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Chylothorax is defined as the accumulation of chyle in the pleural space, mainly by damaging to the thoracic duct. 99m Tc-Dextran is a relatively new tracer for lymphoscintigraphy. A 40-year-old woman had recurrent chylothoraxes after thymoma resection and ligation of the thoracic duct owing to intraoperative suspected thoracic duct injury. She underwent lymphoscintigraphies using 99m Tc-sulfur colloid and 99m Tc-dextran, respectively, to identify the possible leakage site of the thoracic duct. The images showed increased 99m Tc-dextran but unimpressive 99m Tc-sulfur colloid activity at the leakage site. Based on the results, this patient received surgery anastomosing the thoracic duct and the azygos vein., (Copyright © 2020 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Connection of the right pulmonary veins to the azygous is an extremely rare variant of partial anomalous pulmonary venous connection. We describe one such case in the setting of an intact atrial septum. Surgical correction in such a situation can be challenging. We describe a successful surgical approach for this unusual variant., (Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

We report a resection of an azygos vein aneurysm that formed a thrombus during a 6-year follow-up period. An azygos vein aneurysm is commonly detected as an asymptomatic mediastinal mass. A thrombus could suddenly form without enlarging the aneurysm. Therefore we suggest that even asymptomatic azygos vein aneurysms causing blood stagnation should be resected before they can form a thrombus and cause a pulmonary embolism., (Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

A 17-year-old girl visited our hospital for an operation to correct a partial anomalous pulmonary venous return. All the right-side pulmonary veins returned to the azygos vein, which had no connection to the cardiac chamber through the great venous system, such as the superior or inferior vena cava. The azygos vein lacked a normal azygos arch and was connected by multiple connections only to the paravertebral plexus. For the surgical correction, a pericardiostomy was created in the right posterior pericardial wall and azygos vein which was divided at the diaphragm level and was anastomosed to the left atriotomy area through the pericardiostomy site., (Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

The development of pulmonary arteriovenous malformations after cavopulmonary bypass in patients with congenital heart disease is well documented. We report successful management of pulmonary arteriovenous malformations after cavopulmonary bypass in a patient with an interrupted inferior vena cava (IVC) and multiple hepatic veins utilizing an extracardiac conduit from the hepatic veins to the hemiazygous continuation of the interrupted IVC. This technique, performed without circulatory arrest or an atriotomy, may limit morbidity associated with intracardiac procedures in patients with single ventricle morphology. Furthermore, this case suggests an alternative technique for completion Fontan in patients with an interrupted IVC and multiple hepatic venous drainage.

Pulmonary arteriovenous fistulae after a cavopulmonary anastomosis have been reported to resolve after hepatic venous return is included in the pulmonary circulation. We report a case in which the hepatic veins were redirected to the pulmonary circulation by connecting them directly to the azygous continuation of the inferior vena cava that had previously been connected to the right pulmonary artery. The patient's arterial saturation of 71% increased to 92% after 6 months.

Primary anomalies of the azygos vein generally result from intrathoracic tumor compression or inferior vena caval interruption with azygos vein continuation. Vascular malformations, although uncommon, can frequently mimic solid tumors and present as middle or posterior mediastinal masses. We present the case of an isolated giant azygos vein varix in an asymptomatic patient. Preoperative computed tomography and magnetic resonance imaging were not diagnostic in evaluating this patient's anatomy.

Although the classical approaches for mitral valve surgery have remained standard over the years, variations have been described and implemented in an attempt to improve exposure of the mitral valve apparatus. A technical alternative that affords excellent exposure of the roof of the left atrium, allowing for an enlarged left atriotomy and precluding the need for more radical surgical maneuvers and their potential complications, is described.

A standard Glenn anastomosis between the superior vena cava and the right pulmonary artery has been the accepted mode of treatment for patients with complex cyanotic congenital heart disease. We report our experience in 18 patients with such disease who underwent a bidirectional cavopulmonary shunt because of increasing cyanosis and growth cessation. All patients were considered less than "ideal" candidates for a Fontan procedure. We divided the patients into two groups: group 1 had azygos continuation and group 2 did not. Fourteen patients required hypothermic cardiopulmonary bypass. Bidirectional pulmonary blood flow was achieved in all patients. Only 1 death occurred (group 2). The improvement in oxygen saturation and overall clinical condition of these patients, together with the low mortality and morbidity, is encouraging. However, long-term follow-up is mandatory for a comprehensive evaluation of this surgical approach as definitive palliation or as a first stage for a Fontan operation.