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The patient was a 67-year-old man. At 22 years of age, he underwent aortic valve replacement with Starr-Edwards ball valve. At 67 years of age, he complained of fatigue of the New York Heart Association (NYHA) class Ⅲ condition. He was diagnosed with mitral regurgitation, tricuspid regurgitation, ascending aortic aneurysm and chronic atrial fibrillation. Transthoracic and transesophageal echocardiograms showed a mobile, elongated echogenic mass attached to the valve cage and floating downstream. We performed Bentall procedure, ascending aortic replacement, mitral valve replacement, tricuspid annuloplasty and left atrial appendage closure. Explanted ball valve showed extensive cloth destruction and partial cloth tear. Mild pannus formation was observed beneath the valve. Despite 45 years after initial operation, significant valve dysfunction was not observed.

Cardiac metastasis from renal cell carcinoma (RCC) is relatively rare. It generally initiates from the right atrium with or without involvement of the inferior vena cava (IVC). Here, we report a case of metastasis of isolated clear cell RCC to the left ventricular( LV) papillary muscle. An 84-year-old male who had undergone renal resection due to RCC 19 years before, presented to our hospital with suspected LV tumor by echocardiography. The tumor was located near the posterior papillary muscle, with a size of 15×12 mm. The patient underwent resection of the LV tumor. Pathologically, the tumor was diagnosed as clear cell RCC. The postoperative course was stable, and he did not require any chemotherapy. Although there is no definite evidence of the mechanisms of metastasis, the tumor was supposed to metastasize lymphogeneously.

In this series, we describe the techniques of atrial, ventricular incision and closure. Right atriotomy is a surgical procedure necessary to expose congenital abnormalities of the tricuspid valve and other congenital heart diseases such as atrial and ventricular septal defects. Whereas, left atriotomy( for example left side atrial, transseptal or superior transseptal incisions) is a technique needed to expose mitral valve disease, frequently used during the maze procedure. And finally, left ventriculostomy is a surgical approach applied during resection of scar tissue or thrombus of ventricular aneurysm surgery, repair of the ventricular septal rupture and endoaneurysmorrhaphy. These are known techniques that have already been described in many manuscripts and textbooks. Regarding atriotomy and ventriculostomy, the most important thing to know is how to expose the tricuspid, mitral valves and adjacent sections of the heart. Ventriculostomy uses strips of teflon felt to strengthen the suture line and enhance hemostasis.

Prosthetic valve endocarditis (PVE) is associated with high mortality and reoperation rates despite diagnostic and therapeutic improvements. We retrospectively analyzed the data of 35 patients who had undergone reoperative cardiac surgery for PVE in our hospital between January 1, 2005 and December 31, 2014. The mean age of the patients was 68 ± 12 years, and 15 (42%) of those patients were women. Early PVE was defined as PVE that occurred within 1 year after the surgery; 12 (34%) patients showed early PVE. The aortic valve was affected in 25; the mitral valve, in 18;and the tricuspid valve, in 2 patients. Streptococcal, staphylococcal, and other infections were observed in 4, 20, and 7 patients, respectively. Aortic valve replacement, mitral valve replacement, double valve replacement, and aortic root reconstruction was performed in 9, 10, 6, and 10, patients, respectively. The 30-day operative and hospital mortality occurred in 4 (11%) patients. All patients who died had developed early PVE and staphylococci infection. The overall 7-year survival and freedom from valve-related reoperation were 63% and 78%, respectively. Surgical management of PVE remains a challenge and is associated with remarkably high morbidity and mortality rates. In our series, early PVE and staphylococcal infection were associated with very poor prognosis.

A 55-year-old man underwent rectal amputation for rectal cancer in August 2005. A tiny thin-walled cavity lesion in his left S1+2 was found on computed tomography (CT) of the chest in November 2008. The cavity lesion in the left S1+2 gradually increased in size over 3 months and positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) showed FDG accumulation at the lesion. Videoassisted thoracoscopic (VATS) wedge resection was performed to make a definite diagnosis in March 2009. The pathological findings revealed a metastatic lung tumor from the rectal cancer. It is necessary to consider the possibility of metastatic lung tumors in a case with the cavity lesions especially in patients with a history of colon cancer.

A 74-year-old man was admitted to our hospital in order to treat a mediastinal mass and 2 ground-glass attenuations in the right upper lobe detected by chest X-ray and computed tomography (CT). Partial resection of right lung and thymectomy were performed. The mediastinal mass and 2 ground-glass attenuations in the right upper lobe proved to be thymoma and bronchioloalveolar carcinomas, respectively by pathology.

In this series, we describe the method of atriotomy, ventriculotomy and their repairs. Right atriotomy is needed for expose tricuspid valve, atrial and ventricular septal defect. Left atriotomy is needed for expose mitral valve disease and technique for, maze or pulmonary vein isolation. Left ventriculotomy is needed for resection of scar and/of thrombus of ventricular aneurysm, repair of ventricular septal rupture and endoaneurysmorrhphy. Recently, this method is also used to repair for ischemic mitral valve regurgitation. These techniques have already been described in many textbooks. Regarding atriotomy and ventriculotomy, the most important point is how to fully expose the tricuspid and mitral valves and others. The repair of ventriculotomy requires strips of teflon felt to strengthen the suture line and to enhance hemostasis. This method of repair is considered standard by many surgeons.

A 72-year-old woman was reffered to our hospital for further examination of a tumor shadow in the left upper lung field which was detected in a mass screening chest X-ray. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a chest wall tumor located in the left 4th intercostal space. The lesion was suspected to be neurogenic tumor and CT-guided needle biopsy was performed. The tumor was consisted of spindle-shaped cells, but immunohistochemistry demonstrated no evidence of neurogenic tumor. As a possibility of malignant tumor could not denied, we performed tumor resection under video-assisted surgery. The lesion was not originated from nerves, but adhered to the intercostal muscle. Histologically, the tumor was consisted of spidle-shaped cells without atypia which sparsely proliferate in the myxoid stroma adjacent to intercostal muscle. In immunohistochemistry, tumor cells were positive for vimentin, and negative for desmin, S-100 protein, smooth muscle actin, CD34 and factor VIII. It was diagnosed as intramuscular myxoma. This histology in the intercostal muscle is extremely rare.

A 14-year-old girl was admitted to our hospital with a history of syncope and chest pain on exercise. Multi-slice coronary computed tomography (CT) demonstrated ostial stenosis of the left main trunk as well as wall thickening in the ascending aorta. Magnetic resonance imaging (MRI) also showed occlusion of the left carotid artery. She was diagnosed as having angina pectoris caused by aortitis syndrome. We performed off-pump coronary artery bypass grafting (OPCAB) with the left internal thoracic artery to the left anterior descending artery. The postoperative course was uneventful and coronary CT demonstrated good graft patency. We herein report successful OPCAB in a patient with left coronary main trunk ostial stenosis with aortitis syndrome.

A 42-year-old woman was admitted to our hospital because of an abnormal shadow on chest X-ray. Chest computed tomography scan revealed a tumor 4.0 cm in diameter in the right segment S8. We resected the right lower lobe because of the possibility of lung cancer. Historical finding of the resected specimen revealed epithelial-myoepithelial carcinoma of the lung. The patient has remained disease-free for a year and 3 months postoperatively.

A 47-year-old man with a history of surgery for gastric cancer had enlarging right hilar tumor. Primary or metastatic malignant tumor was suggested and the right upper lobectomy with systematic nodal dissection was performed. Pathological diagnosis was lymph node metastasis of the squamous cell carcinoma. He received no additional treatment, and is well without recurrence 5 years after resection.

A 52-year-old woman was admitted to our hospital because of an abnormal shadow on chest X-ray. Chest computed tomography scan and magnetic resonance imaging demonstrated an anterior mediastinal tumor. The tumor was extirpated completely with combined partial resection of the left lung through a median sternotomy. Microscopically, the tumor was diagnosed thymic cancer, basaloid carcinoma. The patient was treated with combination chemotherapy and radiation, postoperatively. We reported a case of thymic carcinoma.

A 52-year-old man was admitted to our hospital because of an abnormal shadow on chest X-ray. Chest computed tomography scan and broncho-fiberscopic examination revealed a tumor at the left main bronchus. The tumor was removed completely by partial resection of the left main bronchus with thoracotomy. Historical finding of the resected specimen revealed a benign pleomorphic adenoma of the bronchus. The postoperative course was un-eventful for 9 years. We reported a rare case of pleomorphic adenoma of the bronchus.

Mucosa-associated lymphoid tissue (MALT) lymphoma of the lung is rare. We present a case of MALT lymphoma of the lung. A 64-year-old man was admitted to our hospital because of an abnormal shadow on chest X-ray. He was performed transbronchial lung biopsy (TBLB) in our hospital, but the results was not diagnostic. We performed surgical biopsy using thoracoscopy due to the possibility of malignancy. The pathological diagnosis was MALT lymphoma. He underwent an chemotherapy after the operation and has been followed up at an outpatient for 8 years.

Small bowel metastasis from lung cancer is rare. We present 2 cases of small bowel metastasis from lung cancer. A 69-year-old man with postoperative lung cancer was admitted to our hospital because of the development of anemia secondary to melena A 56-year-old man with postoperative lung cancer was admitted to our hospital because of weight loss and fever. Both patients were operated on with suspicion of small intestine tumor after some examinations. The metastatic tumors were found in the small intestines. Resection of metastasis to the small bowel of lung cancer is benefical for better prognosis.

Osteogenesis imperfecta is a disease in which fragile bones readily cause fracture. Valvular disease concurrently develops. However, the surgery-related mortality rate is approximately 30%. In this study, we report 2 patients with osteogenesis imperfecta who underwent valvular heart surgery. Patient 1 was a 31-year-old male. He had previously been diagnosed as having osteogenesis imperfecta. Echocardiography suggested aortic valve insufficiency, and aortic valve replacement was performed. Patient 2 was a 59-year-old male. During admission, osteogenesis imperfecta was diagnosed. Echocardiography suggested mitral valve insufficiency, and mitral valve plasty was performed. In the 2 patients, intraoperative hemorrhage was marked. However, there were no fatal complications. We also reviewed the literature.

A 28-year-old Marfan's syndrome woman was referred to our hospital because of sudden chest and back pain. She had received replacement of the descending and ascending aorta for acute aortic dissection previously in other two institutions. CT scan revealed the massive mediastinal hematoma and hemothorax which suggested ruptured dissecting aneurysm of the transverse arch. Emergent total arch replacement, re-ascending replacement and aortic root plasty successfully weve performed. She recovered uneventfully although she had residual thoracoabdominal dissecting aneurysm. It was suggested that total arch replacement should be performed for Stanford A type dissection in Marfan's syndrome.