[Commando Procedure for Rapidly Progressing Infective Endocarditis in Immunosuppressive State: Report of a Case].

A 68-year-old woman with immunosuppressive state following chemotherapy for cancer of unknown primary origin developed infective endocarditis due to methicillin-resistant Staphylococcus aureus (MRSA). Echocardiography showed shunt blood flow from the aortic annular abscess into the left atrium, which indicated infection of the intervalvular fibrosa (IVF). She underwent Commando procedure owing to progression of heart failure. The aortic valve, IVF, and anterior leaflet of the mitral valve were resected. The mitral valve was replaced with a bioprosthesis, and a bovine pericardial patch was used to reconstruct the IVF and left atrial roof. Bentall procedure was performed because the infection extended to the sinus of Valsalva, and the ascending aorta was 49 mm in diameter. She had no serious postoperative complications and is currently being followed up at the outpatient clinic. Because infection in these patients are potentially fatal, we believe Commando procedure is effective in spite of high early mortality rate.

[Resection of Left Upper Division by Uniportal Video-assisted Thoracoscopic Surgery for Congenital Bronchial Atresia:Report of a Case].

We report a case of congenital bronchial atresia resected by the uniportal thoracoscopic approach. A man in his 20s with congenital bronchial atresia diagnosed at 16 years of age visited our hospital with gradually worsening shortness of breath. Chest computed tomography revealed a localized emphysematous area that progressively increased in size, in the left upper lobe and the absence of a left upper division bronchus with mucoid impaction. Surgical treatment was deemed necessary in view of dyspnea and progressively worsening emphysema, and the resection of left upper division was performed by uniportal video-assisted thoracoscopic surgery.

[Surgical Treatment of Right Atrial Malignant Tumor Thrombus Under Deep Hypothermia with Intermittent Circulatory Arrest;Report of Two Cases].

Right atrial tumor thrombus is rare in patients with visceral malignant tumors and can cause right heart failure or sudden death. We present 2 cases of right atrial tumor thrombus treated under deep hypothermic intermittent circulatory arrest (DHICA). A 45-year-old man with right heart failure was diagnosed with right renal cancer extending to the right atrium. Computed tomography revealed no metastasis. He underwent right nephrectomy and tumor thrombus resection under DHICA. He was discharged on postoperative day 11 in good clinical course. A 67-year-old woman with hepatitis C virus liver cirrhosis( Child-Pugh A) was diagnosed with hepatocellular carcinoma and right atrial tumor. She underwent S8 and tumor thrombus resection under DHICA. Hemorrhagic diathesis was controlled using fresh frozen plasma transfusion. She was discharged on postoperative day 24 without liver failure. In cases of atrial tumor thrombus resection, DIHCA may be useful to achieve a bloodless operation field because the procedure is relatively simple and the primary disease need not be considered.

[Leaflet Augmentation with an Autologous Pericardial Patch for Severe Functional Tricuspid Regurgitation].

An 85-year-old man, who had developed right-sided heart failure associated with isolated severe tricuspid regurgitation (TR), was referred to our institution to undergo cardiac surgery. Preoperative echocardiography revealed tricuspid annular dilatation and leaflet tethering, resulting in severe TR. The anterior leaflet was detached from the annulus with 1.5 mm margin for suture incorporation, and an autologous pericardial patch was sutured with 3 5-0 running interlocked sutures to augment the leaflet. Annuloplasty was then performed with an undersized ring. Postoperative echocardiography showed trivial TR with good coaptation of the tricuspid leaflets. This technique may be a therapeutic option for the surgical treatment of severe functional TR due to lack of leaflet coaptation.

[Hourglass transmural lipoma; report of a case].

A 52-year-old man admitted to our hospital with a pulmonary nodule detected by chest X-ray. Painless mass was located on the right anterior chest below the right clavicle, but enlarged recently. Chest computed tomography (CT) and magnetic resonance imaging (MRI) showed the hourglass shaped mass penetrating his right 2nd intercostal muscle, and growing to intra- and extra-thoracic areas. 60 x 40 x 50 mm in size. His laboratory findings were almost within normal ranges. We performed resection of the tumor and partial resection of the 2nd and 3rd ribs with a help of thoracoscopy. Pathological diagnosis was "intramuscular lipoma-infiltrating type, no malignancy". Assistance of thoracoscopic approach was found to be useful for complete resection of the tumor existing intra- and extra-thoracic areas.

[Inflammatory myofibroblastic tumor suspected of lung cancer; report of a case].

A 57-year-old man admitted to our hospital with a pulmonary nodule detected by chest X-ray. Chest X-ray and chest computed tomography (CT) showed a solitary nodule with a spiculation in the right lower lobe (S8), 17 x 15 mm in size. His laboratory findings were almost within normal ranges. Positron emission tomography (PET) showed positive detection correspond to the nodule (SUV max: 5.76). Pathological diagnosis by CT-guided lung biopsy was suspected of gastrointestinal stromal tumor (GIST). Further examination of digestive organs revealed no abnormalities. The enlargement of the nodule was noted 2 weeks later, 23 x 18 mm in size. We couldn't rule out a malignant tumor and performed partial resection of the right lower lobe. Pathological diagnosis by intraoperative frozen section was "inflammatory myofibroblastic tumor (IMT), no malignancy". The patient is alive without any signs of recurrence for 4 months postoperatively.

[Synchronous multiple lung cancer including a lesion with a thin-walled cavity; report of a case].

A 79-year-old woman underwent video-assisted thoracic surgery (VATS)-left S6 segmentectomy for left lung cancer (papillary adenocarcinoma, pT1N0M0, stage IA), and were followed-up at our hospital. Chest X-ray and chest computed tomography (CT) showed ground-glass opacity (GGO) with thin-walled cavity in the right S1, 3 cm in size and small nodule in the right S2, S3 at 1st operation. The shadow in S1 was not changed but nodular lesion in S2, S3 enlarged 7 months later. CT-guided biopsy revealed well differentiated adenocarcinoma VATS-right upper lobectomy was performed and both lesions were diagnosed as "adenocarcinoma with mixed subtypes (BAC : acinar type), synchronous multiple lung cancer one of which formed thin-walled cavity" histopathologically. The patient was discharged on 20th-postoperative day and alive without any signs of recurrence for 16 months post-operatively.