Search

In this study, we describe an intrathoracic microsurgical lymphatico-venous anastomosis as an alternative surgical technique for the treatment of refractory chylothorax in an infant. This procedure allowed us to restore enteral nutrition within days of surgery. At 3-year follow-up, there was no recurrence of pleural effusion., (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Thoracic duct ligation is a widely accepted treatment option for chylothorax. This case report describes another treatment approach for recurrent chylothoraxes after thoracic duct ligation. A 40-year-old woman had chylothoraxes after thoracic duct ligation. She underwent a secondary surgery to ligate the thoracic duct. Three days later, the number of chylothoraxes increased compared with presurgery, and we anastomosed the thoracic duct and azygos vein after releasing the thoracic duct ligation. The patient recovered smoothly and was followed up for 2 years. This case shows that anastomosis of the thoracic duct and azygos vein is an alternative surgical approach to treat recurrent chylothoraxes.

Aims: Inferior vena cava (IVC) interruption is a rare anatomic variant where the azygos vein (AV) drains the blood from the IVC to the upper part of the right atrium via the superior vena cava. Here, we report balloon cryoablation of the pulmonary veins (PVs) via superior access in a patient with atrial fibrillation., Methods and Results: After the first failed ablation attempt due to IVC interruption, balloon cryoablation with a 28-mm Arctic Front Advance cryoballoon (Medtronic CryoCath LP, Quebec, Canada) via superior access was performed; it requires only a single transseptal puncture (TP), and the patient had optimal PV anatomy. Deflectable electrodes were inserted into the right ventricle and coronary sinus from the right femoral vein. The right internal jugular vein was accessed using an SL0 transseptal sheath and BRK needle. The TP was performed under transoesophageal echocardiographic guidance with a Safe Sept wire because the septum was stiff. All PVs were engaged: the left using an ablation catheter before balloon insertion and the inferior following a 'push-up' technique because of a leak above the veins. Cryothermal energy was delivered after checking for occlusion. The procedure lasted 210 min, fluoroscopy time was 78 min, and air-kerma dose was 194 mGy. During the 6-month follow-up, no episodes of atrial fibrillation were detected on several Holter recordings., Conclusions: Successful PV isolation in patients with AV continuation of an interrupted IVC can be safely performed using superior access with balloon cryoablation, after several modifications of standard equipment., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.)

Azygos vein aneurysm is very rare and most cases are detected incidentally. We report a safe resection of azygos vein aneurysm by video-assisted thoracoscopic surgery (VATS) under preoperative evaluation of thrombus by multidetector computed tomography (MDCT). A 60-year old woman presented to our department due to a mediastinal mass revealed by enhanced CT. A dynamic enhanced-CT scan showed a dilated azygos vein with great enhancement in the early phase. Under the diagnosis of azygos vein aneurysm, we analysed the aneurysm by MDCT and confirmed that there was no thrombus within the aneurysm. The resection of the aneurysm by VATS was performed safely. She was discharged 4 days after surgery.

The azygos lobe is a well-known and well-described anatomical variation of the right lung. Primary lung cancer arising from an azygos lobe, however, is exceedingly rare. Only a handful of cases have been previously reported in the literature. We report the first case with operative demonstration of a primary adenocarcinoma arising from an azygos lobe, which was treated with robot-assisted azygos lobectomy.

We report a case of a shrapnel injury to the right thigh in which a foreign body had lodged in, and moved freely from, the femoral vein to the inferior vena cava and right atrium. However, instead of going into the right ventricle and pulmonary artery, it lodged itself in the superior vena cava-azygous junction. During the entire period, the patient remained asymptomatic and the foreign body was surgically retrieved uneventfully.

We report a case of locally advanced excavated non-small cell lung cancer with superior vena cava (SVC) syndrome that underwent four cycles of induction chemotherapy. Due to early treatment failure and the impossibility applying radical radiotherapy, a decision was made to perform surgery. The patient underwent right intrapericardial pneumonectomy with en-bloc resection of the SVC, azygos vein and mediastinal lymph nodes. Prosthetic azygo-atrial bypass was then performed. The patient enjoys one year progression-free survival with patent graft and symptomatic relief of SVC syndrome.

In the surgical treatment of lung cancers invading the superior vena cava (SVC), primary closure is preferred for reconstruction when the resected area is small, but the repaired vessel can become constricted. A novel method for SVC repair with azygos flap, which is a longitudinally opened azygos arch, is a facile and effective treatment, and may prevent a reduction in the lumen if the area of tumor invasion is small and close to the azygos arch. When the azygos arch is not invaded by the tumor, this procedure should therefore be considered as one alternative method for SVC reconstruction.

Indwelling pacemaker or defibrillator leads are often extracted with use of a cutting laser sheath. We report embolization of a tined pacemaker lead tip into the azygous vein, with the use of a distal embolization protection device to retrieve the fragment. Creative and non-traditional use of a filter-based device may assist in retrieval of embolized material.

Less than 25 cases of azygous vein lacerations secondary to blunt trauma have been published in the medical literature, most of these injuries were resulting from motor vehicle accidents, but have been described due to falls or assaults. These lesions should be considered as thoracic great vessels injuries and if not recognized promptly carry a high morbidity and mortality. We report a case of a young male involved in a high-speed car collision, admitted to the emergency room in an unstable condition secondary to hypovolemic shock due to azygous vein injury. The patient underwent emergent right antero-lateral thoracotomy followed by sternotomy for surgical control of the vascular injury and resuscitation. Laparotomy and splenectomy were also required, the abdomen was closed. The thoracic cavity was left packed and closure was delayed for 48 h. The patient survived and was transferred to another hospital seven days later.

We describe the case of a 52-year-old man with end-stage emphysema who underwent a right-sided lung transplantation. During preoperative monitoring an apparently non-functioning Swan-Ganz catheter could not be removed through the insertion site - right internal jugular vein. Another Swan-Ganz catheter was successfully installed through the left internal jugular vein, pulmonary artery pressures could be recorded and the transplant was performed uneventfully. Then, the first catheter was inspected and superior vena cava palpation surprisingly revealed a knot at approximately 25 cm. The catheter was pushed to the azygous vein, proximal and distal controls were obtained and a venotomy was performed. The knotted side was sectioned and removed, while the remaining catheter was removed through the insertion site. Despite being rare, knotted intravascular devices have been increasingly reported. Removal with interventional radiology techniques can be accomplished in most instances, nevertheless, complex knots or knots fixed into cardiac structures require open removal. Since in our case the knot was detected intraoperatively, it was readily removed through the azygous vein. To the best of our knowledge, this is the first report to describe such a route of removal.

We describe a rare case of cyanosis following the Fontan operation with right-to-left shunting at the venous level, that is, an azygos venous to pulmonary venous connection. Few cases with partial anomalous pulmonary venous connection to azygos vein have been reported; however, there have been no reports describing the connection from azygos vein to pulmonary vein, which results in desaturation after Fontan operation. Multidetector-row computed tomography (MDCT) was a useful tool to depict this vascular malformation.

Catheter ablation of the slow pathway for atrioventricular nodal re-entrant tachycardia (AVNRT) is not always possible due to congenital or acquired obstruction of the inferior vena cava (IVC). Although a superior access has been proposed as an alternative approach, a poor manoeuvrability and a lower stability of the ablation catheter may be potential problems. We report a case of slow pathway ablation for AVNRT in a patient with an azygos continuation using a hypoplastic but uninterrupted IVC.

Giant venous hemangiomas of the azygos arch are exceedingly rare and idiopathic. To the best of our knowledge, there have been only two reports of azygos hemangioma. We report a case of hemangioma of azygos arch in a 46-year-old man after a complete resection and discuss the strategy that was used for the diagnosis and therapy.

Massive systemic-to-hepatic venous collaterals developed in a 8-year-old boy with left isomerism and azygos connection of the inferior vena cava who had undergone total cavopulmonary shunt leaving the hepatic vein connected to the common atrium 5 years previously. A hepatic vein-to-azygos vein connection via an autologous pericardial roll successfully ameliorated cyanosis and physical activity. Hepatic vein-to-azygos vein connection is technically easy and is favorable in providing balanced distribution of hepatic venous blood to both lungs. We recommend this technique as an effective alternative to hepatic vein-to-pulmonary artery connection in patients developing collateral vessels after total cavopulmonary shunt.

We report a case of a large saccular idiopathic aneurysm of the azygos vein which was discovered totally thrombosed at operation. To our knowledge, such a case of thrombosis occurring in this exceptional aneurysm location has never been previously reported.