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Background: The one-and-a-half ventricle repair (1.5VR) is an option for definitive surgery of cardiac defects with hypoplastic right ventricle (RV). The 1.5VR with open azygos vein was reported to provide a theoretical advantage of decompressing the supra vena cava (SVC) or the right atrium in patients with SVC hypertension or severe RV dysfunction. The aim of this study is to review and evaluate our experience with this procedure in the long-term period., Methods: Medical records of the patient undergoing 1.5VR with open azygos vein between January 2000 and December 2019 were reviewed retrospective. Pre- and postoperative echocardiography and cardiac catheterization data were also analyzed., Results: 4 patients underwent the 1.5VR with open azygos vein. The median age at time of surgery was 2.2 years, and the median weight was 9.8 kg. The median tricuspid valve (TV) Z-score was  - 3.5, the median right ventricular end-diastolic volume (RVEDV) was 54.0% of normal. There were no operative death and early adverse events. Median follow-up time was 17.1 years. There were no late death and re-operation during the follow-up. The postoperative TV diameter and RVEDV were larger than preoperative data in 3 of 4 patients., Conclusions: The 1.5VR with open azygos vein is a good surgical option for congenital heart disease with hypoplastic RV. The TV and RVEDV may grow and biventricular conversion may be possible., (© 2023. The Author(s), under exclusive licence to The Japanese Association for Thoracic Surgery.)

Azygos vein aneurysm (AVA) is necessary to prevent pulmonary embolism due to the outflow of a thrombus or rupture of the aneurysm. However, there is no established modality to assess the properties of AVA. Time-resolved three-dimensional phase-contrast magnetic resonance imaging (4D-flow MRI) has been used to examine the hemodynamics in various fields. We report a case of AVA to evaluate the flow variability and adhesions of surrounding tissues using 4D-flow MRI. The findings of the study suggested aneurysm turbulence and the absence of thrombi. The cine image, which showed a sliding wall synchronized to the heartbeat, indicated no adhesion to the superior vena cava. Based on these results, the thoracoscopic approach was deemed possible preoperatively. Thoracoscopic AVA resection was performed, and the postoperative course was uneventful. This study documented the utility of 4D-flow MRI for a detailed evaluation of AVA., (© 2022. The Author(s), under exclusive licence to The Japanese Association for Thoracic Surgery.)

A 43-year-old asymptomatic patient was diagnosed with an azygos vein aneurysm on contrast-enhanced computed tomography; at the 5-year follow-up, contrast-enhanced computed tomography revealed development of an azygos vein aneurysm. However, preoperative contrast-enhanced computed tomography at our hospital showed thrombus development along with shrinkage of the azygos vein aneurysm. To prevent thrombus dissemination, we decided to perform surgery. The aneurysm was excised via video-assisted thoracoscopic surgery, and the patient recovered uneventfully. Thoracoscopic surgery is effective in managing azygos vein aneurysms and preventing embolisms in thrombotic aneurysms. This procedure was chosen to avoid excessive compression of aneurysms and to prevent pulmonary embolism. This report presents a case of surgical management of an idiopathic azygos vein aneurysm with thrombosis.Clinical registration number 2020-S-20., (© 2021. The Japanese Association for Thoracic Surgery.)

A 68-year-old man was referred to our hospital because of mediastinal tumor on chest computed tomography (CT). Contrast-enhanced CT showed azygos continuation of the inferior vena cava (IVC). The retro-hepatic IVC was absent superior to the renal veins. The IVC continued into the dilated azygos vein, which joined the superior vena cava. The hepatic vein drained directly into the right atrium. The mediastinal tumor was close to the dilated azygos vein. Video-assisted thoracoscopic resection of the mediastinal tumor was performed, using four ports and CO 2 insufflation. Histological examination of the resected specimen revealed a pericardial cyst without malignancy. After a favorable postoperative course, the patient was discharged 4 days after surgery. It is important to recognize this anomaly before thoracic surgery, because transection of the azygos vein can be fatal. Video-assisted thoracoscopic resection of mediastinal tumor close to the azygos vein using CO 2 insufflation avoids injury to the azygos vein.

We describe here a thoracic esophageal cancer with an unusual type of duplicated inferior vena cava. A 58-year-old man was referred to our hospital because a tumor in his lower esophagus had been identified by endoscopy and radiology. Computed tomography scans showed an unusual type of duplicated inferior vena cava characterized by both common iliac veins flowing back into the left-sided inferior vena cava, which drained into the azygos vein, whereas the right-sided one had no drainage. Esophagectomy was performed 3 weeks later after preoperative chemotherapy. Because the patient could have developed thrombosis of the left-sided inferior vena cava and severe hypotension caused by decreased venous return to the heart if the azygos vein had been severed, the azygos vein was preserved. Thus, when performing surgery for thoracic esophageal cancer, the surgeon should check for a duplicated inferior vena cava and preserve the azygos vein if necessary.

Aneurysm of the azygos vein is rare. We describe the case of a 51-year-old nonsmoking woman with a posterior mediastinal mass caused by a giant azygos vein aneurysm with subtotal thrombosis. Surgical resection of the azygos vein was offered to our patient as a treatment option owing to theoretical risks of rupture and pulmonary embolism. After taping the azygos vein proximally and distally, the aneurysm was resected with video-assisted thoracoscopy. Approximately 30 cases have been reported in the literature to date. Dynamic computed tomography and a videoassisted approach were useful for the diagnosis and treatment for this abnormality.