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Hepatic abscesses are divided into bacterial and amoebic types. Although the prognosis of bacterial liver abscesses has improved owing to progress in drainage techniques and antimicrobial agents, poor outcomes remain common. While there have been some reports of amoebic liver abscesses complicated by thrombosis, bacterial liver abscesses and subsequent thrombus in the right atrium are very rare. We herein report the case of an 82-year-old man. He had suffered acute obstructive suppurative cholangitis 10 months previously, and bile culture yielded Enterococcus faecalis. In the present case, a right atrial thrombus caused by a bacterial liver abscess was observed and the causative organism was thought to be Enterococcus faecalis, for which was detected in a blood culture was positive. The patient was successfully treated with hepatic abscess drainage and surgical right atrial thrombectomy under cardiopulmonary bypass with a beating heart.

A 60-year-old woman was admitted to our hospital for dyspnea. Contrast-enhanced computed tomography( CT) revealed acute pulmonary artery thromboembolism. An echocardiogram showed a movable structure in the right atrium. Emergency surgery was performed under general anesthesia. The movable structure in the right atrium looked like a Chiari network with a diameter of over 5 cm, and no obvious thrombus was found. The patient had a good postoperative course and was discharged home on postoperative day 17. The Chiari network is a remnant structure of the fetal venous sinus valve, and its diagnosis was important for determining the appropriate treatment plan for this case.

A 67-year-old man on chronic hemodialysis was admitted with worsening congestive heart failure due to critical aortic stenosis. Echocardiography showed severe aortic stenosis with a valve area of 0.67 cm2 and an ejection fraction of 0.31. Cardiac catheterization revealed severe pulmonary hypertension with pulmonary artery pressures of 62/32 mmHg. In the middle of cardiac catheterization, the systolic pressure declined to 60 mmHg due to cardiogenic shock. Dopamine hydrochloride and dobutamine hydrochloride infusions were necessary to maintain a systolic pressure greater than 80 mmHg. Balloon aortic valvuloplasty was urgently performed. The patient's symptoms rapidly resolved except for angina on exertion. One month later, elective aortic valve replacement was performed. The postoperative course was uneventful and the he was discharged on the 60th postoperative day. A follow-up echocardiogram 6 months postoperatively revealed normal prosthetic valve function and an ejection fraction of 0.6.

Total arch replacement for extended distal arch aneurysm has been known to have a poor outcome because of a limited view on the distal side. An open stent-grafting technique has been employed in many institutions, but several complications have been reported. Specifically, embolism of the distal artery from aneurysm debris and injury to the aortic wall are serious complications. Therefore, we have developed and tested a new sheathless stent-grafting system. We use a small-sized sheath (12 Fr) as an inner cylinder and a stainless-steel Z-shaped stent (Gianturco:William Cook Europe A/S) in the distal part of the graft. This system is deployed by releasing 3-0 polypropylene suture after inserting the full-length graft. The major advantages of this system, compared with other devices, include flexibility, less invasiveness to the aortic wall and low potential for graft migration. This new system may be feasible and clinically effective in the surgical treatment of extended distal arch aneurysm.

We report a case of functional mediastinal parathyroid adenoma with cystic change. A 72-year-old woman was admitted to our hospital because of general fatigue. Laboratory examinations suggested a diagnosis of hyperparathyroidism (HPT) based on high levels of serum calcium and intact parathyroid hormone (PTH). Computed tomography (CT) revealed the shape of a cystic tumor with a diameter of 4 cm in the anterior mediastinum. 99mTc-MIBI scintigraphy showed accumulation of the radioisotope in the tumor. The patient was diagnosed as primary HPT caused by the cystic parathyroid adenoma. The tumor was resected through a median sternotomy. The patient had an uneventful postoperative course, and her serum calcium and intact PTH levels rapidly returned to normal. Careful dissection is essential in order not to occur implantation of parathyroid tissue.

This is a report of 2 cases, in which preoperative 3-dimentional demonstration of the spinal cord artery with 64-row computed tomography was feasible, less invasive, less time-consuming, and helpful in making an interventional strategy for complex aortic disease, resulting in no postoperative paraplegia One was a 63-year-old man, who underwent total arch replacement and a long elephant trunk method for arch and descending aortic aneurysms. The length of the long elephant trunk was so determined that it ended between the descending aortic aneurysm and the origin of the spinal cord artery. The second case was a 59-year-old man, who underwent descending thoracic aorta replacement for type B aortic dissection. During the distal anastomosis, the dissection septa were trimmed in order to perfuse the blood into the true and 2 false channels, one of which was connected to the spinal cord artery. In this report, we are not suggesting that preservation of the demonstrated spinal cord artery is enough for spinal cord protection, because it is still controversial. Further study is needed to confirm the reliability and reproducibility of our methods.

In this report, aortic arch replacement was performed successfully in 2 cases with our modified method placing priority on the cardiac and cerebral reperfusion, resulting in no postoperative cardiac or neurological complication. One was a 63-year-old man with old cerebral infarction and ischemic heart disease, and the other was a 72-year-old man with severe stenosis of the left common carotid arteries. Our method is similar to so-called "arch first technique". First, the ascending aorta is clamped and proximal anastomosis is accomplished during core cooling, followed by reconstruction of the brachiocephalic arteries under deep hypothermic circulatory arrest. Then perfusion of the heart and brain is restarted, while distal anastomosis is performed. It was proved that the method had several possible advantages such as minimized duration of brain ischemia and deep hypothermia, and elimination of direct cannulation to the branches of the aortic arch and a separate perfusion circuit for the brain.

We report a case of a 76-year-old man with traumatic aortic dissection complicated with cardiac herniation due to traumatic pericardial rupture. He was involved in an automobile crush and was transferred to our hospital. His vital signs were stable except for atrial fibrillation. Enhanced computed tomography (CT) showed aortic dissection on the descending aorta, multiple left rib fractures, substernal hematoma and shift of the heart toward the left chest cavity. We performed emergency operation. Through left thoracotomy, pericardial rupture was observed. Dacron graft replacement of the descending aorta and pericardial patch plasty were performed. He was discharged on the 24th postoperative day. Careful attention should be paid to aortic injury and pericardial rupture in the patient with severe blunt chest trauma.