Roachvinther1754

A 63-year-old man had ventricular septal defect (VSD) and had been followed up without heart failure. Recently, he had palpitation caused by atrial fibrillation and the echocardiography revealed moderate aortic valve regurgitation and stenosis with right coronary cusp prolapse due to subpulmonary ventricular septal defect. He underwent patch closure of VSD, aortic valve replacement with mechanical valve, and maze procedure. In recent years, advanced case like this patient is rare because most of patients with subpulmonary VSD and right coronary cusp prolapse are operated in childhood.A 60-year-old man with hypertrophic obstructive cardiomyopathy (HOCM) combined with organic mitral regurgitation underwent transmitral septal myectomy and mitral valve plasty. Although a transaortic septal myectomy (Morrow's procedure) is generally accepted as the standard surgical treatment for HOCM, it may be difficult to perform sufficient septal myectomy for mid-ventricular obstructive hypertrophic cardiomyopathy and apical hypertrophic cardiomyopathy (HCM). The transmitral approach with temporary detachment of the anterior mitral leaflet provides a good surgical view in the left ventricle, which allows sufficient septal myectomy from the outflow tract to the apex.The patient was a 75-year-old man who presented to our hospital with complaints of palpitation and a cold sensation. COTI-2 solubility dmso Echocardiography revealed ventricular septal perforation(VSP) at the base of the posterior septum. As his hemodynamic condition was stable, patch closure of the VSP was performed on the 50th hospital day after fibrosis at the infarction site developed. Under cardiac arrest, an incision directed toward the cardiac apex was made at the base of the right ventricular inferior wall. Closure of the VSP was performed using double-patch sandwich techniquea bovine pericardial patch on the left, and a Dacron patch on the right ventricular side. The postoperative course was uneventful.Ventricular septal perforation( VSP) leads to a high mortality rate after surgical treatment. The surgical procedure has not been established. Left ventricular (LV) incisions have mainly been performed, while we report a case of right ventricular (RV) approach that resulted in a favorable outcome in a 76-year-old male. The patient was diagnosed with myocardial infarction due to left anterior descending artery (LAD) occlusion. VSP was diagnosed after percutaneous coronary intervention (PCI) and surgery was performed on the 4th day of illness. The perforation site was identified near the anterior septum by epicardiac echography before incision, and a patch made of 3 layers using a pericardial patch, felt, and a Dacron patch was sewn on the perforation with a sandwich technique and closed with bio glue. The RV approach is a useful procedure because it avoids the hemostatic manipulation of left ventricle myocardial necrosis under high pressure and can preserve left cardiac function.A male patient underwent radiation therapy for hypopharyngeal cancer and esophageal cancer at the age of 58 years without recurrence. At the age of 63 years, he started to experience fatigue, numbness of the left upper limb and dizziness. The symptom gradually worsened and he was admitted to our hospital for further investigation. By computed tomography scan and angiography, the subclavian artery (SCA) occlusion and a patent left vertebral artery with retrograde flow were revealed( subclavian steal syndrome). Subclavian artery occlusion could not be recanalized by percutaneous transluminal angioplasty. He underwent carotid-subclavian bypass. His symptoms clearly improved. Postopertive course was uneventful and no further symptoms developed after surgery.A 72 years-old man was admitted with fever and cough. He had undergone aortic arch graft replacement with elephant trunk and endovascular stent graft for distal arch aortic aneurysm 1 year ago. Additionally, he had treated type I endoleak with an endovascular stent graft 3 month previously. Computed tomography showed soft tissue around the aneurysm and visible gas bubble within intramural thrombus, and he was diagnosed with stent graft infection. The stent graft was removed and aortic reconstruction was performed using bovine pericardial roll grafts. The grafts were covered with the greater omentum. He was discharged on the 48th postoperative day, and was alive and well 4 years after the operation.Nuss procedure for pediatric patients with pectus excavatum has been practiced worldwide, including in Japan, due to the simple procedure and has a high therapeutic effect. Because it is usually performed under thoracoscopy to secure the safety, it is performed not only by pediatric or plastic surgeons but also by general thoracic surgeons. On the other hand, a risk of infection must always be considered in this method in which a foreign metal bar is used. In particular, when the skin barrier mechanism is declining due to skin diseases such as atopic dermatitis, the risk of infection of the implant may increase. The present case was an 8-year-old male with a history of atopic dermatitis. He underwent thoracoscopic Nuss procedure. Although there was no problem during his hospitalization, the bar was exposed from the skin on the 58th postoperative day with the infection triggered, and the unexpected early bar removal was performed on the 66th postoperative day. We report this case with some literature review.Solitary diaphragmatic metastasis from early endometrial cancer is quite rare. We present a case of a 58-year-old woman who had been performed radical surgery for stageⅠA, G1 endometrial cancer 3 years before. The patient was referred to our hospital for chest abnormal shadow. Computed tomography (CT) and Magnetic resonance imaging (MRI) showed a mass in the right diaphragm, without the finding of liver invasion. We performed partial resection of diaphragm through video-assisted thoracoscopic surgery (VATS). After surgery, there were no serious complications and was discharged from the hospital on day 6 from surgery. Nine months later, the patient is alive without recurrence.A 68-year-old man was referred to our hospital due to an abnormal shadow on chest X-ray film. Chest computed tomography showed a tumor in the right middle lobe. The tumor was 41 mm in size and invaded S3. Preoperative bronchoscopy revealed that right B1, B2, and B3 were branched independently, and B3 was branched from the middle lobe bronchus. A trans-bronchial biopsy was performed and primary lung squamous cell carcinoma was diagnosed (cT2bN0M0, stageⅡA). Although minor fissure was not observed, S3+4+5 resection was performed successfully by dividing pulmonary blood vessels and bronchus before dividing incomplete lobulation (bronchus-first method). The bronchus-first method is useful to avoid not only post-operative air leakage but also accidental cutting of the displaced bronchus by dividing incomplete lobulation frequently associated with bronchial branching abnormalities.