Shun-Ichiro Sakamoto

Background and Clinical Significance: Hemoptysis caused by acute type B aortic dissection rupturing into the lung is rare but life-threatening; Case Presentation: An 81-year-old man receiving maintenance hemodialysis developed hemoptysis due to an aortobronchial fistula involving the left upper lobe. The ulcer-like projection was located on the greater curvature of the distal aortic arch and enlarged during the clinical course. Immediate thoracic endovascular aortic repair (TEVAR) and open repair were initially considered unsuitable because of hostile access through a previous abdominal aortic graft, a shaggy aorta, and severe cardiac comorbidities. Left upper lobe bronchial ligation was performed as a temporizing airway-isolation procedure and initially controlled airway bleeding. However, recurrent hemoptysis occurred after further enlargement of the aortic lesion and development of a new fistula involving the left lower lobe. Emergency TEVAR was then performed through the previous abdominal aortic prosthetic graft, and no further hemoptysis occurred; Conclusions: Bronchial ligation may temporarily control life-threatening airway bleeding when immediate aortic repair is not feasible, but strict surveillance and readiness for subsequent aortic intervention remain essential.

Background: To describe an aortic arch incision and closure technique (AICT) for proximal fixation of a frozen elephant trunk (FET) and to report early outcomes. Methods: We retrospectively reviewed 15 consecutive patients who underwent distal arch repair with an FET using AICT (mean age 77 ± 7 years; 14 men). Indications were distal arch aneurysm (n = 12), acute Stanford type B dissection (n = 2), and distal arch enlargement after thoracic endovascular aortic repair (n = 1). Under circulatory arrest, an oblique arch aortotomy was created, the FET was deployed antegrade, trimmed, and sutured to the native aortic wall during simultaneous closure, allowing extended posterior fixation. Clinical outcomes and postoperative computed tomography were assessed. Results: No ischemic complications related to graft kinking or thrombosis, reoperation for bleeding, stroke, spinal cord ischemia, or organ failure occurred. One patient died of pneumonia on postoperative day 47 (6.7%). Cervical branch reconstruction was required in 12 patients (80%), whereas two patients with type III arch morphology and acute angulation were treated without debranching via a Zone 3 aortotomy. At a median follow-up of 29 months, no proximal endoleak was observed; one distal endoleak occurred without reintervention. Coronary bypass grafts remained patent in all patients with concomitant or prior CABG. Conclusions: AICT provided secure proximal FET fixation and arch closure while preserving the ascending aorta, offering an alternative to total arch replacement in selected distal arch pathologies.

Background: Cardiac hemangiomas located in the right heart can lead to serious complications, including right ventricular outflow tract (RVOT) obstruction, arrhythmias, and sudden cardiac death. Although surgical resection remains the primary treatment, complete excision of intramural tumors poses risk of impairing cardiac function. This case report describes the successful resection of a large right ventricular hemangioma using intraoperative voltage mapping, which enable maximal tumor removal while preserving myocardial integrity and preventing postoperative heart failure. Case presentation: A 76-year-old female underwent a routine health examination in July 2024, during which cardiomegaly and nonspecific ST-segment changes were detected on electrocardiography. Contrast enhanced computed tomography revealed a well-defined 60 mm mass within the right ventricle, causing significant ROVT stenosis. No evidence of distant metastasis or elevated tumor markers was detected. The patient underwent tumor resection via median sternotomy. Intraoperative voltage mapping was utilized to delineate viable myocardium at the tumor margins. The tumor was excised while preserving functional myocardial tissue. Cryoablation was performed at the resection margins, and resultant defect in the right ventricular wall was reconstructed using a bovine pericardial patch. Histopathological analysis confirmed the diagnosis of cardiac hemangioma. The patient experienced an uneventful postoperative course had no postoperative complications and was discharged on postoperative day 16. Preoperative and postoperative cardiac magnetic resonance imaging demonstrated preserved right ventricular function. Conclusions: Intraoperative voltage mapping proved to be a valuable adjunct in the surgical management of right ventricular tumors, enabling effective tumor resection while preserving myocardial tissue and maintaining postoperative cardiac function.

This case report presents a case of lower extremity peripheral arterial disease (PAD) with severe calcified lesions extending from the external iliac artery to the bifurcation of the superficial femoral artery, involving the groin region. Owing to the complexity and risk of complications, such as infections and delayed wound healing, revascularization was performed with extensive endarterectomy. The inguinal-lifting technique (ILT) was used to provide safe surgical access and minimize complications. The procedure resulted in successful revascularization with no major wound-related issues. The ILT proved to be an effective approach for safe, extensive endarterectomy in complex PAD cases.

Objectives: The venous cuff technique has been used primarily for arterial bypass using artificial grafts to the lower extremities. The boat-form vein cuff was designed to allow adjustment of the size and angle of the anastomosis at any anatomic site. We report our experience and outcomes of the original vein cuff technique in various peripheral artery bypass grafting procedures.Methods: A total of 10 patients underwent arterial bypass grafting using a polytetrafluoroethylene (PTFE) graft with a boat-form venous cuff. The indications for the surgery consisted of peripheral artery disease (n = 4), acute limb ischemia (n = 4), chronic mesenteric ischemia (n = 1), and traumatic upper limb ischemia (n = 1). Five patients required emergency surgery. Surgical outcomes, such as mortality and morbidity, limb salvage rate, and graft patency, were examined using perioperative and postoperative follow-up data.Results: There were no operative deaths or serious complications, including amputation of the lower extremity. During the follow-up period (44 ± 36.9 months), the PTFE graft remained patent in 9 patients (90%). In 1 patient, occlusion of the femoropopliteal bypass graft was observed 3 months after surgery.Conclusions: The simple design and creation of the boat-form vein cuff are useful at any anatomical site in peripheral artery bypass grafting with a PTFE graft.

Background: With the advent of effective chemotherapy, conversion surgery (CS) has been performed in patients who have responded to pretreatment, even for pancreatic cancer diagnosed as unresectable (UR) at the time of initial diagnosis. In CS, major arterial resection and reconstruction are necessary for complete radical resection. Methods: We discuss the key points for safely performing pancreatectomy with celiac axis (CA) resection combined with reconstruction, divided into resection and arterial reconstruction. The possibility of safe pancreatectomy concurrent with CA resection and reconstruction depends on the ability to create a “golden view” that provides an unimpaired view of the Abdominal Aorta, CA, Superior Mesenteric Artery, Inferior Vena Cava, and left renal vein from the ventral side. Pancreatectomy concurrent with CA resection requires arterial reconstruction. Postoperatively, arterial blood flow must be maintained. To achieve this, tension-free and short bypass should be observed. Results: From 2014 to 2024, sixteen URLA patients underwent CS, requiring major artery en bloc resection after pretreatment. We performed DP-CAR in eight patients, gastrectomy-distal pancreatectomy-splenectomy (Appleby procedure) procedure in one patient, PD-CHAR in two patients, PD-CAR in two patients, TP-CAR(spleen preserving) in one patient, and TP-CAR+TG in two patients. In total, five patients required surgery with CA reconstruction. Histopathologically, four of the five patients had T4 pancreatic cancer. The R0 surgical rate was 80%. Complication of Clavien–Dindo IIIa or higher was observed in one patient. There were no deaths. Conclusions: Parallel to the determination of pretreatment, surgeons must be prepared to safely and reliably perform pancreatectomies that require concurrent major arterial resection and reconstruction.

Background: Cardiac neoplasms may cause life-threatening symptoms associated with cerebral infarction, ventricular arrhythmias, and heart failure. Emergency surgery or preoperative treatment may be required for these patients. However, no study has reported the surgical outcomes in cases involving cardiac neoplasms with life-threatening complications. The current study investigated the mid- to long-term outcomes of surgery in patients with cardiac neoplasms in life-threatening conditions. Methods: This study retrospectively analyzed 36 consecutive patients who underwent resection for cardiac neoplasms with life-threatening cardiovascular, respiratory, and cerebral nervous system complications from January 2000 to December 2022. Their mean age at surgery was 54.9 years. In terms of fatal events, one patient who experienced a ventricular tachycardia storm caused by a left ventricular neoplasm was placed under deep sedation and managed with a ventilator preoperatively. Seven patients who presented with limb motor paralysis and visual defects had cerebral infarction. Two of the seven patients with cerebral infarction received cerebrovascular treatment before cardiac surgery. Results: During the follow-up period, cerebral- and cardiovascular-related deaths were not recorded. All postoperative cerebral and cardiovascular complications were new-onset cerebral infarction (n = 2) (with symptoms that improved during the long term). The mean follow-up period was 6.2 years. The 5- and 10-year survival rates of all patients were 89.8% and 78.7%, respectively. There were no significant differences in postoperative prognosis between patients with preoperative cerebral infarctions and those without. Conclusions: The long-term surgical outcome of patients with life-threatening symptomatic cardiac neoplasm was good. Thus, preoperative complications did not affect prognosis.

Background Recent developments in surgical devices, including left atrial appendage closure, have enabled surgeons to perform aggressive operations for atrial fibrillation (AF). However, the outcomes of AF surgery in emergent cases have not been extensively studied. Objective and methods The present study aimed to investigate the effectiveness of AF surgery in emergency surgery cases associated with cardiovascular events. We enrolled 18 patients who underwent various types of AF surgery due to emergencies, including acute aortic dissection (n = 6), acute myocardial infarction (n = 5), bleeding due to perforation from radiofrequency catheter ablation (n = 4), acute mitral regurgitation (n = 2), and cardiac tumor (n = 1). Four and ten patients underwent the full maze procedure and pulmonary vein isolation, respectively. Ganglionated plexi ablation was also performed in three patients as part of a combined procedure. The left atrial appendage was solely closed in four patients. Results There was no surgical mortality or major adverse cardiac and cerebrovascular events in our patient series. The rates of freedom of recurrence of AF or atrial tachycardia at 1 and 3 years were 92.9% and 82.5%, respectively. After a mean follow-up period of 46.7 ± 25.8 months, no thromboembolism events were observed in the patients. Furthermore, no cardiovascular death was recorded. Conclusion The surgical procedures for AF are safe and effective in cases requiring emergency surgery.