[Thoracoabdominal aortic aneurysm repair with preservation of the diaphragm and intercostal muscles].

In thoracoabdominal aortic aneurysm (TAAA) repair, postoperative respiratory complication is a major problem. TAAA repair was performed in a 75-year-old man. The computed tomography showed a TAAA (Crawford type IV) with shaggy descending thoracic aorta. Stomach and small intestine were compressed by the TAAA with resultant appetite loss. And reduced respiratory function was observed. In such a case thoracotomy is usually required for operation. However, we applied the extra pleural dissection without thoracotomy, and the diaphragm and intercostal muscles were preserved. Using the selective abdominal organ perfusion, graft replacement was performed between iliac arteries and descending aorta. The postoperative course was uneventful, and respiratory function was preserved.

Forty-year survival with Smeloff-Cutter and Starr-Edwards prostheses.

This case study describes a 40-year follow-up of a man who had a double valve replacement with Smeloff-Cutter aortic (Cutter Laboratories, Berkeley, CA) and Starr-Edwards mitral prostheses (Edwards Laboratories, Santa Ana, CA) when he was 34 years old. Double valve replacement was performed for aortic and mitral valve stenosis and insufficiency. To date, no surgical treatment has been required except a pacemaker implantation. The patient presented with a New York Heart Association functional class of I to II. Echocardiography revealed intact prostheses.

Primary cardiac chondrosarcoma with large cell pulmonary carcinoma.

A 55-year-old man was transferred to our hospital for removal of cardiac and pulmonary tumors. Transesophageal echocardiography demonstrated a large echogenic mass in the left ventricle. The mass was attached to the posterior wall of the left ventricle and the mitral valve. Chest computed tomography showed a solitary, well-defind nodular lesion in the right upper lung. We performed concomitant resection of cardiac and pulmonary tumors through a midline sternotomy. The pathological diagnosis was cardiac chondrosarcoma with pulmonary large cell carcinoma. Postoperatively pelvic computed tomography, bone and gallium scintigrams did not identify any other active lesion, hence the cardiac tumor was considered to be of cardiac origin. He is alive 20 months after the operation and findings from the cardiac and pulmonary examination are unremarkable. Primary cardiac chondrosarcoma is extremely rare, and to our knowledge, only 13 cases have been recorded. We summarize herein these 14 cases.