobe atelectasis detected on computed tomography (CT). Bronchoscopy revealed mucus obstruction and distal mucosal edema of the right middle lobe bronchus. The patient subsequently developed hemoptysis. Contrast-enhanced CT demonstrated a continuous 11-cm linear high-density structure extending from the right hilum to the inferior cardiac surface, near the middle lobe bronchovascular structures. Intrathoracic migration of a retained TEPW was suspected, and surgical removal was performed. Thoracoscopic exploration revealed dense hilar adhesions; therefore, the pericardium was opened through the same thoracoscopic ports, and the wire was removed using an intrapericardial approach. The postoperative course was uneventful.</p><p><strong>Conclusions: </strong>Retained TEPWs may migrate intrathoracically even many years after cardiac surgery. In the present case, the migrated wire was anatomically adjacent to the middle lobe bronchovascular structures and was clinically associated with atelectasis and hemoptysis, although direct bronchial penetration was not confirmed. In selected cases with hilar or pericardial-adjacent migration, an intrapericardial approach may facilitate safe removal.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"5 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13505134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148820901","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":"Lessons from surgery after neoadjuvant chemoimmunotherapy for bulky, invasive N2 lung cancer: a case report.","authors":"Teppei Hashimoto, Kanji Tanaka, Yasuhiro Fujita, Takehiko Manabe, Hiroki Matsumiya, Masataka Mori, Masaru Takenaka, Koji Kuroda, Fumihiro Tanaka, Hidetaka Uramoto","doi":"10.1186/s44215-026-00271-4","DOIUrl":"10.1186/s44215-026-00271-4","url":null,"abstract":"<p><strong>Background: </strong>Neoadjuvant nivolumab plus chemotherapy increases pathologic complete response rates in resectable non-small cell lung cancer, but the operative safety of this approach in bulky, invasive N2 disease with suspected great-vessel involvement remains uncertain.</p><p><strong>Case presentation: </strong>A 64-year-old woman had left upper lobe adenocarcinoma with bulky single-station N2a disease and suspected aortic arch invasion. After three cycles of nivolumab plus carboplatin-paclitaxel, imaging showed only limited nodal shrinkage. At lobectomy, the subaortic lymph node was broadly adherent to the arch and surrounding structures, causing hemorrhage that required cardiopulmonary bypass and arch resection. Pathology showed pathologic complete response, but lymphocyte-predominant inflammation and fibrosis extended to the aortic adventitia.</p><p><strong>Conclusions: </strong>Radiographic response and pathologic complete response after chemoimmunotherapy do not necessarily indicate safe technical resectability in bulky, invasive N2 lung cancer. Multidisciplinary surgical planning should preserve caution when great-vessel invasion is suspected.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"5 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908532","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":"Rapidly enlarging port-site mass after thoracoscopic lung resection: desmoid-type fibromatosis mimicking pleural recurrence.","authors":"Go Kamimura, Masaya Aoki, Tomohiko Matsushita, Satomi Imamura, Shoichiro Morizono, Yuto Nonaka, Aya Takeda, Koki Maeda, Toshiyuki Nagata, Kazuhiro Ueda","doi":"10.1186/s44215-026-00270-5","DOIUrl":"10.1186/s44215-026-00270-5","url":null,"abstract":"<p><strong>Background: </strong>Desmoid-type fibromatosis is a rare, benign fibroblastic neoplasm characterized by infiltrative growth and a tendency for local recurrence despite the absence of metastatic potential. It has been associated with prior trauma or surgery, and postoperative lesions arising in the chest wall can present a major diagnostic challenge. In patients after lung cancer resection, a new pleural-based or chest wall mass at a previous port site is often interpreted as pleural dissemination, chest wall recurrence, or port-site implantation, even when the primary tumor is pathologically low risk.</p><p><strong>Case presentation: </strong>A 70-year-old woman underwent minimally invasive resection for lung adenocarcinoma, and the final pathological stage was pT1miN0M0 (pStage IA1). She remained asymptomatic, and routine postoperative surveillance was performed. At 10 months after surgery, computed tomography revealed a newly developed, well-demarcated soft-tissue mass arising from the chest wall at the thoracoscopic port site, adjacent to the pleura; the mass rapidly enlarged to 3.0 cm by 14 months. Positron emission tomography/computed tomography with fluorine-18 fluorodeoxyglucose showed mild tracer uptake within the lesion (maximum standardized uptake value, 2.5). Although the primary lung adenocarcinoma was pathologically low risk, pleural dissemination or port-site recurrence could not be confidently excluded based on imaging alone. Considering the need for definitive diagnosis and local control, the patient underwent en bloc resection of the lesion with chest wall excision including the seventh rib. Grossly, the tumor was firm and fibrous. Histopathological examination demonstrated a proliferation of bland spindle-shaped cells embedded in abundant collagenous stroma with infiltrative margins, consistent with desmoid-type fibromatosis. The postoperative course was uneventful. As the surgery was performed recently, long-term follow-up data are not yet available.</p><p><strong>Conclusions: </strong>Desmoid-type fibromatosis can occur at a thoracoscopic port site more than one year after lung cancer surgery and may mimic pleural dissemination or port-site recurrence, even after resection of minimally invasive adenocarcinoma. When malignancy cannot be excluded preoperatively, surgical excision with an adequate margin can establish the diagnosis and achieve local disease control.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"5 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908533","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":"Middle lobe torsion after chest tube drainage for primary spontaneous pneumothorax: a case report.","authors":"Hikaru Kohtake, Naoya Himuro, Katsutoshi Seto, Tetsuya Endo, Masashi Kobayashi","doi":"10.1186/s44215-026-00268-z","DOIUrl":"10.1186/s44215-026-00268-z","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary torsion is an uncommon condition that occurs most frequently after pulmonary resection. Its occurrence in association with spontaneous pneumothorax is very limited. Herein, we report a rare case of pulmonary torsion that developed following chest tube drainage for primary spontaneous pneumothorax.</p><p><strong>Case presentation: </strong>A 26-year-old man with a history of chest drainage for right primary spontaneous pneumothorax presented to our emergency department with dyspnea. Chest radiography revealed a right tension pneumothorax, and chest drainage was immediately performed. Chest computed tomography (CT) revealed no apparent bullous disease, but atelectasis of the right middle lobe was observed. Despite the cessation of air leakage, surgical intervention was planned on hospital day 3 because of the recurrence of spontaneous pneumothorax and its presentation as tension pneumothorax. Intraoperatively, the right middle lobe was rotated to the dorsal side of the lower lobe. No congestion or ischemic changes were observed, and detorsion was successfully performed. No obvious bullous disease was detected, though pleural changes at the lung apex were ablated and covered with a polyglycolic acid sheet. The postoperative course was uneventful, and the patient was discharged on postoperative day 4.</p><p><strong>Conclusions: </strong>Chest tube drainage for primary spontaneous pneumothorax is a routine procedure widely performed in emergency medicine. Therefore, clinicians must recognize that pulmonary torsion, a potentially fatal complication, can occur unexpectedly in the context of this common procedure. When lobar atelectasis is observed after chest tube insertion, clinicians should consider pulmonary torsion and promptly perform CT imaging.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"5 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148908517","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":"Left ventricular outflow tract stenosis following Bentall procedure using the graft insertion technique: a case report.","authors":"Koki Yokawa, Kazunori Yoshida, Ko Ishimoto, Taku Nakagawa, Tomonori Higuma, Yosuke Tanaka, Yoshihiro Oshima, Hidefumi Obo, Hidetaka Wakiyama","doi":"10.1186/s44215-026-00265-2","DOIUrl":"10.1186/s44215-026-00265-2","url":null,"abstract":"<p><strong>Background: </strong>The graft insertion technique is an effective choice for redo aortic root reconstruction in cases with extensive annular destruction. Nevertheless, its impact on postoperative left ventricular outflow tract (LVOT) geometry and flow dynamics has not been investigated in detail.</p><p><strong>Case presentation: </strong>A 69-year-old woman who underwent aortic valve replacement for infective endocarditis developed prosthetic valve dehiscence with paravalvular leakage and a large aortic root pseudoaneurysm after 4 months. Because the native annulus was completely destroyed, redo aortic root replacement using the Bentall procedure with the graft insertion technique was performed. Intraoperative examination revealed no macroscopic evidence of active infection but raised concerns regarding potential LVOT narrowing after the insertion of the inverted graft. Postoperative contrast-enhanced computed tomography demonstrated significant LVOT narrowing, with a minimal diameter of 14 mm, despite the implantation of a 19-mm bioprosthetic valve. Moreover, four-dimensional flow (4D-flow) magnetic resonance imaging (MRI) revealed accelerated systolic flow at the narrowed LVOT, indicating functional LVOT stenosis.</p><p><strong>Conclusions: </strong>This case emphasizes an important pitfall of the graft insertion technique-postoperative LVOT narrowing caused by the intraventricular portion of the inverted graft. Postoperative morphological and hemodynamic evaluation using advanced imaging modalities, including 4D-flow MRI, may be required to ensure the safety of this technique in complex aortic root reconstruction.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551944/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148311247","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":"Thymoma-associated stiff-person syndrome successfully treated with extended thymectomy: a case report.","authors":"Kie Maita, Tomoki Higeta, Hajime Watanabe, Takayuki Nakano, Kentaro Tokuoka, Tomoki Nakagawa, Shigeru Nogawa, Shunsuke Yamada, Ryota Masuda","doi":"10.1186/s44215-026-00264-3","DOIUrl":"10.1186/s44215-026-00264-3","url":null,"abstract":"<p><strong>Background: </strong>Stiff-person syndrome (SPS) is a rare autoimmune neurological disorder characterized by painful muscle stiffness and spasms. Paraneoplastic SPS associated with thymoma is rare. Here, we describe a rare case in which neurological symptoms improved after extended thymectomy.</p><p><strong>Case presentation: </strong>A 60-year-old woman presented with progressive painful muscle spasms and gait disturbances affecting the lower extremities. Neurological imaging revealed no structural abnormalities; however, both serum and cerebrospinal fluid were positive for anti-glutamic acid decarboxylase (GAD) antibodies, leading to a diagnosis of SPS. Despite receiving immunotherapy and symptomatic treatment, the patient's neurological symptoms persisted. Contrast-enhanced chest computed tomography revealed a small anterior mediastinal tumor suspected to be a thymoma. Subsequently, bilateral thoracoscopic extended thymectomy was performed. Histopathological examination confirmed a WHO type B1 thymoma (Masaoka stage I), and her neurological symptoms gradually improved postoperatively. Two years after surgery, she was able to walk independently and climb stairs without assistance.</p><p><strong>Conclusion: </strong>This case suggests that extended thymectomy may contribute to sustained neurological and functional improvement in selected patients with thymoma-associated SPS, even in the absence of normalization of the anti-GAD antibody titer.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528096/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148285072","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":"Left upper lobectomy for lung cancer with a subaortic anomalous left brachiocephalic vein: a case report.","authors":"Ryuhei Sakata, Yukihiro Yoshida, Masaya Yotsukura, Tomohiro Haruki, Shun-Ichi Watanabe","doi":"10.1186/s44215-026-00266-1","DOIUrl":"10.1186/s44215-026-00266-1","url":null,"abstract":"<p><strong>Background: </strong>A subaortic anomalous left brachiocephalic (innominate) vein is a rare systemic venous anomaly. Although usually asymptomatic, when it traverses the aortopulmonary window it may obscure the operative field and increase the risk of vascular injury during left upper mediastinal procedures, including station 4 L lymph node dissection and exposure or control of the left pulmonary artery.</p><p><strong>Case presentation: </strong>A man in his seventies presented with a 4.2-cm solid mass in the left upper lobe (S3b) and an enlarged station 4L lymph node. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of station 4L demonstrated carcinoma consistent with non-small cell lung cancer (NSCLC). Given resectable single-station N2 disease and pre-existing interstitial lung disease with a usual interstitial pneumonia (UIP) pattern, a surgery-first strategy was selected. Preoperative contrast-enhanced computed tomography (CT) with three-dimensional reconstruction demonstrated an anomalous left brachiocephalic vein coursing along the left lateral side of the aortic arch and then beneath the aortic arch, superior to the left pulmonary artery, and crossing the aortopulmonary window before draining into the superior vena cava (Takada pattern b/c). Video-assisted thoracoscopic left upper lobectomy with systematic mediastinal lymph node dissection was performed. Early identification of the left vagus nerve enabled safe proximal tracing to the left recurrent laryngeal nerve. En bloc dissection of the station 4L and station 5 lymph node regions and left pulmonary artery management were completed without neural or vascular injury. The ductus arteriosus ligament (DL) could not be identified intraoperatively, suggesting a retroductal course (Takada pattern c).</p><p><strong>Conclusions: </strong>Preoperative identification of a subaortic anomalous left brachiocephalic vein on contrast-enhanced computed tomography (CT) with three-dimensional (3D) reconstruction, together with early identification of the vagus and recurrent laryngeal nerves and careful pulmonary artery management after establishing a safe dissection plane, may facilitate safe dissection in the aortopulmonary window and help prevent neural or vascular injury.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148285071","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":"Life-saving staged management of a secondary aortoesophageal fistula after arch replacement: a case report.","authors":"Yuki Kamikawa, Yoichiro Machida, Hiromi Fujii, Hiroaki Hata, Shizuyuki Dohi","doi":"10.1186/s44215-026-00267-0","DOIUrl":"10.1186/s44215-026-00267-0","url":null,"abstract":"<p><strong>Background: </strong>Aortoesophageal fistula (AEF) after thoracic aortic repair is a rare and devastating complication with an extremely high mortality (33-100%). Although emergency thoracic endovascular aortic repair (TEVAR) can provide immediate hemostasis, it does not address the underlying infection and therefore is insufficient for long-term survival. A staged multidisciplinary strategy may improve outcomes in selected patients: initial hemodynamic stabilization, early source eradication (esophagectomy), and delayed reconstruction.</p><p><strong>Case presentation: </strong>A 78-year-old woman, who had undergone total arch replacement 6 years prior, presented with sudden haematemesis. Endoscopy and CT confirmed secondary AEF. Emergency TEVAR successfully stabilized bleeding. Two days later, the patient underwent thoracoscopic oesophagectomy, cervical oesophagostomy, jejunostomy, and omental flap coverage. Parvimonas micra was isolated intraoperatively, and targeted antimicrobial therapy was continued for eight weeks. After achieving infection control and nutritional optimization, presternal ileocolonic reconstruction was performed on postoperative day 69. She was discharged home 94 days after the initial intervention and remains well, free of recurrence, at 7 months post-TEVAR.</p><p><strong>Conclusion: </strong>This case highlights the critical role of a well-executed staged strategy in contributing to favorable clinical outcomes from secondary AEF. Immediate TEVAR served effectively as a life-saving bridge. Crucially, the early multidisciplinary coordination allowed for the prompt removal of the oesophageal source within 48 h, an intervention essential to prevent uncontrolled mediastinal sepsis. This sequence-haemostasis, early source control, and delayed extra-anatomical reconstruction-may provide a reasonable strategy for survival in selected high-risk patients.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2026-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148274540","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}