2254
CORRESPONDENCE
References 1. Patel VR, Hofstetter WL, Correa AM, et al. Signet ring cells in esophageal adenocarcinoma predict poor response to preoperative chemoradiation. Ann Thorac Surg 2014;98: 1064–71. 2. Piessen G, Messager M, Robb WB, Bonnetain F, Mariette C. Gastric signet ring cell carcinoma: how to investigate its impact on survival. J Clin Oncol 2013;31:2059–60. 3. Bekkar S, Gronnier C, Messager M, et al. The impact of preoperative radiochemotherapy on survival in advanced esophagogastric junction signet ring cell adenocarcinoma. Ann Thorac Surg 2014;97:303–10.
Robotic Resection of Accessory Mitral Valve Tissue To the Editor: We read with interest the article by Yamaguchi and colleagues describing the resection of accessory mitral valve tissue in an adult using robotic instrumentation [1]. We congratulate this team on their successful procedure. It is not, however, as they claim the first report of successful robotic resection of accessory mitral tissue. We described an almost identical case in 2006 [2]. Using a lateral endoscopic robotic approach, we partially detached the anterior mitral leaflet, excised the accessory mitral leaflet from the left ventricular outflow tract, and repaired the leaflet with autologous pericardium. The patient remains asymptomatic 8 years later. In our report we predicted that the lateral endoscopic approach using robotics would be useful for lesions of the left ventricular outflow tract, and we are gratified to see its successful application by Dr Yamaguchi’s team. Douglas A. Murphy, MD Department of Cardiothoracic Surgery Emory St. Joseph’s Hospital of Atlanta 5665 Peachtree Dunwoody Rd Atlanta, GA 30342 e-mail: [email protected]
Ann Thorac Surg 2015;99:2253–7
Takara-machi 13-1 Kanazawa, Japan 920-8641 e-mail: [email protected]
References 1. Murphy DA. Robotic resection of accessory mitral valve tissue (letter). Ann Thorac Surg 2015;99:2254. 2. Yamaguchi S, Ishikawa N, Tomita S, et al. Robotic resection of dual accessory mitral valve tissue in an adult patient. Ann Thorac Surg 2014;98:1096–8.
Subdermal Contraceptive Implant Embolism to a Pulmonary Artery To the Editor: We read with interest the recent case report of Patel and colleagues [1] describing the embolization of a subdermal contraceptive implant to a pulmonary artery. A 23-year-old woman came to our emergency department with dyspnea. A chest radiogram identified a left pneumothorax and a linear opacity in the left lower lung zone. Computed tomography (CT) of the thorax (Fig 1) confirmed a 4-cm radiopaque foreign body within a segmental branch of the left lower lobe pulmonary artery. The patient had had a subdermal contraceptive implant, Implanon (etonogestrel) (Merek Inc, Ireland) inserted 2 years previously into the medial aspect of her upper left arm. Examination, roentgenology, and ultrasonography of the patient’s arm failed to identify the device, and it was deduced that the subdermal contraceptive implant had embolized to the pulmonary artery. The patient wished to start a family, and wanted the contraceptive device removed. Patel and colleagues [1] suggested that endovascular retrieval may be feasible. We attempted endovascular retrieval by selective catheterization of the left lower pulmonary artery, using
Dr Murphy discloses a financial relationship with Intuitive Surgical.
MISCELLANEOUS
References 1. Yamaguchi S, Ishikawa N, Tomita S, et al. Robotic resection of dual accessory mitral valve tissue in an adult patient. Ann Thorac Surg 2014;98:1096–8. 2. Murphy D, Byrne J, Malave H. Robotic endoscopic excision of accessory mitral leaflet. J Thorac Cardiovascular Surg 2006;131:468–9.
Reply To the Editor: Thank you for pointing out a good suggestion from Dr Murphy and colleagues [1], which is a nice piece of work. As they acknowledged, our work [2] is the first report about “dual” accessory mitral valve tissue. As we realize, excision of accessory mitral valve tissue may be difficult; thus, a robotic procedure with a high resolution camera may make it easier. Shojiro Yamaguchi, MD, PhD Department of General and Cardiothoracic Surgery Kanazawa University School of Medicine Ó 2015 by The Society of Thoracic Surgeons Published by Elsevier
Fig 1. Coronal noncontrast computed tomography demonstrates an intravascular foreign body within a segmental branch of the left pulmonary artery. There is a small left pneumothorax. 0003-4975/$36.00
CORRESPONDENCE
References 1. Patel VR, Hofstetter WL, Correa AM, et al. Signet ring cells in esophageal adenocarcinoma predict poor response to preoperative chemoradiation. Ann Thorac Surg 2014;98: 1064–71. 2. Piessen G, Messager M, Robb WB, Bonnetain F, Mariette C. Gastric signet ring cell carcinoma: how to investigate its impact on survival. J Clin Oncol 2013;31:2059–60. 3. Bekkar S, Gronnier C, Messager M, et al. The impact of preoperative radiochemotherapy on survival in advanced esophagogastric junction signet ring cell adenocarcinoma. Ann Thorac Surg 2014;97:303–10.
Robotic Resection of Accessory Mitral Valve Tissue To the Editor: We read with interest the article by Yamaguchi and colleagues describing the resection of accessory mitral valve tissue in an adult using robotic instrumentation [1]. We congratulate this team on their successful procedure. It is not, however, as they claim the first report of successful robotic resection of accessory mitral tissue. We described an almost identical case in 2006 [2]. Using a lateral endoscopic robotic approach, we partially detached the anterior mitral leaflet, excised the accessory mitral leaflet from the left ventricular outflow tract, and repaired the leaflet with autologous pericardium. The patient remains asymptomatic 8 years later. In our report we predicted that the lateral endoscopic approach using robotics would be useful for lesions of the left ventricular outflow tract, and we are gratified to see its successful application by Dr Yamaguchi’s team. Douglas A. Murphy, MD Department of Cardiothoracic Surgery Emory St. Joseph’s Hospital of Atlanta 5665 Peachtree Dunwoody Rd Atlanta, GA 30342 e-mail: [email protected]
Ann Thorac Surg 2015;99:2253–7
Takara-machi 13-1 Kanazawa, Japan 920-8641 e-mail: [email protected]
References 1. Murphy DA. Robotic resection of accessory mitral valve tissue (letter). Ann Thorac Surg 2015;99:2254. 2. Yamaguchi S, Ishikawa N, Tomita S, et al. Robotic resection of dual accessory mitral valve tissue in an adult patient. Ann Thorac Surg 2014;98:1096–8.
Subdermal Contraceptive Implant Embolism to a Pulmonary Artery To the Editor: We read with interest the recent case report of Patel and colleagues [1] describing the embolization of a subdermal contraceptive implant to a pulmonary artery. A 23-year-old woman came to our emergency department with dyspnea. A chest radiogram identified a left pneumothorax and a linear opacity in the left lower lung zone. Computed tomography (CT) of the thorax (Fig 1) confirmed a 4-cm radiopaque foreign body within a segmental branch of the left lower lobe pulmonary artery. The patient had had a subdermal contraceptive implant, Implanon (etonogestrel) (Merek Inc, Ireland) inserted 2 years previously into the medial aspect of her upper left arm. Examination, roentgenology, and ultrasonography of the patient’s arm failed to identify the device, and it was deduced that the subdermal contraceptive implant had embolized to the pulmonary artery. The patient wished to start a family, and wanted the contraceptive device removed. Patel and colleagues [1] suggested that endovascular retrieval may be feasible. We attempted endovascular retrieval by selective catheterization of the left lower pulmonary artery, using
Dr Murphy discloses a financial relationship with Intuitive Surgical.
MISCELLANEOUS
References 1. Yamaguchi S, Ishikawa N, Tomita S, et al. Robotic resection of dual accessory mitral valve tissue in an adult patient. Ann Thorac Surg 2014;98:1096–8. 2. Murphy D, Byrne J, Malave H. Robotic endoscopic excision of accessory mitral leaflet. J Thorac Cardiovascular Surg 2006;131:468–9.
Reply To the Editor: Thank you for pointing out a good suggestion from Dr Murphy and colleagues [1], which is a nice piece of work. As they acknowledged, our work [2] is the first report about “dual” accessory mitral valve tissue. As we realize, excision of accessory mitral valve tissue may be difficult; thus, a robotic procedure with a high resolution camera may make it easier. Shojiro Yamaguchi, MD, PhD Department of General and Cardiothoracic Surgery Kanazawa University School of Medicine Ó 2015 by The Society of Thoracic Surgeons Published by Elsevier
Fig 1. Coronal noncontrast computed tomography demonstrates an intravascular foreign body within a segmental branch of the left pulmonary artery. There is a small left pneumothorax. 0003-4975/$36.00
