Left ventricular thrombus( LVT) formation is a known complication of ischemic heart diseases including acute myocardial infarction, dilated cardiomyopathy (DCM) and myocarditis. Among them, few cases involve DCM. Two DCM patients with LVT developed acute cerebral infarction and underwent thrombectomy. Both patients presented with sinus rhythm and neither had previous thromboembolic event. However, their transthoracic echocardiography (TTE) showed left ventricular ejection fractions less then 35% and left ventricular diastolic diameters≥60 mm, indicating high possibilities of LVT formation. The TTE findings suggest that DCM patients require anticoagulation therapy and frequent imaging examination, even with sinus rhythm and no history of thromboembolic events. Once a thromboembolic event occurs, thrombectomy is urgently needed.Penetrating heart injury is rare in Japan. A 35-year-old man stabbed himself with a fruit knife that was about 10 cm in length on the left precordium in an attempt to commit suicide and was transferred to our hospital. His vital signs were stable, and the knife remained stabbed in the left precordium. Cardiac injury and cardiac tamponade were suspected on computed tomography, and emergency surgery was performed. A large amount of red hematoma was found in the mediastinum and the pericardial space after median sternotomy. The knife had created a fissure of about 15 mm in the free wall of the right ventricle, and the injury was repairable. The knife passed through the sixth costal cartilage and the left internal thoracic artery, and hemostasis was easy. The patient’s postoperative course was uneventful, but due to the suicide attempt and adjustment disorder, the patient was transferred to a psychiatric hospital on postoperative day 10.A right-sided classical Blalock-Taussig shunt was created in a 3-year-old male infant with hypoplastic left ventricle, common atrioventricular valve, transposition of the great arteries, and pulmonary stenosis. selleck He was diagnosed with near Eisenmenger pulmonary hypertension at the age of 6 years. Surgery to achieve right heart bypass circulation was not conducted. At 33 years of age, he experienced hemoptysis. Pulmonary artery dissection, a life-threatening condition, was detected upon computed tomography performed when the patient was 35 years of age. After three weeks, surgery with cardiopulmonary bypass requiring pulmonary artery replacement using composite prosthetic conduits, closure of the pulmonary valve, and banding of the previously created Blalock-Taussig shunt was performed. Six years after the surgery, the patient’s physical activity is maintained. Although intracardiac repair or definitive palliation with cardiopulmonary bypass is contraindicated in such patients, life-saving surgery with cardiopulmonary bypass that does not worsen pulmonary hypertension can be performed.In recent years, with the improvement of diagnostic techniques and treatment outcomes, the number of lung cancer cases after esophageal cancer treatment has been increasing. In general, severe adhesions are expected in the right lung, during lung resection after esophageal cancer surgery. In this study, we reviewed intraoperative findings of lung resection with respect to the influence of different treatment methods for esophageal cancer, the site of adhesion formation for each lobe, and the techniques and precautions for lung resection. There were no difficulty in the left upper major segmentectomy. During the left lower lobectomy, the inflammation around the inferior pulmonary vein was noted. The adhesions between the reconstructed gastric tube and the inferior pulmonary vein were found during the right lower lobectomy. During the right upper lobectomy, severe adhesions between the lung and the superior vena cava as well as the gastric tube in the posterior mediastinum were observed, which should be paid much attention.Lobectomy for infectious nodules with suspected adhesion is depressing. Initially, we start the surgery through a thoracoscopic approach, but for unavoidable reasons, we sometimes convert it to an open thoracotomy. Here we experienced two rare resected cases of left upper lobe infectious nodule. We completed the left upper lobectomies with a thoracoscopic approach for one case and with an open thoracotomy for another. I will mainly report on the techniques of both approaches.When a presence of significant pleural adhesion is identified at the beginning of surgery, multiple factors determine the outcome of the surgery, particularly when it is performed thoracoscopically. These factors include identification of adhesion at the beginning of the surgery, as well as procedures involved in dissection and additional incisions. If the adhesion is partial, the lack of observation during creation of the surgical field can lead to damage being caused outside the field of view due to traction. Thus, it is important to focus observations. At our department, we started performing thoracoscopic surgery in 1992. Currently, over 80% of annual surgical cases are performed thoracoscopically. We will review our thoracoscopic surgery cases that involved pleural adhesion and discuss the tools and techniques used, as well as providing additional tips for ensuring successful thoracoscopic surgery.There were 74 cases (29.5%) with adhesive and fissureless complications in comparison with all 251 cases who had undergone video-assisted thoracic surgery (VATS) lung operations in author’s hospital. On lobectomy and segmentectomy adhesive and fissureless effective factors were old age( p=0.012), the difference between %DLco to %DLco/VA( p less then 0.05), Brinkman index( p=0.043) compared with non-ad- hesive cases, therefore operation times of fissureless group prolonged (p=0.009). The point at issue was in what manner we should perform appropriate division of the bronchus, the pulmonary arteries and the veins on the fissureless lobectomy. Especially it is very important which the apicoposterior artery( rA2bAsc) on right upper lobectomy and the lingular segmental artery( lA4+5) on left upper lobectomy branch from the major fissure or not. For that purpose the management procedure had been done pulmonary artery (primary upper division A1+2+A3)→ pulmonary vein → bronchus → residual pulmonary artery (rA2b or lA4+5).