[Right Atrial Rupture due to Blunt Trauma;Report of a Case].

The survival rate of cardiac rupture due to blunt trauma is generally low. We report a case of surgical treatment of blunt cardiac trauma. A 55-year-old man was admitted to our hospital for blunt trauma due to a car accident. His hemodynamics was compromised due to cardiac tamponade. The patient underwent pericardial drainage by small subxiphoid incision. Although about 400 ml of blood was evacuated, hemorrhage was still continuing. After full sternotomy, we found a 3 mm tear in the right atrial appendage and sutured it easily without cardiopulmonary bypass. The patient recovered uneventfully and was discharged on the 10th postoperative day. He is now leading a normal life.

Analysis of myocardial temperature changes in conventional isolated coronary artery bypass grafting.

BACKGROUNDS: To determine whether cold blood cardioplegia (CBCP) can get over coronary artery lesions, we analyzed the relationship between myocardial temperature changes and lesion severity of major coronary arteries. METHODS AND RESULTS: From April 1991 to October 2003, we measured myocardial temperature before and after antegrade and retrograde delivery of CBCP in 492 patients undergoing conventional coronary artery bypass grafting. Stenotic severity of three major coronary arteries was classified into four grades according to preoperative coronary arteriography; grade 0 for 50 % or less, 1 for 75 %, 2 for 90 %, 3 for 99 % or 100 %. We analyzed relationships between myocardial temperature changes [ΔT-A (antegrade) & ΔT-R (retrograde)] and the coronary artery lesion's severity. Average ΔT-A of the right coronary artery had no relationship with stenotic grades. Mean ΔT-A of the left anterior descending (LAD) became less and less in proportion to its stenotic grade [9.7 °C for grade 0, 8.2 °C for grade 1, 7.1 °C for grade 2, and 6.0 °C for grade 3, respectively, (p = 0.0042)]. ΔT-A of the circumflex artery showed similar but weaker tendency than those of LAD. Significant inverse correlations were found between ΔT-A and ΔT-R1 in each territory (p < 0.001). CONCLUSIONS: Antegrade delivery was less effective in situations with tight proximal lesion, especially in the LAD territory. Retrograde delivery supplemented antegrade delivery. Myocardial temperature monitoring enables us to deal with inadequate cardioplegic delivery, and is a good indicator of myocardial protection.

Composite vein graft reconstruction for infected descending aortic prosthesis.

We report a case of successful in situ replacement with a superficial femoropopliteal vein panel graft for Dacron graft infection of the thoracic aorta. A 75-year-old man presented with septicemia and pseudoaneurysm caused by methicillin resistant staphylococcus aureus 2 years after Dacron graft replacement of the mid-descending aortic aneurysm. The patient underwent in situ replacement with a panel graft constructed of 3 deep vein panels after excision of the infected Dacron graft. The patient is free of infection and doing well over 2 years after surgery.

[Pneumothorax secondary to congenital bronchial atresia].

We present a rare case of pneumothorax due to the perforation of bullae associated with congenital bronchial atresia. A 25-year-old woman complained of right chest pain and shortness of breath. Chest radiography revealed a right pneumothorax. Chest tube drainage was performed. When the lung re-expanded, chest computed tomography (CT) showed blind-ending B4 of the right middle lobe associated with mucoid impaction and hyperlucency of the corresponding lung parenchyma. Additionally, there were multiple air cysts located at the affected lung surface. A surgical procedure was considered because of persistent air leaks. At operation, several bullae projected above the pleural surface of the hyperinflated S4, and one of the bullae ruptured. A lateral segmentectomy of the middle lobe was successfully performed by thoracoscopy-assisted limited thoracotomy. Diagnosis of congenital bronchial atresia and subpleural bullae was confirmed by pathological examination.

Pulmonary cryptococcosis with a solitary focal ground-glass opacity on high-resolution computed tomography.

We report a 74-year-old woman with cervical cancer who developed pulmonary cryptococcosis which presented as a solitary focal ground-glass opacity (GGO) on high-resolution computed tomography (HRCT). Serial HRCT showed the progression from the GGO to a discrete solid nodule. We hypothesize that the initial GGO may correspond pathologically to partial filling of air spaces with cryptococcal organisms and inflammatory cells. To our knowledge, this is the first report of pulmonary cryptococcosis with a solitary focal GGO on HRCT in the literature.

Mitral annular reconstruction with anterior leaflet flip-over in concomitant surgery for mitral regurgitation associated with extensive posterior annular calcification and hypertrophic obstructive cardiomyopathy.

We describe a case of severely calcified posterior mitral annulus associated with grade IV mitral regurgitation in addition to significant hypertrophic obstructive cardiomyopathy. A 70-year-old woman underwent successfully annular reconstruction with anterior mitral leaflet flip-over and mitral valve replacement with a bileaflet mechanical prosthesis combined with left ventricular septal myectomy. This technique can serve not only to cover the debrided posterior annulus, but also to eliminate left ventricular outflow tract obstruction and to keep left ventricular function by virtue of not severing ventricular-annular continuity.

Aortic valve replacement after midline-crossed internal thoracic artery grafting.

In the presence of a midline-crossed internal thoracic artery graft, a median sternotomy may jeopardize the graft and compromise hemodynamics. We report successful aortic valve replacement using a "staircase" thoracotomy and hypothermic axillary perfusion with balloon aortic occlusion in 2 men who had patent right internal thoracic artery grafts that was previously anastomosed to the left anterior descending coronary artery.