Disseminated intravascular coagulation with acutely-thrombosed popliteal aneurysm.

Disseminated intravascular coagulation (DIC) is an extremely rare complication of acute thrombosis in popliteal aneurysms and makes it difficult to restore the blood flow with thrombolytic therapy or surgical repair. A 75-year-old man with a history of hypertension presented to the emergency department with complaints of right leg pain and bleeding tendency over a 5-day period. The laboratory findings and multislice computed tomography were suggestive of overt DIC caused by acute thrombosis in the right popliteal aneurysm. Successfully treated with medication, he could discharge without surgical or thrombolytic recanalization of the aneurysm.

New ring annuloplasty for extremely dilated tricuspid valve annulus: plication to physiologic septal segment size and over-reduction of posterior segment.

We describe a tricuspid valve ring annuloplasty for a 67-year-old woman who had an extremely dilated tricuspid valve annulus. During surgery, we found that the septal segment of the annulus was dilated to 60 mm, nearly double its normal size. Therefore, a standard annuloplasty without a prosthetic ring seemed unlikely to provide the needed annular plication. We used a 28-mm prosthetic ring, about the size of a normal septal segment, to plicate it. First, 5 U-shaped sutures, with 1 at each septal commissure, were used to plicate the septal segment to its physiologic size. Next, U-shaped sutures for the posterior and anterior segments were used to reduce the length of the posterior segment much more than that of the anterior segment. The septal sutures were then passed equidistantly between 2 markers on the prosthetic ring, and the remaining sutures were passed equidistantly through the ring. Finally, the prosthetic ring was affixed to the tricuspid annulus. Echocardiography revealed trivial tricuspid valve regurgitation postoperatively. In cases of dilated tricuspid valve annulus, particularly when the septal segment is very dilated, some modification of the annuloplasty may be needed. The physiologic size of the septal segment of the tricuspid valve annulus and the relative physiologic proportions of the anterior and posterior segments should be taken into consideration.

Rapid development of a papillary fibroelastoma in the aortic valve: report of a case.

We report a case of a fast-growing cardiac papillary fibroelastoma (CPF) arising in the aortic valve. A 71-year-old woman was referred to a cardiologist for investigation of palpitations. Cardiac catheterization, coronary angiography, and echocardiography showed no stenosis of the coronary arteries, nor any other cardiovascular abnormalities. However, 12 months later she was referred to our hospital for further investigations when she began experiencing chest discomfort on exertion. This time, echocardiography showed an abnormal mass arising from the aortic valve, floating between the left sinus of Valsalva and the ascending aorta. Considering the risk of an embolic event, we performed semi-emergency surgery to remove the tumor, preserving the aortic valve. The resected tumor was 16 x 7 mm, and sea anemone-like, with many villus projections. It was diagnosed as papillary fibroelastoma. Such rapid development of CPF is rare.

Reduction of atrioventricular valve regurgitation by atrioventricular sequential pacing for an adult with corrected transposition of the great arteries.

The case of a 64-year-old woman who underwent corrected transposition of the great arteries with significant systemic atrioventricular valve regurgitation and complete atrioventricular block is described. The patient underwent implantation of a DDD-type pacemaker and experienced relief of symptoms after discharge. Follow-up evaluation 30 months after the pacemaker implantation demonstrated a decrease in the cardiothoracic ratio on chest X-ray, the b-type natriuretic peptide level, and regurgitation at the systemic atrioventricular valve.

Left ventricular mass: impact on left ventricular contractile function and its reversibility in patients undergoing aortic valve replacement.

BACKGROUND: We examined the relationships of left ventricular (LV) contractile state with LV geometry and hypertrophy in patients with aortic valve disease, and investigated the reversibility of LV hypertrophy and contractility following aortic valve replacement. METHODS: Preoperative data from quantitative cineangiography and pressure measurements in 132 patients with chronic aortic valve disease, of whom 82 aortic regurgitation (AR), 41 aortic stenosis (AS), and 9 had mixed stenosis and regurgitation (AS-AR), were reviewed. Late after surgery, 59 of the patients (39 with AR, 20 with AS) were studied to elucidate the postoperative reversibility of LV performance and regression of LV hypertrophy. RESULTS: Preoperatively, multiple comparison tests found significant changes in the variables of LV volumes and dimensions in relation to LV contractile state. In stepwise regression analysis, the LV mass index was initially incorporated into a multivariate regression model as an important correlate of LV contractile state. LV geometric variables showed either no or a poor correlation with contractile state. Following aortic valve replacement, improvement of LV contractile dysfunction and regression of LV hypertrophy were limited in many of the patients who had severe preoperative hypertrophy (LV mass index 200% of normal or greater). Further, a close association between LV hypertrophy and LV contractility persisted postoperatively. CONCLUSION: Our results suggest that the development of LV hypertrophy in terms of an increase in LV mass index, in contrast to changes in geometric patterns, is significantly associated with deterioration in contractile function. LV hypertrophy may become irreversible and pathological at equivalent degrees of hypertrophy (LV mass index >/=200% of normal), regardless of the type of aortic valve lesion.