Jeong Seob Yoon

Concomitant Aortoesophageal and Aortobronchial Fistula After Endovascular Aortic Repair

d a u g d 75-year-old man was admitted with excruciating chest pain and hemodynamic collapse 2 months earlier. mergency computed tomographic scan showed a rupured thoracic aorta with mediastinal hematoma (Fig 1A). n endovascular stent-graft was deployed along the decending thoracic aorta through emergency angiogram (Fig B). Completion angiogram showed successful exclusion of he ruptured descending thoracic aorta (Fig 1C). The patient was readmitted with recurrent pneumonia nd intermittent hemoptysis 4 months later. A computed omographic scan on readmission showed crescenthaped air bubbles around the endovascular stent-grafted

Congenital Tracheobiliary Fistula in an Adolescent Patient

Congenital tracheobiliary fistula is a rare malformation that allows communication between the respiratory system and hepatobiliary tract. We describe a male adolescent patient who was admitted with a destroyed lung caused by repetitive bile pneumonitis with a congenital tracheobiliary fistula. Left pneumonectomy was performed, and the fistula tract was successfully divided.

Nodular fasciitis on chest wall in a teenager: a case report and review of the literature.

We report the case of a 16-year-old boy with a rapid growing mass on his left anterior chest wall. The mass was completely resected, and pathological examination confirmed nodular fasciitis. Benign chest tumors rarely occur in childhood. Nodular fasciitis is a benign proliferation of myofibroblast that is often mimicked by a sarcoma of the soft tissue. Physicians should consider the possibility of nodular fasciitis in chest wall tumors in the pediatric population.

Delayed-onset hypovolemic shock after the Nuss procedure for pectus excavatum.

The Nuss procedure, which is a minimally invasive approach for treating pectus excavatum, has better functional and cosmetic outcomes than other invasive procedures. Cardiac perforation is the most serious complication and several methods for the prevention of intraoperative events has been developed. Although most cardiac injuries are detected in the operating room, in the case described herein the patient experienced sudden hypovolemic shock during the postoperative recovery period. This indicates that special caution is mandatory even after successful execution of the Nuss procedure.

Total occlusion of both right-sided pulmonary veins after radiofrequency ablation for atrial fibrillation.

Fig. 1. For ectopic origin from the right superior pulmonary vein, the encircling ablatio under the electroanatomic mapping system 7 months earlier. The patient was anticoa 2.0—2.5 for 6 months after the procedure. On admission, the chest radiograph showe After thoracostomy tube drainage, multiple interstitial infiltrate of the right-sided tomographic scan (B). In addition, complete occlusion of the right-sided pulmonary v LLA, left atrial appendage; LIPV, left inferior pulmonary vein; LSPV, left superior p occlusion of right-sided pulmonary veins.

Endovascular repair of an intra-thoracic ruptured aneurysm of left subclavian artery in a patient with a right-sided aortic arch with aberrant left subclavian artery.

Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary’s Hospital, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul 137-701, Republic of Korea Department of Interventional Radiology, Seoul St. Mary’s Hospital, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul 137-701, Republic of Korea Department of Thoracic and Cardiovascular Surgery, Incheon St. Mary’s Hospital, The Catholic University of Korea, 665-8 Bupyeong 6-dong, Bupyeong-gu, Incheon 403-720, Republic of Korea

Disseminated intravascular coagulopathy caused by type II endoleak after endovascular aneurysm repair in severe aortic stenosis

A 72-year-old man with severe aortic stenosis (AS) presented with a type II endoleak after endovascular aneurysm repair (EVAR). Laboratory findings were consistent with disseminated intravascular coagulopathy (DIC) with thrombocytopenia. The platelet count increased slightly after aortic valve replacement but fully recovered with the reversal of DIC after surgical repair of the type II endoleak.

Influence of lung resection volume on risk of primary spontaneous pneumothorax recurrence

Background Thoracoscopic stapled bullectomy is a popular procedure for the treatment of primary spontaneous pneumothorax (PSP) that has a relatively high postoperative recurrence rate. One reason for PSP recurrence is the formation of a new bulla around the staple line. We hypothesized that different resected specimen volumes might cause differences in staple line tension. In this study, we analyzed the relationship between postoperative pneumothorax recurrence and resected lung volume. Methods Between April, 2009 and December 2013, 360 cases which underwent video-assisted thoracoscopic surgery (VATS) for PSP were selected. Recurrence after VATS was examined by electronic medical records and telephone survey. Resected volume and vertical area of specimen were calculated with the size of pathologic specimen. Results A mean follow up period was 44.5±24.4 months and recurrence rate was 11.1% (40/360). Large volume of resected specimen (≥16 cm3) (P=0.027 by the log-rank test) and larger vertical area of resected specimen (≥2.0 cm2) (P=0.003 by the log-rank test) showed significantly high recurrence rate. Cox regression analysis demonstrated that age [hazard ratio (HR), 0.083, P=0.006], vertical section area of resected specimen (HR, 1.239, P=0.020) and volume of resected pathology specimen (HR, 1.039, P=0.009) were independent risk factors of recurrence. Conclusions Bulky resection during VATS for PSP increases the risk of recurrence. Large volume and vertical area of resected specimen are associated with greater tension in stapling line. Avoidance of wide resection and the firing of stapler after full collapse of lung are recommended for reducing the pneumothorax recurrence after VATS.

New bullae formation in the staple line increases the risk of recurrent pneumothorax following video-assisted thoracoscopic surgery bullectomy for primary spontaneous pneumothorax

Background The study aimed to investigate the association between the recurrence of pneumothorax following video-assisted thoracoscopic surgery (VATS) for primary spontaneous pneumothorax (PSP) and the formation of new bullae. Methods This retrospective review examined patients who underwent VATS for PSP between April 2009 and December 2014. Of the 415 operated lungs, high-resolution computed tomography (HRCT) scans of 85 were analyzed. Results Of the 85 HRCT scans examined, 21 (24.7%) were diagnosed with recurrent pneumothorax and 60 new bullae were found. In total, 39 new bullae were located in the staple line, 38 were at other sites far from the staplers, and 17 were concurrent in the stapling and non-stapling areas. The group with new bullae in staple line exhibited significantly higher recurrence rate following VATS than the groups with no new bullae in the staple line (P=0.000, log-rank test). Cox regression analysis revealed that new bullae formation in the staple line [hazard ratio (HR), 26.664; P=0.003] and the volume of a resected pathology specimen (HR, 1.032; P=0.020) were independent risk factors for pneumothorax recurrence. Conclusions New bullae formation in the staple line increases the risk of recurrent pneumothorax following VATS. Thus, the current concept of VATS bullectomy-resect with sufficient margin-warrants reconsideration.

Low grade myxofibrosarcoma in the right ventricle presenting as pulmonary thromboembolism

We report an unusual malignant cardiac neoplasm that initially presented as pulmonary thromboembolism in a 78-year-old male. Despite anticoagulation, the pulmonary artery lesion progressed and a mass-like lesion developed in the right ventricular outflow tract. Venoarterial extracorporeal membrane oxygenation was applied before surgery due to the presence of severe right-side heart failure with pulmonary hypertension. A round mass was found in the right ventricle and separate lobulated masses were found in both pulmonary arteries, and these were consistent with low-grade myxofibrosarcoma.