Bronchial obstruction due to Teflon pledgets migration 13 years after lobectomy

Bronchopleural fistula is a major cause of morbidity and mortality after pulmonary resection. Different techniques of reinforcing the bronchial stump to prevent this complication have been described. Pledgeted sutures have been suggested for this purpose but have the potential to erode into the bronchus years after resection. We report an unusual case of airway obstruction 13 years after lung resection where pledgeted sutures had been used to reinforce a lobectomy stump. Bronchoscopic management of this rare complication consisted of endobronchial débridement and placement of a silicon stent to allow remodeling of the stenotic airway.     

Tracheal stenosis due to relapsing polychondritis managed for 16 years with a silicon T-tube covering the entire trachea

We report the case of a 35-year-old man with tracheal stenosis caused by relapsing polychondritis. The disease began at age 17, and he underwent steroid therapy and tracheostomy. After 2 years, owing to inflammation and fibrosis, a T-tube was inserted from the glottis to the tracheal bifurcation. Besides hospitalization for mild pneumonia, the patient was able to lead a normal sedentary life with satisfactory communication. T-tubes are an effective and low-risk treatment measure for preserving airway function in patients with tracheal stenosis due to polychondritis. In this report we discuss the advantages and disadvantages of different stents in treating relapsing polychondritis.     

Surgical repair of rupture of the membranous septum after blunt chest trauma

Rupture of the membranous septum is a very rare complication of blunt chest trauma. In this report, we describe a 22-year-old man who sustained multiple blunt trauma injuries during a motor vehicle accident. Rupture of the membranous septum was diagnosed 48 hours after the initial trauma and the defect was closed with Gore-Tex (W.L. Gore & Assoc, Flagstaff, AZ). However, the operation was complicated by complete atrioventricular block requiring implantation of a permanent DDD pacemaker.     

Combined free vascularized iliac osteocutaneous flap and pedicled pectoralis major myocutaneous flap for reconstruction of anterior chest wall full-thickness defect

Large defects of the anterior chest wall lead to gross chest instability that can result in paradoxic respiration. Osteoradionecrosis of the lower sternum and multiple left ribs resulted in a huge, full-thickness defect of the left anterior chest wall in a 67-year-old woman. An iliac osteocutaneous flap (bone segment 3 × 14 cm) was harvested for reconstruction of the bone defect. The skin defect was covered by the skin paddle of the iliac osteocutaneous flap and a contralateral rotational pectoralis major muscle flap. Months postoperatively, the patient was physically active, the chest was stable, and the vascularized iliac bone was incorporated into the recipient bone.     

Spontaneous closure of pseudoaneurysm after transapical aortic valve implantation

Transcatheter aortic valve implantation by an apical approach has been developed as an alternative to conventional aortic valve replacement. Complications with these relatively new procedures are being reported. We report a case of transapical transcatheter aortic valve implantation, in which a pseudoaneurysm at the apex of the left ventricle as a complication of the procedure developed in the patient and was treated without surgery. The defect spontaneously closed.     

Extracorporeal membranous oxygenation and left atrial decompression: a fast and minimally invasive approach

Left atrial decompression for patients under extracorporeal membranous oxygenation is sometimes mandatory, but it may be technically difficult. We describe a safe and minimally invasive technique to perform this while placing a small cannula antegradely in the pulmonary artery trunk.     

Mucosa-associated lymphoid tissue lymphoma of the left mainstem bronchus

Primary mucosa-associated lymphoid tissue (MALT) lymphoma of the large airway is extremely rare. We report a patient in whom we performed a sleeve resection of the left main bronchus without resection of lung parenchyma for MALT lymphoma. During restaging of the disease, tumor cells were detected in the bone marrow, and the patient subsequently underwent systemic chemotherapy with anti-CD20 antibody. The patient currently remains free of recurrence. Local resection of bronchial MALT lymphoma is very important to avoid airway difficulties. In addition, although MALT lymphoma of the bronchus appears to be localized, systemic spread of the disease must be considered and investigated.