Aortic endostent followed by extended pneumonectomy for T4 lung cancer

Pulmonary and aortic en bloc resection may be performed with cardiopulmonary bypass support, but is associated with high surgical morbidity and mortality. A 59-year-old man with left lower lobe cancer invading the aorta was considered to be unsuitable for such an extended operation because of previous myocardial infarction, coronary bypass grafts, and subsequent multiple coronary artery stenting. Pneumonectomy with en bloc resection of aortic adventitia and media was accomplished after thoracic aorta endovascular stent graft placement. The aortic defect was reinforced with an extrathoracic muscle flap. The postoperative course was uneventful, and the patient was faring well at the 23-month follow-up. An endovascular stent may be an alternative in selected patients with aortic involvement, avoiding the need for cardiopulmonary bypass.     

Thoracoscopic extrapleural pneumonectomy for mesothelioma

Mesothelioma is the most common primary pleural malignancy. Surgical therapy offers limited cure benefits at the cost of high morbidity. Although technically challenging and performed rarely, a less invasive approach to extrapleural pneumonectomy was developed with the intent to speed convalescence, hasten adjuvant therapies, improve quality of life, and reduce wound surface area for possible tumor contamination.     

Successful bilateral lung transplantation after previous pneumonectomy

We report successful bilateral lung transplantation for end-stage suppurative lung disease after a previous right-sided pneumonectomy performed for a destroyed lung. Our results demonstrate the feasibility of the procedure even in the context of mechanical ventilation and extracorporeal artificial oxygenation. Posttransplantation follow-up revealed excellent gas exchanges, no airway complications, and well-functioning grafts with right-sided ventilation and perfusion of 37% and 22%, respectively.     

Pedunculated parietal pleural lesion: a rare presentation of bronchogenic cyst

We present a 35-year-old man with a preoperative diagnosis of a right lower lobe cystic mass. Misled by a radiological suggestion of an intraparenchymal lesion, he had a thoracotomy and right lower lobectomy. An intraoperative finding of a pedunculated cyst arising from the parietal pleural with subsequent histopathology confirmation of a benign bronchogenic cyst, however, would have made a less invasive surgical excision more appropriate.     

En bloc resection of 3 vertebra in a pancoast patient: long-term stability using a free vascularized fibular graft

Vertebral involvement is no longer a contraindication for resection in superior sulcus tumors. We describe the reconstruction of thoracic vertebras 2 to 4 using a free vascularized fibular graft combined with dorsal and ventral stabilization using rods, screws, and hooks after resection of a superior sulcus tumor that invaded the thoracic spine. No complications have occurred after 7 years of follow-up, and the reconstruction has been durable and stable.     

Solitary nasopharyngeal metastasis from lung primary: a long-term survivor after radiotherapy

Isolated nasopharyngeal metastasis from lung primary is a rare condition. We report a patient with stage 1B adenocarcinoma of the lung who underwent anatomical lung resection and was subsequently found to have solitary nasopharyngeal metastasis. The patient received radiotherapy to nasopharynx and remained disease-free for 10 years from the date of diagnosis of nasopharyngeal metastasis. We postulate that solitary nasopharyngeal metastasis from lung primary might be a separate entity that responded well to radiotherapy.     

Cystic degeneration of a carcinoid lung tumor: an uncommon cause of an intrathoracic cyst

Carcinoid tumor is a rare, slow-growing neuroendocrine tumor that accounts for less than 1% of all lung tumors. It occurs most commonly in the midgut, then the lung, and usually presents as a solid lesion. We report a patient with a typical carcinoid tumor that had undergone cystic degeneration.     

Rupture of a left sinus of valsalva aneurysm with coronary compression: a rare cause of ischemic chest pain

We describe the case of a 52-year-old man presenting with chest pain and ischemic electrocardiogram changes. He was initially prepared to undergo primary percutaneous intervention, but echocardiography revealed pericardial effusion and computed tomography confirmed the diagnosis of rupture of a left sinus of Valsalva aneurysm. Emergency surgery was performed, and the aneurysm was repaired using a composite Dacron-Aortic homograft patch. The patient had a good postoperative recovery. This case report demonstrates the difficulty dealing with the minority of patients presenting with presumed ST elevation myocardial infarction, but for whom the life-saving treatment is surgery.     

Intraoperative diagnosis of bilateral coronary ostia stenosis: a rare case of ischemic heart disease in a 3-month-old patient

We report a case of a 3-month-old child, presenting with signs of myocardial ischemia and hemodynamic instability, requiring extracorporeal membrane oxygenation support. Due to the unclear preoperative instrumental findings, a surgical exploration was performed revealing the presence of coronary ostia stenosis and an intramural course of both coronary arteries. The child underwent a successful plasty of the coronary artery ostia by resecting the excessive obstructing fibrous tissue followed by unroofing of the intramural coronary artery course with restoring of a normal myocardial perfusion and function.     

The completion Bentall procedure

Patients that have undergone aortic valve replacement may subsequently present with an aortic root aneurysm, but with a normally functioning prosthetic valve. We describe our method of replacing the aortic root while retaining the existing aortic valve as the "completion Bentall procedure."