Palliative surgery for malignant mediastinal tumor invading the superior vena cava and right atrium

Intra-atrial extension of a superior vena cava (SVC) tumor is rare and it is associated with high mortality rates. An 80-year-old woman presented with malignant mediastinal tumor invading the superior vena cava and right atrium. The unresectable tumor caused uncontrolled SVC syndrome and led to the risk of pulmonary artery tumor thrombosis. Palliative surgery for the intracaval and atrial tumor was performed. Presently, 6 months after surgery, the patient remains free from SVC syndrome and has received effective adjuvant chemotherapy to reduce the size of the tumor.     

Partial anomalous pulmonary venous connection to the superior vena cava

We describe the surgical technique of reimplantation of the right superior pulmonary vein into the left atrium in 2 patients with partial anomalous pulmonary venous connection to the superior vena cava without atrial septal defect. A right axillary minithoracotomy is done through the fourth intercostal space. The pulmonary vein is detached from its origin in the superior vena cava. This is sutured with 6-0 reabsorbable polydioxanone suture (Ethicon, Somerville, NJ). A lateral clamp is applied to the left atrium, and the pulmonary vein is reimplanted. The patient is extubated in the operating room. Neither cardiopulmonary bypass nor blood transfusion was required. It is simple, safe, and reproducible.     

Complete resection of a mediastinal solitary extramedullary plasmacytoma and reconstruction of right pulmonary artery and superior vena cava

Solitary extramedullary plasmacytoma located in the thorax is a rare tumor. We present a 21-year-old patient who was diagnosed with a mediastinal solitary extramedullary plasmacytoma. Complete resection of the tumor with reconstruction of the right pulmonary artery and superior vena cava was performed. The patient is alive without evidence of recurrence 8 months after the operation. Extensive resection and reconstructive surgery with the addition of radiotherapy can prolong the patient's life.     

Superior vena cava bypass with cryopreserved ascending aorta allograft

Initially superior vena cava obstruction is typically managed by an endovascular approach. However, in some patients, particularly those in whom angioplasty and stenting is not technically possible, or those who have recurrent disease after previous endovascular repair, an open surgical approach may be indicated. Conduit choices for caval reconstruction are less than ideal; hence we describe a case using a cryopreserved aortic allograft.     

Repair of lacerated intrapericardial inferior vena cava after cardiac massage

We successfully undertook surgical treatment of intrapericardial laceration of the inferior vena cava caused by external cardiac massage in a patient with acute coronary syndrome. Injury to the inferior vena cava without blunt trauma is very rare, and diagnostic imaging does not show it clearly, making it difficult to diagnose. Rapid and accurate judgment and management are necessary, because the mortality due to this injury is very high.     

Functional total anomalous pulmonary venous drainage by left atrium-to-superior vena cava shunt

Total anomalous pulmonary venous connection is occasionally associated with a functional single ventricle and is thought to be a risk for the staged Fontan approach. We report a patient with a very rare presentation of mitral atresia and intact atrial septum with physiologically total anomalous pulmonary venous drainage by a connecting vein between the left atrium and the superior vena cava. A surgical atrioseptectomy as a functional repair of total anomalous pulmonary venous connection and pulmonary artery banding was successfully performed as the first palliation for Fontan completion.     

Surgical resection of locally advanced pulmonary adenocarcinoma after gefitinib therapy

First-line therapy with gefitinib prolongs progression-free survival and improves quality of life among selected patients with non-small cell lung cancer. Selected locally advanced patients may derive benefit from surgical resection after gefitinib therapy. Further clinical trials are needed to evaluate the role of gefitinib therapy followed by surgical resection.     

An unusual complication from hemostatic packing to control bleeding during cervical mediastinoscopy and an off-pump approach for the later exploration of the superior vena caval injury

Cervical mediastinoscopy has been widely used and is considered a safe method for the histologic diagnosis and staging of many conditions. Hemorrhage still remains one of the main possible complications, and hemostasis is usually achieved without any further surgical intervention. We present a previously unreported complication of absorbable hemostatic gauze packing, which led to superior vena caval injury and multiple pulmonary emboli, necessitating further surgical repair with the use of a veno-venous shunt.