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Thoracoscopic plication for congenital diaphragmatic eventration in an adult. Diaphragmatic eventration is known to be abnormal elevation of diaphragm and congenital causes are due to abnormal diaphragm muscle development. Here we report surgical treatment of congenital diaphragmatic eventration. A 45-year-old woman who complained of cough was admitted to our hospital. She had history of cough and was diagnosed as diaphragmatic eventration in childhood. Chest X-ray showed elevated left hemidiaphragm with a bowel gas underneath. Under the diagnosis of congenital eventration of left hemidiaphragm, plication of the left diaphragm by video-assisted thoracoscopic surgery (VATS) was performed. One month after surgery, severe cough disappeared completely.

The patient a 75-year-old man who was treated for diabetes and angina pectoris. He relapsed with an angina attack. Coronary angiography revealed three-vessel disease. We performed coronary artery bypass grafting (CABG). During surgery, we converted from off-pump CABG to on-pump beating CABG because of hemodynamic instability. After surgery, severe circulatory failure occurred with uncontrollable hyperglycemia and hyperlactatemia, which did not improve with catecholamine administration and insulin infusion. However, after continuous hemodiafiltration( CHDF) was initiated, in addition to aortic balloon pumping, his arterial blood pressure increased, and blood glucose and lactate levels decreased. Postoperative hyperinflammatory condition might have induced severe circulatory failure, hyperglycemia, and hyperlactatemia. CHDF might have contributed to improving the condition.

Introduction: Respiratory failure and respiratory tract infections are frequently observed as post-operative pulmonary complications, and significantly contribute to morbidity and mortality. However, the risk factors of post-operative respiratory failure and respiratory tract infections are controversial, and how these factors affect on incidence of complications is still unclear., Objective: To identify risk factors of post-operative respiratory failure and respiratory tract infections, and evaluate its impact on incidences after cardiovascular surgery., Methods: From June 2013 to May 2015, adult patients undergoing cardiovascular surgery in the department of cardiovascular surgery and post-operative rehabilitation of Nagasaki University Hospital (Nagasaki, Japan) were retrospectively investigated., Results: Fifty-two of 416 patients(12.5%)suffered from post-operative respiratory failure and respiratory tract infections. Identified risk stratification indicates the relevant operative factors were more important than pre-operative factors. The operative time (OR 1.696, 95% CI 1.302~2.211), post-operative water balance( OR 1.025, 95% CI 1.004~1.046)and emergency operation( OR 3.607, 95% CI 1.492~8.716)were significant independent risk factors in the development of post-operative respiratory failure and respiratory tract infections., Conclusions: These results indicated that the operative factors are more important as onset of post-operative respiratory failure and respiratory tract infections after cardiovascular surgery.

We recently encountered a case of native valve endocarditis caused by Corynebacterium striatum (C. striatum) in the absence of immunosuppression and a prosthetic valve. A 49-year-old woman was urgently admitted for disturbance of consciousness and nosebleeds. Careful clinical examination revealed infective endocarditis caused by C. striatum, for which replacement of aortic and mitral valves was performed. The postoperative course was favorable, and we were able to save the patient with no postoperative complications. Detection of C. striatum may be recognized as contamination because this organism is a rare pathogen. However, elderly patients and patients with immunosuppression are rapidly increasing, and it is important to keep C. striatum in mind when Gram-positive bacilli are detected in the clinical examination.

Objective: We report the use of the elephant trunk technique at all anastomotic sites in acute type A aortic dissection surgery., Methods: Artificial graft carrying a 2-mm short elephant trunk were prepared for both distal and proximal anastomotic sites. Subjects were 82 patients with acute type A aortic dissection who underwent surgery using this procedure between March 2009 and August 2015. The mean age was 69.6 ±10.7 years( range, 43~89 years). Seventeen patients( 20.7%) had cardiac tamponade or shock, while 8 cases( 9.8%) had organ ischemia due to malperfusion., Results: Total aortic arch replacement was performed in 22 patients (26.8%), while replacement of the ascending aorta was performed in 60( 73.2%). The mean durations of surgery, extracorporeal circulation, and cardiac ischemia were 352 ± 64, 199 ± 37, and 123 ± 26 min, respectively. Five in-hospital deaths( 6.1%) occurred. With respect to early complications, 5 patients( 6.1%) had permanent encephalopathy. Nine (11.0%) had respiratory failure, and 4 (4.9%) required tracheotomy. None of the patients had bleeding requiring additional thoracotomy for hemostasis and none had complications attributed to preparation of the artificial vessels., Conclusion: Artificial graft were prepared using the elephant trunk technique for use at all anastomotic sites in acute type A aortic dissection surgery. This procedure, involving stepwise proximal anastomosis, is highly effective for hemostasis and safe.

A 51-year-old woman was stabbed in the chest with a kitchen knife. Twenty minutes after arrival at our hospital by ambulance, she was transferred to the operating room, and a cardiopulmonary bypass was established from the right femoral artery and vein, and a median sternotomy was performed. The knife had damaged the surface of the heart and penetrated the lingular segment of the left lung. Both wounds were directly sutured. Chest X-rays taken after closing the chest showed bleeding in the left lung probably because of the administration of heparin. Bleeding was controlled by lingulectomy. The postoperative course was uneventful.

Since general thoracic surgery requires a short fasting period, the number of cases that require nutrition support after surgery is limited and few reports exist about nutrition in general thoracic surgery and chronic empyema. Here we report 2 cases of chronic empyema treated with nutritional support team (NST) followed by omentopexy. For chronic empyema, a long period is required to sterilize the thoracic cavity by closed or open drainage before radical treatment. During this period, improvement of the nutrition status is important to control local infection, and to increase the volume of the omentum or muscle flaps used for filling the empyema space effectively. In our 2 cases, radical surgeries using omental flap were successfully performed after the improvement of general condition by aggressive nutritional support.

Annulus dilatation is present in almost all patients with mitral regurgitation, tricuspid regurgitation. Therefore annuloplasty is required to obtain normal leaflet coaptation. Annuloplasty ring or band offers more stability in valve repair, improving long-term outcome. Since annuloplasty ring and band of various types can be used, to understand the characteristics and to select proper size are important.

We report a case of hemothorax complicated with celiac artery compression syndrome (CACS). A 43-year-old man presented with a sudden onset left back pain. Computed tomography (CT) showed its hemothorax, esophageal artery aneurysm and severe stenosis of the celiac truncus with its anterior compression by median accurate ligament, and a diagnosis of CACS associated with rupture of the aneurysm was made. Emergent transcatheter arterial embolization of the aneurysm resulted in a technical failure, although the patient's condition was stable and performed esophageal artery ligation through video-assisted thoracoscopic surgery on day 5 after onset. After surgery, the patient recovered without significant incidents. A cause of this aneurysmal development was supposed to be a significantly increased esophageal arterial blood flow with its luminal dilation to compensate a decreased celiac blood flow. Segmental arterial mediolysis could not be excluded as another cause.

It seems that mitral valve surgery in patients older than 80 years increase against the background of the aging society. Basically, there are not particular differences between elderly patients and younger patients in procedures for diagnosis and operative indication in mitral valve diseases. However, cardiac surgery for patients older than 80 years has been reported to have high mortality rate. Therefore, it is necessary that we should evaluate and treat complications of important organs such as brain/coronary artery/lungs/liver/kidney, adequately. Our mortality rate of the whole mitral valve operations was 2.4% and that of patients older than 75 years was 7.9%. This result compares favorably with those reported from other institutions. However, when we perform mitral valve operations for patients older than 80 years, it is necessary to investigate activities of daily living and quality of life before and after the operation.