Three-dimensional computed tomography analysis of the mitral annulus for mitral annuloplasty in 100 cases of robotic mitral valve repair.

Objectives: This study aimed to evaluate the efficacy of preoperative computed tomography in assessing mitral annulus anatomy and the posterior annular plication rate in mitral valve repair with annuloplasty. Methods: From July 2018 to August 2023, we performed robotic mitral valve repair with ring annuloplasty using a semi-rigid ring in 100 patients. Preoperative anatomical assessment of the mitral annulus was conducted by three-dimensional computed tomography. The ring size was selected based on the perioperative commissure-to-commissure length or the anterior leaflet area. Results: The mean commissure-to-commissure length, posterior mitral annular length, and minimum distance between the left circumflex artery and mitral annulus values were 31, 109, and 3.8 mm, respectively. No postoperative left circumflex artery injury or ring detachment was recorded. The mean plication rate (length of the posterior side of the prosthetic ring/posterior annular length) was 0.68, and it did not differ among each prosthetic ring size. The posterior plication rate (duplicate ring size 19.4) was a factor influencing the postoperative transmitral mean pressure gradient of 5 mmHg or higher. Freedom from moderate or severe mitral regurgitation was not different between the two groups above and below the posterior plication rate × ring size of 19.4 (p = 0.73), with an event-free rate of 97% vs. 96% in 3 years, respectively. Conclusions: Preoperative evaluation of the mitral annular anatomy is useful for safe mitral valve repair with ring annuloplasty. Determining ring size by focusing on the posterior annular plication rate may be a new method for ring size selection.

[Outcomes of Modified Bentall Procedure with French Cuff Technique].

BACKGROUND: We evaluated early and mid-term outcomes of modified Bentall procedure with French cuff technique for aortic root disease. METHODS: Between 2017 and 2024, 45 patients underwent modified Bentall procedure with French cuff technique. We excluded patients who had cardiopulmonary resuscitation. The mean age was 64.8± 14.0 years, and 35 patients were male( 77.8%). The mean predicted operative mortality rate according to JapanSCORE 2 was 11.2%. RESULTS: No patients had any trouble with bleeding from the aortic root. Hospital mortality was 2.2%, as one patient died due to a fungal infection. Twelve patients( 26.7%) experienced complications during hospitalization. The 3- and 5-year overall survival rates were 97.7% and 88.0%, respectively. Freedom from reoperation was 93.7% and 93.7% at 3 and 5 years, respectively. One patient underwent re-aortic valve replacement due to a stuck valve, and one underwent re-Bentall due to a seroma. There were no pseudoaneurysm formations of the aortic root and coronary ostia during the followed-up. CONCLUSIONS: The modified Bentall procedure with French cuff technique may be a useful technique with good outcomes.

Delayed traumatic aortic valve perforation after blunt chest trauma.

BACKGROUND: Aortic valve perforation is a rare complication of blunt chest trauma. We report a case of delayed aortic insufficiency presenting several months after trauma. CASE PRESENTATION: A 17-year-old male presented to the emergency department with traumatic brain injuries and blunt chest trauma, but no evidence of cardiac injuries. Three months later, he developed acute heart failure due to severe aortic valve regurgitation with left ventricular dysfunction. A sizable tear in the right coronary cusp caused aortic insufficiency. He was treated successfully by surgical replacement with an aortic bioprosthesis. CONCLUSION: We reported a successful surgical case of valve replacement for delayed aortic valve perforation. Delayed valve perforation should be kept in mind after blunt chest trauma.

Vascular access site complications after transfemoral transcatheter aortic valve implantation: a comparison of open and percutaneous puncture approaches.

Background: In transfemoral transcatheter aortic valve implantation (TF-TAVI), which approach has lower vascular access site complications between the open puncture (OP) and percutaneous puncture (PP) approaches is still controversial. Moreover, few studies have analyzed risk factors for vascular access site complications in TF-TAVI. This study aimed to compare vascular access site complications between the OP and PP approaches in patients undergoing TF-TAVI and access risk factors for vascular access site complications. Methods: Three hundred fifty-one patients who underwent TF-TAVI via the PP (n=251) and OP (n=100) were retrospectively examined. Results: Incidence of vascular access site complications was 7.0% in the OP group and 8.4% in the PP group (P=0.828). Two deaths from vascular access site complications occurred in the PP group. After performing inverse probability weighting (IPW), regression analysis showed that PP was associated with a significantly higher odds of vascular access site complications [odds ratio =2.033; 95% confidence interval (CI): 1.397-2.958; P<0.001]. Common femoral artery (CFA) depth (hazard ratio =1.04; 95% CI: 1.000-1.070; P=0.045) and sheath/CFA diameter ratio (hazard ratio =971; 95% CI: 22.6-41,700; P<0.001) were independent complication risk factors. In patients with CFA depth ≥35 mm, the incidence of vascular access site complications was higher with PP than OP. Sheath/CFA diameter ratio ≥0.9 was associated with increased risk of vascular injury with both approaches. Conclusions: The incidence of vascular access site complications in patients undergoing TF-TAVI was significantly lower with OP than PP after IPW. OP may be preferable when CFA depth is ≥35 mm. When the sheath/CFA diameter ratio is ≥0.9, approaches other than the TF approach should be considered.

Midterm Results of Mitral Valve Repair Using Loop Technique With Simple Height Reduction of the Large Posterior Leaflet.

OBJECTIVE: Systolic anterior motion (SAM) is one of the most serious problems in mitral valve repair. Height reduction is a key procedure to solve SAM, and there are limited data on the surgical results of height reduction procedure. This study is to assess the effectiveness and midterm results of simple height reduction procedure for SAM in patients with severe mitral regurgitation (MR). METHODS: From 2008 to 2022, 50 patients underwent loop technique with an additional simple height reduction procedure for prevention of SAM. We examined the midterm results of patients with simple height reduction regarding recurrent MR and reoperation. The follow-up period ranged from 171 to 3,816 days (median, 883 days). RESULTS: There were 338 patients (87%) who underwent loop technique without height reduction and 50 patients (13%) who underwent loop technique with height reduction. After the height reduction procedure, SAM was prevented in 44 patients, and 6 patients needed volume loading to suppress SAM. Freedom from recurrence of moderate to severe or severe MR at 1, 3, and 5 years was 98%, 88%, and 88% in the height reduction group versus 98%, 96%, and 94% in the group with loop technique alone (P = 0.074). Receiver operating characteristic curves showed that a systolic dimension of 26 mm had a sensitivity of 75% and a specificity of 83% for predicting SAM after height reduction. CONCLUSIONS: Loop technique with simple height reduction was a simple, secure, and effective procedure to prevent SAM and recurrent significant MR in the midterm periods.

Flexible Total Ring Annuloplasty With Continuous Wrapping Suture Considering the Anatomy and Histology of the Tricuspid Valve.

OBJECTIVE: About half of tricuspid valves (TVs) have 2 posterior leaflets, and the fibrous tissue of the tricuspid annulus is poor. Considering the anatomy and histology of the TV, we devised a secure ring annuloplasty technique. We herein report the outcomes of our continuous wrapping suture annuloplasty technique using a flexible total ring. METHODS: We used a Tailor™ ring (Abbott, Chicago, IL, USA) as a full ring. The mark on the left side of the ring was fixed to the anteroseptal commissure, and the midpoint of the ring's markers was fixed at the center of the septal leaflet annulus. Using a continuous suture, all stitches were passed around the annuloplasty ring without penetration. One suture from the anteroseptal commissure ran toward the left side and another from the midpoint of the septal leaflet annulus ran toward the right, leading to annuloplasty without TV deformation. RESULTS: Eighty patients underwent TV repair with this technique. The tricuspid regurgitation (TR) score in all patients improved from 1.9 ± 0.7 to 0.8 ± 0.4 (P < 0.001) at 3 years postoperatively. The TR score of TVs with 2 posterior leaflets also improved from 1.9 ± 0.7 to 0.6 ± 0.4 after the operation and was unchanged during follow-up. The median follow-up period was 1.3 (0.5 to 2.0) years, and no patients required TV reoperation. The 3-year survival rate was 93%, and the 3-year rate of freedom from pacemaker implantation was 95%. CONCLUSIONS: The continuous wrapping suture technique using a flexible total ring is a useful procedure without TV deformation even when 2 posterior leaflets are present.

Mitral valve repair with patch augmentation for atrial functional mitral regurgitation complicated with giant left atrium.

OBJECTIVE: We aimed to assess the results of posterior leaflet augmentation with an autologous pericardial patch in atrial functional mitral regurgitation. METHODS: Data of 16 patients with atrial functional mitral regurgitation who underwent posterior leaflet patch augmentation for mitral valve repair were retrospectively analyzed. This procedure was applied to a short posterior leaflet with a height of < 10 mm in P2. The median age was 72.5 [67.8-78.3] years. Preoperative New York Heart Association functional class was II in 7 (43.8%) and III or IV in 9 (56.2%) patients. Mitral regurgitation was moderate in 2 (12.5%) and severe in 14 (87.5%) patients. RESULTS: Operative mortality occurred in 1 (6.2%) patient due to cerebral infarction. One patient required valve replacement because of patch perforation early after operation. Mitral regurgitation was reduced to less than mild in 15 (93.8%) patients and less than trivial in 11 (68.8%) patients (P < 0.01) postoperatively. As for mid-term results, New York Heart Association functional class improved to I or II in 12 (75%) patients (P < 0.01). Two cases of thrombotic complication were observed. Remote recurrent regurgitation occurred in one case due to small patch size. The 3-year free rate of valve-related morbidity and regurgitation recurrence was 65.6% and 87.1%, respectively. The 5-year survival rate was 93.8%. CONCLUSIONS: Pericardial patch augmentation in atrial functional mitral regurgitation leads to good survival and mitral regurgitation recurrence-free rates. Steady anticoagulation and the use of larger patches would be necessary to reduce thrombotic complications and recurrent MR.

Patch augmentation vs. valve replacement for patients with atrial functional mitral regurgitation and long-standing atrial fibrillation.

Background: Long-standing atrial fibrillation is associated with atrial functional mitral regurgitation (AFMR) with atriogenic tethering. We compared the outcomes of patch augmentation (PA) and valve replacement (VR) for AFMR. Methods: We retrospectively compared the data of 16 patients who underwent PA for AFMR with the data of 15 patients who underwent VR between 2008 and 2021. Patients with a left ventricular ejection fraction (LVEF) of <50% were excluded. We also performed atrial plication and left appendage closure if the patients had no weak atrial wall that led to severe bleeding. Results: The median age was 72.5 and 76.0 years in the PA and VR groups, respectively. The PA group had a longer cardiopulmonary bypass time (206 vs. 172 min, P=0.012). Although there were no differences in hospital morbidity and mortality between the PA and VR groups, one patient underwent reoperation for patch perforation in the PA group. The overall 3-year survival rate was 93.8% and 100% in the PA and VR groups, respectively (P=0.878). The 3-year rate of freedom from major adverse cardiac events was 75.0% and 53.6% in the PA and VR groups, respectively (P=0.181). Three and six patients were readmitted for congestive heart failure in the PA and VR groups, respectively. Two patients in the PA group developed severe recurrent regurgitation, including one patient who required reoperation. No patients in the VR group required reoperation. The postoperative left atrial volume index (LAVI) was associated with thromboembolic events (P=0.016). Conclusions: PA may achieve comparable outcomes to those of VR for AFMR. Operative procedures should be chosen based on each patient's background. Atrial reduction could be considered to prevent thromboembolic events.

Histology of the tricuspid valve annulus and right atrioventricular muscle distance.

OBJECTIVES: Histologically, the mitral valve annulus comprises a collection of collagen fibres. However, the existence of collagen fibres in the tricuspid valve annulus has not been elucidated. Our goal was to clarify the histology of the tricuspid annulus. METHODS: Fifty human hearts without heart disease that were autopsied at Osaka City University Hospital between January 2009 and December 2017 were examined. The tricuspid valve was sectioned at 12 sites around the annulus, and the atrioventricular junction distance was measured. RESULTS: None of the tricuspid valve annulus samples had a continuous aggregation of collagen fibres that could be called an annulus. The interventricular space between the right atria and ventricles was composed of adipose tissue only on the anterosuperior and inferior sides, and no adipose tissue was found on the septal side. Comparing the atrioventricular muscle distance of the anterosuperior and inferior sides, the distance at the inferior side was statistically significantly larger than that of the anterosuperior side in 47 cases (P < 0.0001). CONCLUSIONS: There was no continuous circumferential aggregation of collagen fibres in the right atrioventricular junction. The distance between the right atrial and ventricular myocardium was greater at the inferior side than that at the anterosuperior side, which might lead to more inferior annular dilation versus anterosuperior dilation. These anatomical features will be fundamental for future discussions of the suturing method used in prosthetic ring annuloplasty for tricuspid regurgitation.

Early outcomes of the Frozenix J-graft with exclusion of the non-stent part at a single center.

Background: The frozen elephant trunk technique is useful in aortic arch repair; however, some adverse events are associated with the Frozenix J-graft. We designed a technique to prevent these adverse events and achieve easy anastomosis (Total Exclusion of the Non-Stent part of Frozenix using an Everting anastomosis [TENSE]), and we assessed the outcomes of this technique in the present study. Methods: From April 2017 to May 2021, 44 patients with aortic arch disease underwent TENSE, in which the proximal stump of the stent part of Frozenix was matched to the distal anastomosis end between the left common carotid and left subclavian arteries. Results: The median age of the patients (35 men, 9 women) was 76.5 years. The predicted mortality and morbidity rates were 10.0% and 40.2%, respectively, according to the JapanSCORE II. Two patients (4.5%) died of aneurysm rupture and interstitial pneumonia, respectively, during hospitalization. Four patients (9.1%) who developed postoperative cerebral infarction had a previous cerebral infarction (P=0.010). No patients developed spinal cord complications or Frozenix kinking. Follow-up computed tomography showed no endoleaks or aneurysmal dilatation, although one patient had possible distal stent graft-induced new entry. Conclusions: Our strategy provided good early outcomes without spinal cord complications or Frozenix kinking in patients with aortic arch disease. Continuous follow-up is needed to avoid missing distal changes.

Three-dimensional transesophageal echocardiographic morphological evaluation of the tricuspid valve.

OBJECTIVES: The morphology of the tricuspid valve (TV), particularly valves with two posterior leaflets, is attracting attention. The present study was performed to investigate the usefulness of three-dimensional transoesophageal echocardiographic data for morphological evaluation of the TV . METHODS: Sixty patients underwent morphological evaluation of the TV by preoperative transoesophageal echocardiography followed by TV repair with median sternotomy, and each leaflet was measured intraoperatively. We analysed the TV morphology in 51 patients whose preoperative echocardiographic findings were consistent with intraoperative findings. RESULTS: The mid-systolic echo data, which included the annulus diameter of each leaflet, were correlated with the intraoperative evaluation findings compared with those in the mid-diastole. The annulus and area of the posterior leaflet were larger in patients with two than one posterior leaflet valve (42.4 ± 13.5 vs 30.7 ± 9.1 mm, P < 0.001 and 327 ± 185 vs 208 ± 77 mm2, P = 0.006, respectively). In the severe tricuspid regurgitation patients, the annulus of the posterior leaflet was larger and the annulus of the anterior leaflet was smaller in patients with two than one posterior leaflet valve [posterior: 48 mm [95% confidence interval (CI), 41-54 mm] vs 36 mm (95% CI, 27-45 mm), respectively; P = 0.043 and anterior: 38 mm (95% CI, 33-42 mm) vs 46 mm (95% CI, 40-52 mm), respectively; P = 0.025]. CONCLUSIONS: Patients who had a TV with two posterior leaflets had a larger annulus and area of the posterior leaflets. Preoperative three-dimensional transoesophageal echocardiography is useful for the morphological evaluation of the TV.

Aortomitral angle affects cardiovascular events after mitral valve repair for atrial functional mitral regurgitation.

PURPOSE: This study aimed to elucidate the geometric parameters of the aortomitral (AM) complex affecting postoperative cardiovascular events (CVEs) in patients with atrial functional mitral regurgitation (MR). METHODS: From October 2008 to August 2018, we performed mitral and tricuspid valve repairs in 58 patients with atrial functional MR. We examined the determinants of CVEs using preoperative and postoperative echocardiographic data. Furthermore, we analyzed the effect of left atrial (LA) plication on AM geometries after surgery. The follow-up period ranged from 56 to 3283 days (median, 1073 days). RESULTS: All patients underwent mitral and tricuspid annuloplasty. Seventeen patients (29%) underwent additional LA plication. The AM angle was narrowed after surgery in patients with CVEs (115° ± 6.8° to 106° ± 4.2°, p = .00336), whereas it widened in patients without CVEs (115° ± 7.4° to 118° ± 8.4°, p = .0278). The postoperative AM angle was an independent predictor of postoperative CVEs (p = .000829). LA plication was not a predictor of CVEs; however, it was a predictor of the obtuse postoperative AM angle (p = .0071). CONCLUSIONS: Our results suggest that a narrow postoperative AM angle is an independent predictor of postoperative CVEs. Additional LA plication reduces the sharpening of the AM angle, which may prevent CVEs after mitral valve repair for atrial functional MR.

Outcomes of loop technique with ring annuloplasty: a > 10-year experience.

OBJECTIVE: We assessed the long-term outcomes of the loop technique with ring annuloplasty for mitral regurgitation from our > 10-year experience. METHODS: We retrospectively reviewed 362 patients who underwent the loop technique with ring annuloplasty via median sternotomy or right mini-thoracotomy for mitral regurgitation. The median follow-up duration was 4.1 years (interquartile range 2.3-5.8 years). RESULTS: This study involved 147 women and 215 men (median age, 66.5 years). Mitral regurgitation was caused by Barlow's disease in 27 patients. Seven patients required reoperations (recurrent regurgitation caused by technical issues, n = 3; progression of degenerative disease, n = 4). The 5- and 10-year cumulative incidences of reoperation considering death as the competing event were 1.4% and 5.4%, respectively. The 5- and 10-year postoperative cumulative incidences of moderate-to-severe recurrent mitral regurgitation were 4.7% and 13.0%, respectively. Residual regurgitation ≥ mild (hazard ratio, 6.99; 95% confidence interval, 1.520-32.12; P = .012) was an independent risk factor for reoperation. The independent risk factors for moderate-to-severe recurrent regurgitation were residual regurgitation ≥ mild (hazard ratio, 9.60; 95% confidence interval, 3.042-30.31; P < .001) and the loop-in-loop technique (hazard ratio, 3.40; 95% confidence interval, 1.058-10.90; P = .040). The median mean pressure gradient was sustained at almost 3.5 mmHg for > 7 years. CONCLUSIONS: The loop technique with ring annuloplasty provided excellent results with good hemodynamics beyond the mid-term. Residual regurgitation ≥ mild and the loop-in-loop technique may not be preferable for durable outcomes.

Morphological diversity of the tricuspid posterior leaflet affects surgical complexity for control of tricuspid regurgitation.

OBJECTIVE: We investigated the effect of morphological diversity of the tricuspid valve with multiple posterior leaflets on the technical outcomes of tricuspid valve repair. METHODS: From April 2016 to November 2020, 141 patients were diagnosed with secondary tricuspid regurgitation associated with left heart disease and underwent tricuspid valve repair. We retrospectively analyzed the clinical and echocardiographic data of patients who underwent both preoperative and postoperative transthoracic echocardiography. We divided the patients into two groups according to the surgical technique used to treat tricuspid regurgitation: ring annuloplasty alone (Group 1, n = 109) or additional approximation of leaflet edges (edge-to-edge repair) with ring annuloplasty (Group 2, n = 32). We measured the morphological diversity of the tricuspid valve during the operation in all patients. RESULTS: The preoperative tricuspid regurgitation score was higher in Group 2 than in Group 1 (2.1 ± 0.78 vs. 1.6 ± 0.7, respectively; p = 0.0046), and Group 2 contained more patients with two posterior leaflets than Group 1 [20 (63%) vs. 36 (33%), respectively; p = 0.003]. The univariate and multivariate logistic regression analyses showed that the presence of two posterior leaflets was an independent risk factor for additional procedures during tricuspid valve repair (odds ratio, 2.6; 95% confidence interval, 1.1-6.1; p = 0.033). CONCLUSIONS: Additional procedures to reduce tricuspid regurgitation were required more frequently in patients with two posterior leaflets of the tricuspid valve. The morphological diversity of two posterior leaflets is a potential risk factor for a more complicated tricuspid repair.

Computed tomography to identify risk factors for left circumflex artery injury during mitral surgery.

OBJECTIVES: Cases in which the left circumflex coronary artery (LCX) runs close to the mitral annulus are considered high risk for LCX injury during mitral surgery. We investigated the anatomical relationship between the LCX and the mitral annulus using 3-dimensional (3D) computed tomography (CT). METHODS: We constructed 3D-CT images of the LCX and the mitral annulus before surgery in 122 patients with mitral regurgitation (MR). We classified coronary dominance by 3D-CT and MR aetiologies (degenerative, atrial functional MR, ventricular functional MR and Barlow's disease) using echocardiography. We detected the point on the mitral annulus closest to the LCX (X point) and measured the minimum distance from the LCX to the mitral annulus (mCAD). We judged whether atrioventricular disjunction existed using CT. We also investigated the factors affecting mCAD and examined how coronary dominance and MR aetiologies relate to the location of the X point. RESULTS: The median mCAD was 4.2 mm (range 0.9-11.4 mm). Considering coronary dominance and MR aetiologies, mCAD was shorter in patients with left coronary dominance and Barlow's disease. The X point mostly existed on the lateral side of the posterior annulus, but it sometimes existed on the medial side. Multiple regression revealed left dominance and mitral annular disjunction as significant factors affecting mCAD (P = 0.01). CONCLUSIONS: The anatomical relationship between the LCX and the mitral annulus can be recognized using superimposed 3D-CT images. This approach is useful to avoid LCX injury in mitral valve surgery since the X point varies between patients.

Loop technique for degenerative mitral regurgitation due to extended prolapse.

PURPOSE: Our study aims to examine the midterm outcomes of the loop technique for extended mitral valve (MV) prolapse patients. METHODS: From October 2008 to August 2020, we performed MV repairs in 407 patients with severe mitral regurgitation (MR). Follow-up ranged in duration from 287 to 2899 days (median, 872 days). The prolapse extensiveness (p-score) was determined based on the ratio of prolapsing segment's areas to whole area. We divided the whole MV into 10 segments (A1, A2 medial, A2 lateral, A3, P1, P2 medial, P2 lateral, P3, AC, and PC). Patients were categorized into three groups according to the p-score: simple (0.1-0.2), intermediate (0.3-0.4), and extensive (0.5-0.9). RESULTS: All patients underwent MV repair with the loop technique. The rates of freedom from significant (moderate to severe or severe) MR at 5 and 7 years after surgery were 91% and 91%, respectively. There were 252, 115, and 40 patients in simple group, intermediate group, and extensive group, respectively. The following were significantly increased in extended group: Barlow disease (23/40 patients, p < .001), the number of loops (p for trend < .0001), and the technique score (p for trend < .0001). The rates of freedom from significant MR at 7 years after surgery were 92% in simple group, 87% in intermediate group, and 94% in extended group, respectively (p = .995). Receiver-operating characteristic curves showed a postoperative mild MR with a sensitivity of 86% and a specificity of 68% for predicting significant MR recurrence. CONCLUSIONS: MV repair using the loop technique was useful even in groups with extended prolapse.

Shrinkage of a Giant Type-B Dissecting Aneurysm Treated by Complete False Lumen Occlusion 20 Years after Presentation: A Case Report.

In this study, we report the case of a 47-year-old female who presented with extensive acute type IIIb aortic dissection and cerebral infarction. At 69 years of age, dilatation of the descending aorta was noted to be more than 70 mm with compression of the left atrium. We performed endovascular repair with distal false lumen occlusion. However, further dilatation of the descending aorta with false lumen flow from the re-entry of the common carotid artery was detected. She subsequently underwent additional proximal false lumen occlusion by embolization at the aortic arch. A year later, as per her computed tomography angiography findings, appreciable shrinkage of the descending aorta without endoleakage was observed.

Corynebacterium jeikeium-induced infective endocarditis and perivalvular abscess diagnosed by 16S ribosomal RNA sequence analysis: A case report.

INTRODUCTION: Corynebacterium jeikeium normally presents on human skin, and it is often judged as contamination when it is cultured from blood. C. jeikeium can cause infective endocarditis, especially, that associated with cardiac surgery and prosthetic valvular endocarditis. CASE REPORT: A 66-year-old Japanese male patient was diagnosed with C. jeikeium-induced infective endocarditis (IE) and perivalvular abscess after a coronary artery bypass grafting and aortic valve replacement with bioprosthesis; pyogenic spondylodiscitis was also observed. Patch repair for aortic valve annulus and re-Bentall procedure with bioprosthesis was performed for IE and perivalvular abscess. The causative bacterium was confirmed as C. jeikeium on 16S ribosomal RNA sequencing of surgical sample and positive blood culture. The patient underwent six weeks of intravenous antibacterial treatment with vancomycin and an additional two weeks of oral treatment with linezolid, following which, his condition improved. Corynebacterium jeikeium can cause infective endocarditis and perivalvular abscess, which is a more severe condition than IE. CONCLUSION: 16S ribosomal RNA sequencing is useful in diagnosing bacterial species that can cause contamination, such as Corynebacterium spp.

Concomitant operation for pulmonary artery aneurysm and pulmonary valve regurgitation.

A 48-year-old man with a pulmonary artery aneurysm was referred to our hospital. Enhanced computed tomography revealed an aneurysm extending from the main trunk to the bilateral pulmonary branch (maximum diameter 6.4 cm) of the artery. Echocardiography revealed moderate pulmonary valve (PV) regurgitation with right ventricle dilatation. Surgery was indicated because of the pulmonary aneurysm and dyspnea on exertion due to moderate PV regurgitation. Intra-operatively, two cusps were found to be normal in shape, whereas a third left-facing cusp was thick and resembled a small ridge. Therefore, we created one neo-cusp with autologous pericardium using a custom-made template and sutured it along a new, predetermined annulus. We then replaced the pulmonary aneurysm with a T-shaped artificial graft. Postoperative echocardiography showed satisfactory movement of the neo-cusp without pulmonary regurgitation and reduced right ventricular size.

Loop technique with ink-dot marking test: An alternative strategy to the ink test.

OBJECTIVE: We assessed the long-term outcomes of the loop technique with the ink-dot marking test, an alternative to the ink test for aligning the mitral valve (MV) leaflet height, during MV repair. METHODS: We retrospectively reviewed 351 patients who underwent MV repair with the loop technique via median sternotomy or right mini-thoracotomy. The ink-dot marking test involves creation of a dotted line between the rough and clear zones in the anterior leaflet and the center of the posterior leaflet by gentian violet. According to this marking, we adjusted the fixing position of the loops with or without the loop-in-loop technique and additional neochordal repair. RESULTS: This study involved 141 women and 210 men (mean age, 63.7 ± 13.0 years). Forty-one patients required additional adjustment after the ink-dot marking test. No significant differences were found in the need for second arrest between patients who did and did not require additional adjustment after the ink-dot marking test (3 vs 32 patients, P = .782). Predischarge transthoracic echocardiography showed trivial residual MV regurgitation (MR) in 285 patients, mild in 64, and moderate in 2. Ten patients needed reoperations (9 MV replacements and 1 MV re-repair) because of recurrent MR during postoperative follow-up. The 3-, 5-, and 10-year postoperative cumulative incidence of moderate to severe recurrent MR was 3.6%, 6.0%, and 19.8%, respectively. CONCLUSIONS: The loop technique with the ink-dot marking test provided good early and long-term results. This test may help to decrease residual MR, especially when using the loop technique.