We report a rare case of primary pulmonary meningioma in a 52-year-old woman. A right middle lobe pulmonary nodule was first detected on chest X-ray at the age of 38. Chest computed tomography (CT) suggested a pulmonary hamartoma, and the patient was followed conservatively. Because the nodule gradually enlarged over time, a partial resection of the right middle lobe was performed by videoassisted thoracoscopic surgery for diagnostic and therapeutic purposes. Histopathological examination revealed a meningioma. Meningiomas are the most common tumors of the central nervous system, however, ectopic meningiomas, including those occurring in the lung, are rare.

A 66-year-old woman with lung cancer and an anomalous branching of the right posterior segmental vein( V2) underwent robot-assisted right upper lobectomy. Preoperative computed tomography( CT)revealed that the V2 existed dorsal to the right main bronchus and drained directly into the left atrium. Intraoperatively, the V2 was identified and divided using a stapler. The right upper lobectomy and lymph node dissection were performed safely, and the V2 stump was covered with an anti-adhesive material. Anomalous V2 branching may pose significant risks, making detailed preoperative imaging evaluation essential. In robot-assisted surgery, the risk of vascular injury from grasping or traction is higher, necessitating careful technique. In addition, central ligation may prevent thrombus formation at the pulmonary vein stump.

A 72-year-old man was diagnosed with gastric cancer. Preoperative chest computed tomography (CT) revealed three nodules in the right lung. The patient had no history of malignant disease and had undergone surgery for thyroid follicular adenoma six years previously. Based on the morphology of the nodules, the right lower lobe nodule was suspected to be a primary lung cancer, whereas the right upper and middle lobe nodules were suspected to be lung metastases secondary to lung or gastric cancer. After distal gastrectomy, thoracoscopic wedge resection was performed for the pulmonary nodules. The right lower lobe pulmonary nodule was diagnosed as primary lung cancer, and the right upper and middle lobe pulmonary nodules were diagnosed as lung metastases from thyroid follicular carcinoma. When a patient with a history of thyroid follicular adenoma presents with a lung nodule, lung metastasis from thyroid follicular carcinoma should be considered.

We report a case of hemoptysis due to pulmonary artery pseudoaneurysms controlled by transcatheter arterial embolization (TAE) and surgery. An 83-year-old man presented with hemoptysis one month after treatment for pneumonia and referred to our hospital. Chest computed tomography( CT)revealed a lung abscess in the left lower lobe and two pulmonary artery pseudoaneurysms by the abscess. TAE was performed to control hemoptysis, and the hemoptysis improved. After his general condition improved, a left lower lobectomy was safely performed.

Right-sided infective endocarditis(IE) is rare, accounting for 5~10% of all cases. Herein, we report a 70-year-old man who developed methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and tricuspid valve endocarditis (TVE) with severe tricuspid regurgitation (TR) following bladder fistula placement. Echocardiography revealed a 17×14 mm vegetation on the septal leaflet. Despite antibiotic therapy, the symptoms of heart failure worsened and surgery was indicated. Under cardiopulmonary bypass, the infected anterior and septal leaflets were excised, and valve reconstruction was performed using glutaraldehyde-treated autologous pericardium. Postoperative echocardiography revealed mild TR. The patient underwent prolonged antibiotic therapy and was discharged in good condition. At two years follow-up, there was no recurrence of infection or worsening of TR. This case suggests that autologous pericardial patch repair is a useful strategy for MRSA-associated TVE, particularly in patients with a high reinfection risk, where prosthetic material should be avoided.

Cold agglutinins are a rare autoimmune hemolytic disorder in which immunogloburin(Ig) M antibodies bind to red blood cells at low temperatures, potentially causing hemagglutination and complement-mediated hemolysis during cardiac surgery under hypothermic cardiopulmonary bypass (CPB). We report a 73-year-old woman with severe aortic regurgitation and positive cold agglutinin (titer 1:512, critical temperature 30 ℃). To avoid intraoperative hemagglutination, normothermic CPB was performed with a minimum rectal temperature of 34.7 ℃. Warm blood cardioplegia(34 ℃) with increased potassium concentration was used for myocardial protection. The postoperative course was uneventful without hemolytic or thrombotic complications. This case demonstrates that normothermic CPB with warm cardioplegia can be safely applied in patients with cold agglutinin positivity when the critical temperature is above the target intraoperative temperature.

Cardiac surgery after retrosternal gastric tube reconstruction presents significant technical challenges because of interference with the median sternotomy approach. We report a 67-year-old man who successfully underwent aortic valve replacement and mitral valve repair a year after subtotal esophagectomy with retrosternal gastric tube reconstruction for esophageal cancer. The gastric tube was carefully mobilized using a combined laparoscopic and cervical approach, allowing safe median sternotomy without injury to the right gastroepiploic artery. Both valve procedures were completed successfully under cardiopulmonary bypass. The patient resumed oral intake on postoperative day 4 and was transferred for rehabilitation on day 15. This case illustrates that with elaborate preoperative planning and careful intraoperative management, complex cardiac surgery can be performed safely even after retrosternal gastric tube reconstruction.

An 80-year-old woman underwent mitral valve replacement, tricuspid annuloplasty, and left atrial plication for symptomatic mitral stenosis, tricuspid regurgitation, and atrial fibrillation. Following admission to the intensive care unit, she developed low-output syndrome. Transthoracic echocardiography showed extensive apical asynergy, and electrocardiography showed negative T waves in leads Ⅱ, Ⅲ, aVF, and V2-V6. Coronary angiography demonstrated no significant coronary artery stenosis, whereas left ventriculography showed basal hyperkinesis with apical asynergy, leading to a diagnosis of Takotsubo cardiomyopathy. Although hemodynamic stabilization was difficult, the patient's condition gradually improved with catecholamine therapy alone, which was discontinued on postoperative day 11. In cases of postoperative acute-onset low-output syndrome, the possibility of Takotsubo cardiomyopathy should be considered.

A 70-year-old male was diagnosed with a ventricular aneurysm at the apex. The aneurysm was large, measuring 77 mm, so surgery was performed. We performed the operation to prevent rupture and improve low cardiac function, following the septal anterior ventricular exclusion procedure. Postoperative pathological examination revealed that the protruding wall on the right ventricular side consisted of fibrous tissue with sclerosis and a small amount of myocardial tissue, leading to a diagnosis of a pseudo-false aneurysm. Postoperative cardiac function improved, with the ejection fraction (EF) increasing from 24% to 45%. Left ventricular pseudo-false aneurysm is rare, and we report this case including the review of the literature.

Subepicardial ventricular aneurysm is a form of ventricular aneurysm that occurs concomitantly with acute myocardial infarction, characterized by a rupture limited to the myocardium while the epicardium remains intact. Herein, we report a case in which closure of the aneurysm was performed via left mini-thoracotomy minimally invasive cardiac surgery (MICS). The patient was a 75-year-old female with a history of ascending aortic replacement, who developed a subepicardial ventricular aneurysm in the apex during percutaneous coronary intervention(PCI) for the left anterior descending artery. Due to the risk of aortic injury at the anastomotic pseudoaneurysms of the ascending aorta, cautious observation was undertaken, and four months later, closure of the aneurysm under beating heart conditions was successfully performed via left mini-thoracotomy MICS. The postoperative course was uneventful.

Concomitant left atrial(LA)-only surgical ablation(SAB) of atrial fibrillation(AF) with mitral valve procedure was performed in nine cases with radiofrequency ablation devices. LA-SAB includes connected bilateral pulmonary vein isolations, mitral isthmus ablation, and LA appendage ablation and occlusion at its base. There were no such adverse events as 30-day mortality, thromboembolic event, permanent pacemaker implantation, readmission due to heart failure, or cardiac death (follow-up:mean:10±5 years, range:0.75~15 years). Freedom from AF without classⅠ/Ⅲ antiarrhythmic drugs at six months was 77.8%(7 of 9 cases), and sinus rhythm (SR) has been maintained more than 10 years in 4 of those 7 cases. In one of two postoperative AF cases, SR recovery was confirmed four years after surgery, and AF has not been detected for three years. LA-SAB is considered to be safe, effective, and feasible, although further investigation and patient selection are needed.

Hypernatremia due to polyuria following cardiac surgery is rare. We report a case that required to identify the cause of massive polyuria. A 50-year-old male underwent aortic arch replacement for acute aortic dissection. Early postoperatively, he developed marked polyuria [over 3,000 ml within 6 hours after intensive care unit (ICU) admission, over 15,000 ml within 24 hours] and hypernatremia (peak value 187 mEq/l). We first assumed vasopressin deficiency due to cardiopulmonary bypass, and desmopressin nasal spray was somewhat effective. Continuous vasopressin infusion combined with massive 5 % glucose infusion started to reduce serum sodium value to 160 mEq/l. Neither a vasopressin challenge test on post operative day 16 nor a water restriction test on post operative day 48 demonstrated an increase in urine osmolality, leading to a diagnosis of nephrogenic diabetes insipidus. This case highlighted the complexity of fluid management when nephrogenic diabetes insipidus complicates postoperative course after surgery using cardiopulmonary bypass.

An 81-year-old man underwent surgical aortic valve replacement (SAVR) for stenotic bicuspid valve with a 21-mm CEP bioprosthesis 17 years ago. Four years ago, he underwent valve-in-valve (ViV)transcatheter aortic valve replacement (TAVR) using a self-expandable Evolut R 23-mm valve due to structural valve deterioration (SVD) and redo SAVR was indicated because of repeat SVD and heart failure symptoms. Transcatheter valve and prior surgical valve adhered to the anterior mitral leaflet. Removal of the valve caused perforation, which required repair. Aortic valve replacement was performed using an Epic Plus 21-mm valve. SAVR after TAVR is more invasive and has higher mortality than ViV, but in younger or low-risk patients, treatment should be planned with long-term prognosis in mind.

With the increasing adoption of robot-assisted thoracic surgery(RATS), the role of surgical assistants has evolved compared to traditional open or video-assisted thoracic surgery(VATS). At our institution, a 5-port look-up view approach with the da Vinci Xi system has been in use since May 2021, and since June 2024, we have transitioned to a solo-surgery approach in which the primary surgeon independently manages both console operation and surgical field exposure. In this retrospective single-center study, we quantitatively evaluated assistant interventions in 115 cases during the introduction phase and 45 cases during the solo-surgery phase. Assistant interventions such as suctioning and retraction significantly decreased in the solo-surgery phase, while port hopping-a technique allowing instrument switching by the surgeon-was introduced as an alternative. No conversions to thoracotomy or blood transfusions occurred throughout the study period. These findings suggest that, with appropriate strategies and technical adaptations, solo-surgery in RATS is not only feasible but can be performed safely without compromising operative outcomes.

An 81-year-old woman underwent endovascular treatment for a cerebral aneurysm under general anesthesia with intubation using a 7.0-mm endotracheal tube. Shortly after extubation, she developed hemoptysis. Bronchoscopy revealed a longitudinal laceration and bleeding of the tracheal membranous wall, extending from approximately 4-cm below the vocal cords to near the carina. Hemostasis was achieved with diluted epinephrine. Chest computed tomography (CT) showed no pneumomediastinum or perforation. Given her stable condition and that the injury was confined to the mucosal layer, conservative management was chosen. Follow-up bronchoscopy on day 5 showed healing without rebleeding or stenosis. This case highlights the importance of careful risk assessment and appropriate endotracheal tube size selection, particularly in elderly, small-framed women. It is important to develop an algorithm for selecting endotracheal tube size based on risk factors such as age, sex, and body habitus, in order to prevent tracheal injury.