ABSTRACT
A 76-year-old man with a history of total esophagectomy and retrosternal gastric tube reconstruction for esophageal cancer was transferred to our hospital because of consciousness disorder. It became an emergency operation on diagnosis of Stanford type A acute aortic dissection on enhanced CT. Because CT showed the retrosternal gastric tube ran along the right side of the body of the sternum through the back side of the manubrium, we opted for skin and the suprasternal incision on the left side from center. We could perform total aortic arch replacement without the damage of the gastric tube except that the right side of the operative view was slightly poor. We did not recognize digestive organ symptoms such as postoperative passage disorders nor mediastinitis. The patient was discharged from our hospital on postoperative day 24.
ABSTRACT
Abstract The median sternotomy remains the standard approach in cardiovascular surgery but, in some conditions, it can be considered difficult to perform, especially in patients with history of esophagectomy. This case report describes a successful resection of a left atrial myxoma through a right anterolateral thoracotomy approach in a patient with a previous retrosternal gastric tube reconstruction. The decision for the best surgical approach was made after a heart surgery team discussion. Through this surgical access, a safe and excellent exposure of the left atrium was possible, and a complete resection of the myxoma was performed without any injury to the gastric tube.
Subject(s)
Humans , Male , Aged , Heart Neoplasms/surgery , Myxoma/surgery , Thoracotomy , Gastrostomy , Treatment Outcome , Heart Atria/surgery , Heart Atria/pathologyABSTRACT
An 80-year-old man presented with a history of retrosternal gastric tube reconstruction for esophageal cancer. He experienced sudden chest pain, and temporarily lost consciousness, before being transferred to our hospital. Contrast-enhanced computed tomography revealed acute Stanford type A aortic dissection and a retrosternal gastric tube. We performed emergency operation using a median sternotomy approach. Before median sternotomy, we detected the gastric tube in the subxiphoid and suprasternal spaces. The anterior and right sides of the gastric tube were dissected bluntly from the posterior surface of the sternum and median sternotomy was performed. The gastric tube was mobilized to the left side and we were able to obtain the usual operative view for ascending aorta graft replacement. Intraoperatively, the gastric tube remained intact and uninjured. The patient was transferred to another hospital for rehabilitation on postoperative day 34.
ABSTRACT
We present a rare case of cardiac surgery for coronary artery single vessel disease and aortic valve stenosis after substernal gastric interposition for gastric cancer. An 80-year-old man, who had undergone esophagectomy and substernal gastric interposition 7 years previously, was referred to our institute for surgical treatment of coronary artery disease and aortic valve stenosis. Through a median sternotomy with cardiopulmonary bypass, we performed aortic valve replacement and coronary artery bypass grafting to the right coronary artery without injury to the gastric tube. Postoperatively, the patient was on respirator care and catecholeamine support for several days. Although urinary tract infection occurred, he recovered with antibiotic therapy. Finally, he was discharged on postoperative day 40. For cardiac surgery after substernal gastric interposition for esophageal cancer, even though the substernal gastric tube may preclude the usual median approach, median sternotomy is an appropriate alternative with close preoperative examination and careful dissection of substernal gastric tube.
ABSTRACT
A 79-year-old man developed congestive heart failure. He was given a diagnosis of severe mitral regurgitation with calcification of the posterior mitral annulus and secondary tricuspid regurgitation. He had a history of esophageal resection with retrosternal gastric tube reconstruction about 20 years previously. We replaced the mitral valve with a mechanical prosthesis and performed tricuspid ring annuloplasty through a right parasternal approach. We did not risk resecting the calcified annulus, but fixed the prosthesis and annulus with the equine pericardium in between as a cushion and collar, to prevent perivalvular leakage. The postoperative course was uneventful.