Desmoid-type fibromatosis arising in a bifid rib chest wall Abstract Desmoid-type fibromatosis is a rare soft tissue tumor and the chest wall is one of the common sites of its extra-abdominal occurrence. A bifid rib is one of the congenital rib abnormalities. We report a case of desmoid-type fibromatosis arising in a chest wall’s bifid rib. A 42-year-old female complained of right chest pain without remarkable medical, traumatic, or familial history. Chest-computed tomography revealed a chest wall tumor located adjacent to a bifid costal cartilage of third rib. We performed chest wall resection of second and third ribs. Pathologically, the tumor was diagnosed a desmoid-type fibromatosis of the chest wall. We surmise mechanical stimulation due to the bifid rib may be related to the occurrence of the tumor. In case of desmoid-type fibromatosis without somatic gene mutation, traumatic history, wound, implants, or use of female hormonal agents, we should search also local congenital abnormality.

Two cases of air leak syndrome after bone marrow transplantation successfully treated by the pleural covering technique Abstract Air leak syndrome (ALS) is a rare complication after bone marrow transplantation (BMT) and usually has a fatal outcome because of the high recurrence rate and treatment-refractory nature. A 32-year-old man with a history of BMT for acute lymphoblastic leukemia suffered from metachronous bilateral ALS. Bullectomy and the pleural covering procedure (PLC) were successfully performed for each side of the thorax. After surgery, no relapse of pneumothorax was seen for 2 years on the right side and for 1 year on the left side. A 38-year-old man with a history of BMT for acute myelogenous leukemia (AML) suffered from ALS at the thorax on the left side. Bullectomy and the PLC were successfully performed. After that no recurrence of left pneumothorax for 7 years. We experienced two cases of ALS after BMT successfully treated by the PLC. This technique may be a viable treatment option for future lung transplantation.

Application of decellularized allograft for primary repair of congenital heart disease in Japan Abstract A 6-month-old infant with a double outlet right ventricle, doubly committed ventricular septal defect, and right ventricle outflow tract (RVOT) stenosis underwent intracardiac repair with RVOT reconstruction using a fresh decellularized allograft derived from a 1-year-old heart transplant recipient in Japan. Early postoperative evaluation via echocardiography and cardiac magnetic resonance imaging revealed that the pulmonary allograft and cardiac function were stable. This is the first case report on using a decellularized heart valve, which was resected from a heart transplant recipient, for primary repair of congenital heart disease in Japan.

Folding procedure to diminish type 3 endoleakage after open stent graft surgery with TEVAR extension Abstract We herein report a new procedure to prevent type 3 endoleakage (EL3) after open stent graft (OSG) surgery with thoracic endovascular aortic repair (TEVAR) extension. The OSG Dacron graft portion is reversed and folded inside the OSG stent graft portion intraoperatively, filling the crack between the OSG and TEVAR device. We applied this procedure in two patients with no postoperative complications. Our folding procedure may prevent EL3 after OSG surgery if TEVAR extension is needed in the future.

Spontaneous ascending aortic rupture in a pregnant woman with neurofibromatosis type 1 Abstract Neurofibromatosis type 1 (NF-1) is an autosomal dominant disorder that affects 1 in 3000 individuals. Vascular involvement in NF-1 is a well-recognized, but rare, feature of this disease. In pregnant women, the risk of aortic dissection or rupture is elevated during pregnancy and the postpartum period. We report a pregnant woman who had a history of NF-1 with a spontaneous ascending aortic rupture. This rupture was successfully treated by emergent surgery. The mother and the 28-week-gestation newborn recovered uneventfully. During 7 years of follow-up, aorta of the patient shows no significant change. A review of the literature regarding the pathogenesis of this condition is also presented.

“ Mantle-style ” modification of Cabrol shunt for hemostasis after extended aortic reconstruction in acute type A aortic dissection Abstract Cabrol shunt and several of its modifications have been used as adjunctive procedures to control inaccessible bleeding occurring after aortic root surgeries. Nevertheless, the hemostatic effect of the shunt is suboptimal when the reconstructive procedure extends to the aortic arch and coronary arteries. We propose a “Mantle-style” modified Cabrol shunt to facilitate hemostasis of the exsanguination from the neo-root after aortic root replacement with concomitant arch and coronary reconstruction.

Behavior of primary tracheal glomus tumor, uncertain malignant potential subtype Abstract The behavior of the pathological subtypes of tracheal glomus tumor (benign, uncertain malignant potential UMP, malignant) is vague. In a 51-year-old gentleman, suffering from cough for 4 months, computed tomography scan showed a mass at lower third of the trachea and the bronchoscope revealed exophytic mass at the tracheal lumen. Segmental tracheal resection was done using special modified endotracheal tube for the distal lung ventilation. The tracheal glomus tumor was also diagnosed based on the immunohistochemical staining. The tumor was 2 cm in diameter, deeply located, mitotic phase was difficult to identify, and a diagnosis of UMP subtype was made. There was no recurrence after 2 years follow-up. This is the first reported case of UMP subtype in lower trachea and we studied the treatment options with the clinic-pathological behavior of this tumor and its sequel by regular follow-up.

Significance of preoperative right ventricular function on mid-term outcomes after surgical ventricular restoration for ischemic cardiomyopathy Abstract Objectives To analyze our surgical experiences with surgical ventricular restoration (SVR) for dilated ischemic cardiomyopathy (ICM) and to determine the significance of preoperative right ventricular (RV) function on outcomes. Methods and results This study retrospectively analyzed 19 patients who underwent SVR between April 2010 and May 2016. Their mean age and New York Heart Association functional class were 62 ± 11 years and 2.9 ± 0.8, respectively. The preoperative mean left ventricular (LV) end-systolic volume index and LV ejection fraction (LVEF) were 134 ± 56 mL/m2 and 24 ± 7%, respectively. The preoperative mean RV fractional area change (RVFAC) to quantify RV systolic function was 33 ± 13%, as assessed by transthoracic echocardiography. The mean follow-up period was 47 ± 20 months. Three patients died of cardiac causes during the follow-up, with the 3-year and 5-year freedoms from cardiac-related death of 89% and 79%, respectively. Major adverse cardiac events (MACEs) occurred in ten patients, with the 3-year and 5-year MACE-free survival rates of 58% and 41%, respectively. RVFAC (risk ratio [RR] = 0.92, 95% confidence interval [CI] 0.86–0.98, p = 0.01) and LVEF (RR = 0.83, 95% CI 0.68–0.97, p = 0.02) were significant predictors of MACEs in the multivariate analysis. Patients with RVFAC of < 35% had significantly poorer MACE-free survival rates (33% at 3 years) than those with RVFAC of ≥ 35% (80% at 3 years). Conclusion SVR for ICM provided acceptable freedom from cardiac-related death; however, MACEs commonly occurred and was associated with RV dysfunction.

If post-thoracotomy pain is the target, Integrated Thoracotomy is the choice Abstract Objectives Despite the overgrowth of procedures done by VATS, there are still needs for thoracotomy. Post-thoracotomy pain plays an important role in many post-operative morbidities. Surgeons should make efforts to evolve new techniques to reduce post-thoracotomy pain with its associated morbidities. This trial aimed to study the impact of combining lack of rib retraction with protection of both intercostal nerves on post-operative pain. Methods This was a prospective study of 57 patients who had Integrated thoracotomy (I group) which consists of modified French window with Double-Edge closure. The results of I group were compared to our previous study that contained two groups 60 patients each, double edge (DE group) in which standard thoracotomy was closed using double-edge technique and (PC group) in which pericostal sutures was used for closure of thoracotomy. Outcomes assessed were operative time, time to ambulation, doses of analgesics injected in the epidural catheter, post-operative complications, chest tube drainage, hospital stay, and pain score and use of analgesics during the first post-operative year. Results All groups had similar demographics, operative time, and incisions length, but in I group, there were significantly a smaller number of lobectomies and pneumonectomies. Patients in I group had significantly lower time to ambulation, epidural doses and post-operative pain score throughout the first week. Patients in the (I group) had a significantly lower pain score throughout the first 9 months post-operatively. Up to 6 months post-operatively, there was significantly less use of analgesics among the I group. Conclusion The combination of retractor-free exposures and neurovascular exclusion sutures for thoracotomy is safe and effective in decreasing post-thoracotomy pain and use of analgesics.

Preoperative frailty is associated with progression of postoperative cardiac rehabilitation in patients undergoing cardiovascular surgery Abstract Objective Preoperative frailty affects the progression of cardiac rehabilitation (CR) after cardiovascular surgery. Different frailty assessment measures are available. However, it remains unclear which tool most likely predicts the progress of CR. Our aim was to evaluate preoperative frailty using different methods and to identify the predictors in the progress of postoperative CR. Methods Eighty-nine patients underwent elective cardiovascular surgery at our institution between May 2016 and April 2018. Mortality cases and patients without evaluation of preoperative frailty were excluded. This study included the remaining 78 patients. We divided the patients into two groups: 47 patients who achieved 100 m walking within 7 days after surgery (successful CR group) and 31 patients who achieved 100 m walking later than 8 days after surgery (delayed CR group). Preoperative frailty was assessed using the Kaigo-Yobo Check-List, Cardiovascular Health Study, Short Physical Performance Battery, and Clinical Frailty Scale. Results The prevalence of frailty defined by these four measures was higher in the delayed CR group. The delayed CR group had lower nutritional status, serum hemoglobin level, serum albumin level, and psoas muscle index. Multivariable analysis demonstrated the Kaigo-Yobo Check-List score as an independent predictor for delayed CR (odds ratio 1.53, 95% confidence interval 1.18–1.98, p = 0.001) and Clinical Frailty Scale as an independent predictor for discharge to a health care facility (odds ratio 3.70, 95% confidence interval 1.30–10.51, p = 0.014). Conclusions Among the various tools for assessing frailty, the Kaigo-Yobo Check-List was most likely to predict the progress of postoperative CR after elective cardiovascular surgery.