A 60-year-old woman was admitted because of dyspnea and a cough. Computed tomography and transthoracic echocardiography showed a tumor in the left atrium. However, transesophageal echocardiography alone could show the tumor and its extension in the interior wall of the left atrium. Peripheral blood chemistry showed a high CA125 level. The first operation was carried out in order to perform a complete resection of the tumor which was 3.5×4.0×2.0cm, but the interior wall of the left atrium seemed normal. The CA125 level returned to within a normal range 80 days after the first operation. Histopathology showed the tumor had myxomatous changes and ring structure formations, but malignancy was also suspected. Transthoracic echocardiography performed 14 months after the first surgery showed a recurrence of the tumor, and subsequent transesophageal echocardiography showed the tumor and its invasion in the interior wall of the left atrium. A second operation was performed to resect the tumor, which had invaded a part of the left atrial interior wall. The histopathology showed the tumor was myxoid but had mitoses and foci of necroses. This tumor was consistent with a myxosarcoma. The patient died as a result of a recurrent tumor blocking the left atrium 20 months after the first surgery.

Malignant disease in the mediastinum often involves cardiac structures such as the cardiac chamber and great vessels, and causes circulatory impairments that limit therapeutic options and longevity. In the present study, we evaluated curative or palliative surgical management for 6 cases of such malignancy in the mediastinum with circulatory impairment who were operated on between January 2001 and February 2004 (4 men and 2 women aged 17 to 72 years). Procedures included tumor resection with cardiopulmonary bypass (CPB) for mitral strangulation due to left atrial myxosarcoma; pericardiectomy without CPB for constrictive pericarditis due to invasive thymoma; radical nephrectomy for renal cell carcinoma with right atrial tumor thrombus using CPB; two pericardial fenestrations with or without partial tumor resection for cardiac tamponade due to pericarditis carcinomatosis caused by malignant lymphoma or lung cancer; and right ventricular metastatic lesion resection with outflow tract reconstruction for the recurrence of renal cell carcinoma using CPB. The follow-up ranged from 4 days to 30 months. Procedure-related death occurred in the patient with invasive thymoma due to heart failure on postoperative day 4. Five operative survivors had improved quality of life and received other therapeutic options. Although the patient with malignant lymphoma died of sepsis during chemotherapy at three weeks, the remaining 4 patients were discharged from the hospital postoperatively but 3 died during follow-up due to the progression of malignant disease. The cause of death were local recurrence at 20 months after operation in the patient with myxosarcoma, liver metastasis at 13 months in the renal cell carcinoma patient, and carcinomatous cachexia at 8 months in the patient with metastatic lung cancer. The patient with recurrence of renal cell carcinoma is doing well without any symptoms of tumor progression at 30 months after metastatic lesion rsection. Despite poor prognosis of the patients of mediastinal malignancy, surgical management for circulatory impairments can be indicated with acceptable risk to lengthen survival and improve the quality of life.

Intercostal artery aneurysm is a rare disease, and is usually associated with aortic coarctation, trauma and infection. Until recently, diagnosis of the aneurysm had not been possible before rupture of aneurysm. However, recent advances in computed tomography (CT) and magnetic resonance imaging (MRI) have made it possible to diagnose this lesion. A 68-year-old man was admitted with an abnormal shadow on chest X-ray film. A chest CT scan showed an aneurysm beside the descending aorta, suggestive of intercostal artery aneurysm. Intraoperative inspection confirmed the diagnosis. The aneurysm was shown to be atherosclerotic in origin by postoperative histological examination.

A 60-year-old man complained of palpitation due to transitory atrial fibrillation. The annulo-aortic ectasia was recognized, and was getting enlarged to 52 mm. After an additional examination, membranous ventricular septal aneurysm was revealed. There was no evidence of thrombus, shunt, or infection in the membranous ventricular septal aneurysm. The valve-sparing aortic root replacement (reimplantation) and the patch-closure of the membranous ventricular septal aneurysm were performed. Stabilizing the subannular tissue by a Dacron patch made the reimplantation technique feasible. To secure a subannular suture line, 3 mattress stitches were passed inside-out through the Dacron patch, the fibrous rim of the membranous septum and the prosthetic graft again. He was discharged without any complication 12 days after the operation.