| Autotransplantation and Concomitant
Pneunectomy for an Intracardiac Metastatic Lesion and Primary
Pulmonary Blastoma of the Left Lung |
(Division of Pediatric Cardiovascular Surgery, Children's
Research Hospital, Kyoto, Japan and Divison of Thoracic Surgery,
Kyoto Prefectural University of Medicine*, Kyoto, Japan)
| Masaaki Yamagishi |
Keisuke Shuntoh |
Tsutomu Matsushita |
| Akiyuki Takahashi |
Katsuji Fujiwara |
Takeshi Shinkawa |
| Takako Miyazaki |
Nobuo Kitamura |
Shougo Toda* |
|
Pulmonary blastoma is rare and its
prognosis very poor. A 6-year-old boy was referred to our hospital
with chest pain. Computed tomography demonstrated that the left
pleural cavity was filled with a tumor. Cardiac echocardiography
demonstrated that the tumor had invaded through the pulmonary
vein into the left atrium and that the tumor extended into the
left ventricle. Part of the tumor was adhered to the anterior
leaflet of the mitral valve. To increase operative radicality,
an autotransplantation technique was performed concomitantly
with resection of the original lesion. Through a median sternotomy,
a moderate hypothermic cardiopulmonary bypass was established
to obtain cardiac arrest. First, longitudinal incision of right-sided
of the left atrium was made. The tumor invaded into the left
atrium through the left superior pulmonary orifice. The ascending
aorta, the main pulmonary artery, and both caval veins were transected.
The left atrium was incised along the pulmonary venous orifices.
The heart was completely removed from the mediastinum and transferred
to another table. Resection of the intracardiac metastatic lesion
and mitral valve replacement was accomplished. During this time,
thoracic surgeons performed a left pneunectomy. The left atrial
wall around the left pulmonary venous orifices was resected in
combination with the left lung. After the deficit of the left
atrial wall was repaired with a Gore-Tex patch, the heart was
replaced and we reconstructed the great arteries and caval veins.
The autotransplantation technique is a useful procedure for combined
lesions of the heart and lung.
Jpn. J. Cardiovasc. Surg. 33: 38 -41 (2004) |
|
