We report two cases of metastatic cardiac tumors managed surgically. Case 1 involved a 52-year-old man with colorectal cancer and pulmonary metastases who developed respiratory distress during chemoradiotherapy. Imaging revealed a right atrial mass extending into the right ventricle. Mass reduction of the intracardiac tumor was surgically performed to reduce embolic risk and to enable subsequent chemotherapy. Postoperative chemotherapy resulted in complete remission without recurrence. Case 2 involved a 50-year-old woman with cervical cancer who experienced worsening dyspnea during treatment. Positron emission tomography (PET) and echocardiography identified a tumor extending from the right atrium to the pulmonary artery. As complete resection was unfeasible, mass reduction with tricuspid valve replacement was performed, followed by chemotherapy. The patient remains alive. Pathology confirmed metastatic cardiac tumors in both cases. These tumors present variably depending on the primary cancer and metastatic pattern, making diagnosis and treatment challenging. In symptomatic cases, especially with heart failure or embolism, prompt surgical intervention is critical. Mass reduction can relieve symptoms and improve survival. A focused literature review is also included to support clinical decision-making.

A 50-year-old male was diagnosed with aortic annulus ectasia (AAE) and aortic valve regurgitation (AR), and was thus referred to our department for surgery. Computed tomography (CT) revealed a Valsalva aneurysm with a maximal diameter of 52 mm. Echocardiography revealed severe AR with left ventricular enlargement [left ventricular internal dimension in diastole (LVDd) 85 mm]. The creatinine (CRE) level was 0.97 mg/dl, and the C-reactive protein (CRP) level was 1.92 mg/dl. David's procedure was initiated as a therapeutic intervention; however, severe adhesion and enlargement of the ascending aorta were observed after it was exposed during cardiopulmonary bypass (CPB). Based on this finding, the patient was suspected of having Takayasu's arteritis, and thus a Bentall procedure, with ascending aorta replacement by selective cerebral perfusion (SCP) and systemic cooling, was performed. Pathological examination revealed an inflammatory reaction from the adventitia to the intima with mononuclear cell infiltration, leading to a histological diagnosis of Takayasu's arteritis. The postoperative course was uneventful, and the patient was discharged on postoperative day 21. Steroids were used to treat Takayasu's arteritis and to prevent its recurrence after discharge.

Primary cardiac malignant tumor is rare and is associated with poor survival. We report a case of primary cardiac intimal sarcoma. A 41-year-old man was admitted to our hospital with congestive heart failure. We performed tumor resection under emergency. The pathological diagnosis of the resected tumor was cardiac intimal sarcoma. There have been few reports of cardiac intimal sarcoma, and the frequency of its occurrence and prognosis are unknown. Surgery and postoperative radiation therapy may improve the prognosis.

The patient is an 86-year-old woman. She had ascites and was being treated with diuretics, but developed dyspnea, so a chest computed tomography( CT) scan was performed which revealed right pleural effusion. After aspiration of pleural effusion, abdominal distention due to ascites decreased and video-assisted thoracoscopic surgery was performed on suspicion of pleuroperitoneal communication. The diaphragm was sutured using an automatic suture device because a hole was found in the diaphragm. Insufflation into the abdominal cavity technique was safety and useful for identifying pleuroperitoneal communication.

The patient is a 58-year-old male who underwent aortic valve replacement and ascending aortic grafting five years ago. Postoperatively, a temporary epicardial pacing wire( TEPW) could not be removed, and was subsequently cut at insertion to the skin and left in situ. Despite ongoing antibiotic therapy, the patient's C-reactive protein (CRP) level remained elevated. An endoscopic examination revealed that the TEPW had migrated and penetrated the esophagus, prompting its endoscopic removal. TEPW can cause fatal complications, so they should be removed whenever possible. In patients with TEPW left in the body, wires should be checked constantly by imaging studies.

In a 77-year-old man, there was difficulty in removing a guidewire that had strayed into the right ventricle during leadless pacemaker insertion. Surgical removal was required. During removal of the wire, the tendon cords of the anterior tricuspid valve were pulled out, resulting in acute severe tricuspid regurgitation. The patient underwent tricuspid valve repair under cardiac arrest. He had a good postoperative course, a permanent pacemaker was implanted on postoperative day 14, and he was discharged on postoperative day 20. Although complications associated with catheter procedures have been increasing in recent years, there have been no reports of cases in which a guidewire became entangled in the tendon cords of the tricuspid valve. We discuss the cause of this case from the viewpoint of preventing recurrence and refer to acute tricuspid regurgitation that occurred during the removal of the catheter.

The patient was a 71-year-old man with a history of hypertension and myocardial infarction. Transthoracic echocardiography revealed a left ventricular ejection fraction of 26% and moderate mitral regurgitation. Computed tomography (CT) showed a wide-ranging aneurysm from the aortic arch to the abdomen. Maximum short diameter of the thoracic aortic aneurysm (TAA) was 54 mm. We planned a two-stage hybrid surgery to avoid a long aortic clamp time. During the first surgery, we performed mitral annuloplasty (MAP) and a total debranching procedure using a three-branch graft from the ascending aorta to the brachiocephalic artery, left common carotid artery, and left axillary artery under cardiopulmonary arrest. Thoracic endovascular aortic repair (TEVAR) was performed 20 days after the first surgery. No complications were encountered and the patient was discharged 31 days after the initial surgery. Hybrid surgery involving MAP and second-stage TEVAR after branch reconstruction was effective in this case of extensive TAA with low cardiac function.

An eight-day-old boy with the transposition of the great arteries (TGA) with posterior aorta underwent original Jatene procedure. He has been developing well. Cardiac catheterization revealed good coronary artery blood flow at five years of age. At the age of 13 years, he had a critical episode of fainting during excessive physical exertion in the junior high school club activities. Three-dimensional computed tomography (CT) revealed a slit-like stenosis of the left coronary artery orifice. Enlargement of the left coronary orifice was successfully performed. Stretching of the left coronary artery into the enlarged aorta may cause the coronary orifice stenosis. The patient is doing well two years after surgery.

The lupus anticoagulant is one of the antiphospholipid antibodies that inhibit the phospholipid-dependent coagulation pathway. Lupus anticoagulant-positive patients are often associated with abnormal blood coagulation, which cause thrombosis or miscarriage. We report two surgical cases of pulmonary nontuberculous mycobacterial disease (M. avium) with the lupus anticoagulant. Both patients were women around 70 years of age with no past history, including thrombosis or miscarriage. Despite treatment, M. avium continued to be cultured from their sputum and eventually blood sputum appeared. They were performed surgical operations and the postoperative courses were uneventful without anticoagulation. Although the report of pulmonary nontuberculous mycobacterial disease with the lupus anticoagulant is extremely rare, the involvement of infection in the pathogenesis of the lupus anticoagulant has been reported. The further research between lupus anticoagulant and pulmonary nontuberculous mycobacterial infection is necessary.

A 72-year-old man underwent bronchoscopy for an abnormal shadow on chest imaging, but no definitive diagnosis was made. The lesion was followed for four years as atelectasis, during which time it gradually increased in size. A computed tomography (CT)-guided biopsy suggested mucinous adenocarcinoma; however, a definitive diagnosis remained elusive. Surgical resection was ultimately performed for both diagnostic and therapeutic purposes, and the patient was diagnosed with invasive mucinous adenocarcinoma. Invasive mucinous adenocarcinoma, characterized by abundant mucus components, may be difficult to diagnose through preoperative biopsy. Even when atelectasis is suspected, the possibility of invasive mucinous adenocarcinoma should be considered. Prompt re-evaluation is warranted when an enlarging shadow is observed. In some cases, surgical resection may be necessary as part of the diagnostic strategy.