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Ann Thorac Surg 2000;70:340-341
© 2000 The Society of Thoracic Surgeons

Correspondence

Reply

Shin-ichi Takeda, MD, PhDa

a Department of Surgery Course of Interventional Medicine (E1), Osaka University Graduate School of Medicine, Osaka 565-0871, Japan

e-mail: stakeda{at}surg1.med.osaka-u.ac.jp

To the Editor

We thank Dr Shimokawa and his colleagues for their comments and interest in our article [1]. We agree with their contention that it is important to prevent such a life-threatening complication. We recognized this from our experience. We are also well familiar with the useful device, axillofemoral venous bypass, [2] that Dr Shimokawa applied in surgery for thoracic malignancy with superior venal cava (SVC) syndrome. But they merely mentioned the contribution of SVC syndrome on cardiopulmonary collapse. However, the point of our paper was to describe that the life-threatening hypoxemia was caused by total arterio-venous shunt due to compression by the mediastinal tumor (total obstruction of left main bronchus and of the right pulmonary artery) during the anesthesia. Retrospectively, we experienced another similar fetal complication in early 1950 among 450 anterior mediastinal tumors that we studied between 1950 and 2000. Ironically, we proved the underlining pathophysiology in the second case in 1997. Recently, our colleague, Dr Yoon experienced a similar case intraoperatively [personal communication], which was successfully managed by changing position as Dr Cole commented on in the Invited Commentary accompanying our report [3]. Again, the aim of our case report was to recognize this fetal complication during anesthesia when faced with a huge anterior mediastinal tumor.

References

  1. Takeda S., Miyoshi S., Omori K., Okumura M., Matsuda H. Surgical rescue for life-threatening hypoxemia caused by a mediastinal tumor. Ann Thorac Surg 1999;68:2324-2326.[Abstract/Free Full Text]
  2. Shimokawa S., Yamashita T., Kinjo T., et al. Extracorporeal venous bypass. Ann Thorac Surg 1996;62:1863-1864.[Abstract/Free Full Text]
  3. Cole J. Surgical rescue for life-threatening hypoxemia caused by a mediastinal tumor. Ann Thorac Surg 1999;68:2346.[Abstract/Free Full Text]

Related Article

Fatal complication due to a mediastinal tumor
Shinji Shimokawa, Shun-ichi Watanabe, and Koh-ichi Sakasegawa
Ann. Thorac. Surg. 2000 70: 340. [Extract] [Full Text] [PDF]




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