General Thoracic and Cardiovascular Surgery Cases最新文献

{"title":"Endovascular repair of abdominal aortic aneurysm associated with residual type B aortic dissection utilizing iliac branch endoprosthesis: a case report.","authors":"Kunitaka Kumagai, Yuichiro Kishimoto, Takeshi Onohara, Rikuto Nii, Naoki Sumi, Nozomi Kishimoto, Yosuke Ikeda, Yuki Yoshikawa, Kazuma Yamane, Yasushi Yoshikawa","doi":"10.1186/s44215-025-00194-6","DOIUrl":"10.1186/s44215-025-00194-6","url":null,"abstract":"<p><strong>Background: </strong>Iliac branch endoprosthesis (IBE) can preserve the internal iliac artery. Endovascular aortic repair (EVAR) for abdominal aortic aneurysms associated with residual type B aortic dissection has been rarely reported, and IBE has not been utilized in any of the reported cases. Herein, we describe a rare case of EVAR using IBE for an abdominal aortic aneurysm and a common iliac artery aneurysm associated with residual type B aortic dissection after thoracoabdominal aortic replacement.</p><p><strong>Case presentation: </strong>A 70-year-old man underwent conservative treatment for acute type B aortic dissection 5 years ago. Contrast-enhanced computed tomography (CT) revealed type B aortic dissection and a thoracoabdominal aortic aneurysm, an abdominal aortic aneurysm, and an aneurysm in the right common iliac artery. Since the patient had a concomitant right common iliac artery aneurysm and reconstructing the right iliac artery would have been difficult in a one-stage operation, a two-stage surgical strategy for thoracoabdominal and abdominal aortic graft replacement, separately, was designed. Thoracoabdominal aortic graft replacement from the proximal descending aorta to the infrarenal abdominal aorta was performed using a triplex 24-mm prosthesis (Terumo Aortic, Inchinnan, UK) without any problem. We recommended abdominal aortic graft replacement; however, he preferred EVAR over abdominal aortic graft replacement. The risk of spinal cord ischemia was a concern because a conventional EVAR would require embolizing the right internal iliac artery. Therefore, EVAR was performed with IBE to preserve the right internal iliac artery. The postoperative course was uneventful, and no spinal cord injury was observed. Follow-up CT showed no enlargement of the aneurysms 1 year postoperatively.</p><p><strong>Conclusions: </strong>Despite anatomic limitations, EVAR for abdominal aortic and common iliac artery aneurysms associated with residual aortic dissection after thoracoabdominal aortic graft replacement can be safely performed by embolizing the branch to the false lumen and using IBE.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"4 1","pages":"8"},"PeriodicalIF":0.0,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11806783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143371259","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":"A stage IIIA lung adenocarcinoma case achieving pathological response with only one cycle of preoperative nivolumab combination chemotherapy.","authors":"Shuhei Baba, Fumihiko Kinoshita, Yoshihiro Yamamoto, Yoshiyuki Nakanishi, Takaki Akamine, Mikihiro Kohno, Keigo Ozono, Tomoyoshi Takenaka, Tomoharu Yoshizumi","doi":"10.1186/s44215-025-00187-5","DOIUrl":"10.1186/s44215-025-00187-5","url":null,"abstract":"<p><strong>Background: </strong>Preoperative nivolumab combination chemotherapy has shown its efficacy in resectable stage II-III non-small cell lung cancer and become one of the standard treatments. While preoperative nivolumab combination chemotherapy is generally a regimen of three cycles, the efficacy of nivolumab combination chemotherapy when treatment is prematurely discontinued remains unclear.</p><p><strong>Case presentation: </strong>An 81-year-old man was diagnosed as lung adenocarcinoma (cT3N1M0, cStage IIIA). A computed tomography (CT) showed a 58 mm mass in left upper lobe with an intrapulmonary metastasis, and a positron-emission tomography/CT suggested metastatic lymph nodes at the left pulmonary hilum. Preoperative nivolumab + carboplatin + paclitaxel were administered; however, after the first cycle, the treatment was discontinued due to grade 3 anorexia, grade 1 body weight loss, and grade 4 neutropenia. It was affair that continuation of preoperative therapy made him unsuitable for surgery, and CT scan showed a reduction in the tumor size to 20 mm. Then, we decided to discontinue the preoperative therapy and perform surgery. Video-assisted thoracoscopic left upper lobectomy and lymph node dissection were performed, and the postoperative course was uneventful. The pathological examination revealed 15% of residual tumor cell in primary lesion and no metastatic lymph nodes was diagnosed. The patient did not undergo adjuvant chemotherapy, and no recurrence was observed 1.5 years after surgery CONCLUSIONS: In this case, preoperative nivolumab combined chemotherapy was discontinued only one cycle due to adverse events; however, a significant treatment effect was achieved. Therefore, even it is unable to continue preoperative nivolumab combined therapy, it is important not to miss the chance of surgery, as good treatment effect may have been achieved.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"4 1","pages":"6"},"PeriodicalIF":0.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792341/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143124263","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":"Multidisciplinary surgical strategy for an invasive thymoma in an immunocompromised patient: a case of a successful resection and postoperative troubleshooting.","authors":"Tomonari Oki, Shuhei Iizuka, Toru Nakamura","doi":"10.1186/s44215-025-00192-8","DOIUrl":"10.1186/s44215-025-00192-8","url":null,"abstract":"<p><strong>Background: </strong>Robot-assisted thoracoscopic surgery has become prevalent as a feasible approach for anterior mediastinal tumor resections, while conventional open surgery, such as a median sternotomy, remains preferred for a combined resection of adjacent organs. However, an additional thoracotomy may be necessary when tumors extend into one hemithorax. This complex approach can cause significant damage to the osseous thoracic cage, increasing the risk of surgical morbidity especially in immunocompromised patients.</p><p><strong>Case presentation: </strong>A 77-year-old man presented with an anterior mediastinal thymoma measuring 71 mm, detected during an annual health check with suspected involvement of the left brachiocephalic vein and upper lobe of the left lung. The patient had a medical history of recurrent surgical site infections and fasciitis panniculitis syndrome requiring immunosuppressive therapy. To minimize any thoracic cage destruction, a multidisciplinary approach combining robotic surgery with open surgery according to vascular or pulmonary invasion was planned. The patient, initially placed in the supine position with the robot docked over the right side, underwent a thymic dissection, revealing a firm adhesion to the left brachiocephalic vein. The robot was then undocked, and a transmanubrial osteomuscular sparing approach was initiated, enabling a tumor dissection under the proximal and distal control of the left brachiocephalic vein. As invasion into the proximal upper pulmonary vein and extensive dorsal adhesions were observed, the patient was repositioned to the right lateral decubitus position, and a thoracoscopic left upper segmentectomy with adhesiolysis was performed, achieving an R0 resection. The patient was extubated on day 1 but required non-invasive ventilation until day 5. Mediastinitis, likely due to a sternal wire infection, developed on day 9, necessitating debridement, sternal wire removal, and negative pressure wound therapy. After 17 days of treatment, the infection subsided, allowing for a sequestrectomy and chest wall reconstruction with a pedicled pectoralis major myocutaneous flap. By avoiding a total sternotomy, the extent of the mediastinitis was localized, allowing for a limited sequestrectomy. Wound healing was satisfactory, with no recurrent infection at 12 months and minimal functional impairment.</p><p><strong>Conclusions: </strong>A multidisciplinary approach offers a feasible option for managing an invasive thymoma to minimize postoperative morbidity, particularly in immunocompromised patients. Preoperative surgical planning is essential for guiding intraoperative decision-making and ensuring optimal outcomes.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"4 1","pages":"7"},"PeriodicalIF":0.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11792598/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143124266","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":"Effective management of nonconvulsive status epilepticus following cardiac surgery: a case report.","authors":"Yusuke Yanagino, Taro Yamasumi, Takayuki Miyauchi, Koichi Inoue, Haruhiko Kondoh","doi":"10.1186/s44215-025-00189-3","DOIUrl":"10.1186/s44215-025-00189-3","url":null,"abstract":"<p><strong>Background: </strong>Epileptic seizures following adult cardiovascular surgery occur in 0.9-3% of patients, with the condition in 3-12% of these patients progressing to status epilepticus (SE). SE is a severe condition that significantly impacts prognosis and necessitates early diagnosis and treatment. However, the diagnosis of nonconvulsive status epilepticus (NCSE) is challenging due to its subtle clinical symptoms. Herein, we report a case of NCSE that was diagnosed early by aggressive electroencephalogram (EEG) and treated effectively following cardiac surgery, resulting in discharge without sequelae.</p><p><strong>Case presentation: </strong>A 44-year-old man with a history of meningitis-induced intellectual disability since childhood underwent aortic valve replacement and grafting of the ascending aorta for a bicuspid aortic valve, severe aortic regurgitation, and ascending aortic dilatation. We observed repeated tonic-clonic seizures on the day of surgery and the following day when the sedation was reduced. On the first postoperative day, an EEG revealed sharp, high-amplitude waves during the tonic-clonic seizure and 2-Hz rhythmic delta activity after motor symptoms disappeared. Based on these findings, the patient was diagnosed with NCSE. Under EEG monitoring, we initially used propofol at 4 mg/kg/h, but owing to a decrease in blood pressure, we achieved deep sedation and burst suppression by combining propofol at 1.5 mg/kg/h with midazolam at 0.18 mg/kg/h. We also administered levetiracetam and fosphenytoin as antiseizure medications. Levetiracetam was administered at 1000 mg/day and fosphenytoin at 20.5 mg/kg, followed by maintenance at 7.2 mg/kg/day. The patient's consciousness improved upon cessation of sedation on postoperative day 6. Postoperative magnetic resonance imaging revealed no abnormalities. Fosphenytoin was discontinued, and the patient was discharged on postoperative day 32 without any sequelae. The patient continues to take levetiracetam orally at a dose of 1000 mg/day and has been followed up in the outpatient clinic for 4 years without any seizure recurrence.</p><p><strong>Conclusion: </strong>Postoperative seizures following cardiac surgery may occur with NCSE, even after visible seizures have ceased. This case highlights the importance of thorough EEG monitoring in cases of prolonged disturbance of consciousness, indicating that early diagnosis and treatment of NCSE can improve the prognosis.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"4 1","pages":"5"},"PeriodicalIF":0.0,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11762878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143044043","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":"Redo mitral valve replacement with annular reconstruction of left atrial dissection following mitral valve replacement for infective endocarditis: a case report.","authors":"Hiroki Tada, Junya Yokoyama, Akinobu Otani, Keiwa Kin, Yukitoshi Shirakawa","doi":"10.1186/s44215-025-00188-4","DOIUrl":"https://doi.org/10.1186/s44215-025-00188-4","url":null,"abstract":"<p><strong>Background: </strong>Left atrial dissection is a rare and occasionally fatal complication of cardiac surgery and is defined as the creation of a false chamber through a tear in the mitral valve annulus extending into the left atrial wall. Some patients are asymptomatic, while others present with various symptoms, such as chest pain, dyspnea, and even cardiac arrest. Although there is no established management for left atrial dissection, surgery should be considered in patients with hemodynamic disruption. Herein, we report a case of left atrial dissection managed using redo mitral valve replacement (MVR) with annular reconstruction.</p><p><strong>Case presentation: </strong>A 60-year-old man presented to our hospital with bilateral lower-extremity purpura and cognitive decline. Blood tests showed an elevated inflammatory response, and blood culture revealed Streptococcus mitis. Transesophageal echocardiography (TEE) revealed severe mitral regurgitation with vegetation on both the anterior and posterior leaflets, and infective endocarditis was diagnosed. We performed minimally invasive cardiac surgery-MVR through a right mini thoracotomy using Epic mitral valve 29 mm (Abbott Laboratories, Green Oaks, IL, USA). On postoperative day (POD) 2, the patient was discharged from the intensive care unit (ICU). On POD 3, sudden cardiac arrest occurred; we started cardiopulmonary resuscitation and urgently inserted a peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO) cannula. Contrast-enhanced computed tomography revealed extravasation from the posterior wall of the left atrium. Therefore, we performed an emergency median sternotomy, controlled the bleeding from the posterior wall of the left atrium, and returned the patient to the ICU with gauze packing under VA-ECMO. Two days later, when the gauze was removed, TEE revealed a false lumen on the left atrial wall, and left atrial dissection was diagnosed. Accordingly, we performed annular reconstruction with bovine pericardium to close the entry point and, in succession, redo MVR with a bioprosthetic Epic mitral valve 27 mm. The postoperative course was uneventful. The patient was transferred to a rehabilitation hospital on POD 74.</p><p><strong>Conclusion: </strong>We report a case of left atrial dissection following MVR. The complex lesion was successfully repaired using redo MVR with annular reconstruction.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"4 1","pages":"4"},"PeriodicalIF":0.0,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11734570/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143019976","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":"Aortic valve repair with sinus plication for a regurgitant bicuspid aortic valve: a case report.","authors":"Atsutaka Aratame, Takashi Kunihara, Toshio Baba, Masanori Sakaguchi, Yosuke Sumii, Mikado Fukuda, Yosuke Takahashi","doi":"10.1186/s44215-024-00184-0","DOIUrl":"10.1186/s44215-024-00184-0","url":null,"abstract":"<p><strong>Background: </strong>Repair of the regurgitant bicuspid aortic valve is an attractive alternative to valve replacement. Although good long-term outcomes have been reported, postoperative aortic stenosis remains a major late cause of repair failure in bicuspid aortic valves. Sinus plication is effective for creating a more symmetrical commissural angle, leading to a decrease in the mean transvalvular pressure gradient. Herein, we report a successful case of aortic valve repair with sinus plication for a regurgitant bicuspid aortic valve.</p><p><strong>Case presentation: </strong>The patient was a 34-year-old man with bicuspid aortic valve, severe aortic regurgitation, and left ventricular dilatation. Echocardiography revealed an eccentric aortic regurgitation jet caused by a fused cusp prolapse. The commissural angle was approximately 136°, classified as asymmetrical. The patient underwent surgery via median sternotomy. Cardiopulmonary bypass was initiated using the ascending aortic and single two-stage atrial cannulation with left ventricular venting via the right superior pulmonary vein. After the ascending aorta was cross-clamped, transection was performed 5-10 mm above the sinotubular junction. Based on the valve configuration, annuloplasty, sinus plication, and ascending aortic replacement were planned in addition to triangular resection of the bulking raphe tissue with central cusp plication. Mattress sutures of 4-0 polypropylene, reinforced with autologous pericardium, were placed outside the fused cusp for sinus plication. The sutures extended from the basal ring to the sinotubular junction, reducing the sinus circumference by approximately 15 mm. Intraoperative transesophageal echocardiography revealed trivial aortic regurgitation and modified commissural angulation. The operation, cardiopulmonary bypass, and aortic cross-clamping times were 311, 129, and 95 min, respectively. The clinical course was uneventful, without major complications. Postoperative echocardiography demonstrated an improved commissural angle. Follow-up echocardiography demonstrated trivial aortic regurgitation and a decreased mean transvalvular pressure gradient.</p><p><strong>Conclusions: </strong>Sinus plication may be one of the most effective repair techniques for asymmetrical bicuspid aortic valves, especially in cases without Valsalva sinus dilation. This technique helps avoid postoperative aortic valve stenosis.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"4 1","pages":"3"},"PeriodicalIF":0.0,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11731531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985976","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":"Rupture of the staple suture site after stapling the right inferior pulmonary vein with double rows of staples: a case report.","authors":"Jun Suzuki, Satoshi Shiono, Hikaru Watanabe, Takayuki Sasage, Kazumasa Hoshijima, Kohei Abe, Tetsuro Uchida","doi":"10.1186/s44215-025-00186-6","DOIUrl":"10.1186/s44215-025-00186-6","url":null,"abstract":"<p><strong>Background: </strong>With advancements in minimally invasive thoracic surgery techniques, such as video-assisted thoracoscopic surgery and robotic surgery, the design of vascular staplers has evolved to meet the requirements of these procedures. Consequently, newer generations of automatic staplers with improved handling and reduced size have been introduced, such as two-row staplers, which are more maneuverable and less bulky than their three-row counterparts.</p><p><strong>Case presentation: </strong>A 68-year-old man with lung cancer underwent a right middle and lower lobectomy due to tumor invasion into the central middle bronchial trunk, rendering the preservation of the middle lobe impossible. His medical history included chronic atrial fibrillation. The surgery involved a posterolateral incision and a fifth intercostal thoracotomy, where various pulmonary arteries and veins were dissected using vascular staples. Despite completing the surgery without initial complications, the patient experienced significant postoperative bleeding, leading to approximately 800 mL of bloody fluid being drained after coughing episodes. Reoperation was necessary to address and control the bleeding, which was challenging due to the location and nature of the hemorrhage. The source was identified at the transected edge of the inferior pulmonary vein, requiring direct suture after pericardium incision for better access. The total operative time amounted to 751 min, with a blood loss of 2092 mL. The patient recovered smoothly from the second operation and was discharged on the fifth postoperative day. Histopathological examination revealed myocardial cell presence adjacent to the pulmonary vein wall, suggesting that vein thickening could have played a role in the observed postoperative bleeding.</p><p><strong>Conclusions: </strong>In conclusion, when selecting staples for vascular use, particularly for the detachment of pulmonary veins, it is advisable to carefully choose between two-row and three-row staples.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"4 1","pages":"2"},"PeriodicalIF":0.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11715081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142961160","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":"Simultaneous gastroepiploic artery to right coronary artery bypass and trans-catheter aortic valve implantation: case series.","authors":"Kentaro Honda, Teruaki Wada, Hideki Kunimoto, Yoshiharu Nishimura","doi":"10.1186/s44215-024-00185-z","DOIUrl":"https://doi.org/10.1186/s44215-024-00185-z","url":null,"abstract":"<p><p>Patients with coronary artery disease undergoing trans-catheter aortic valve implantation (TAVI) often receive TAVI alone. However, in cases of severe coronary lesions or anticipated difficulty in coronary access post-TAVI, percutaneous coronary intervention or coronary artery bypass grafting may be necessary. We performed simultaneous gastroepiploic artery to posterior descending artery bypass and TAVI in two patients with severe calcification of the right coronary artery ostium which is unsuitable for percutaneous intervention. The procedure was conducted through an upper median laparotomy, avoiding a full sternotomy. Patients were discharged on postoperative days 6 and 9, respectively. By combining minimally invasive techniques and avoiding median sternotomy, we achieved favorable outcomes without compromising the less invasive nature of TAVI. This approach demonstrates the potential for tailored, hybrid procedures in high-risk patients with concomitant aortic valve disease and complex coronary lesions.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"4 1","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11706028/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142961161","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":"Reoperation for chronological complete dislodgement of the bioprosthetic aortic valve into the left ventricle due to Takayasu arteritis.","authors":"Shogo Matsunaga, Hiromichi Sonoda, Tomoki Ushijima, Meikun Kan-O, Satoshi Kimura, Akira Shiose","doi":"10.1186/s44215-024-00182-2","DOIUrl":"10.1186/s44215-024-00182-2","url":null,"abstract":"<p><strong>Background: </strong>Takayasu arteritis is a large-vessel vasculitis, in addition to giant cell arteritis. Various post-operative complications associated with the cardiac macrovasculature have been reported. Detachment of the prosthetic valve, pseudoaneurysm formation, and dilatation of the aortic root are well-known post-operative complications associated with vasculitis syndromes, including Takayasu arteritis. Here, we report a rare complication involving aortic bioprosthetic valve dislodgement in the left ventricular outflow tract due to Takayasu arteritis.</p><p><strong>Case presentation: </strong>A 76-year-old female underwent aortic valve replacement with a 21-mm Carpentier-Edwards Perimount valve for severe aortic regurgitation and a coronary artery bypass graft from the left internal thoracic artery to the left anterior descending artery for ischemic heart disease. Fourteen years after the initial surgery, echocardiography revealed severe aortic valve sclerosis due to structural valve deterioration of the bioprosthesis. Upon scrutiny, the bioprosthetic aortic valve was found to have dislodged into the left ventricular outflow tract. We performed re-implantation of the bioprosthetic aortic valve and replacement of the ascending aorta.</p><p><strong>Conclusions: </strong>Although dislodgement of the bioprosthetic aortic valve is an extremely rare complication associated with Takayasu arteritis, the possibility that it could occur should be considered when treating the post-operative patients.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"3 1","pages":"58"},"PeriodicalIF":0.0,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11687195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911380","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":"Lung transplantation for diffuse pulmonary arteriovenous malformations associated with juvenile polyposis-hereditary hemorrhagic telangiectasia overlap syndrome: a case report.","authors":"Taiki Ryo, Daisuke Nakajima, Satoshi Kimura, Hiroshi Date","doi":"10.1186/s44215-024-00183-1","DOIUrl":"10.1186/s44215-024-00183-1","url":null,"abstract":"<p><strong>Background: </strong>Lung transplantation is a viable lifesaving option for patients with diffuse pulmonary arteriovenous malformations (AVMs). We present a case of diffuse pulmonary AVMs associated with juvenile polyposis and hereditary hemorrhagic telangiectasia (JP-HHT) that was successfully managed by lung transplantation.</p><p><strong>Case presentation: </strong>A 19-year-old woman developed severe hypoxemia due to pulmonary AVMs diagnosed at 4 years of age. She also had epistaxis, hemangioma of the tongue, and numerous polyps in the gastrointestinal tract, leading to the JP-HHT diagnosis. Although she had undergone transcatheter embolization for pulmonary AVMs four times, all lesions became recanalized, and her hypoxemia never improved. She also had hepatic AVMs that did not result in portal hypertension or required any interventions. She underwent bilateral lung transplantation from a brain-dead donor at 3 years after registration. Given that she had severe hypoxemia caused by intrapulmonary shunting, venoarterial extracorporeal membrane oxygenation (V-A ECMO) support was initiated from the femoral vessels under local anesthesia. Then, she was anesthetized and intubated. Peripheral V-A ECMO was switched to central cardiopulmonary bypass during the transplant procedure to prevent persistent hypoxia of the upper body and thromboembolic event due to severe polycythemia. The total graft ischemic time was > 11 h, which resulted in ischemia-reperfusion injury immediately after transplantation. Furthermore, the patient's postoperative course was complicated by acute cellular rejection and right heart failure due to hepatic AVM progression. She was finally discharged home without oxygen therapy on postoperative day 68. At 1-year post-transplantation, she is currently enjoying college life. However, she still has to undergo periodic endoscopic examinations to monitor her numerous polyps, which are known to carry a risk of cancer development.</p><p><strong>Conclusions: </strong>Lung transplantation can be a viable treatment option for diffuse pulmonary AVMs in patients with JP-HHT. However, meticulous perioperative management is mandatory to prevent the development of multiple organ disorders.</p>","PeriodicalId":520286,"journal":{"name":"General Thoracic and Cardiovascular Surgery Cases","volume":"3 1","pages":"57"},"PeriodicalIF":0.0,"publicationDate":"2024-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11681709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142901588","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}