[Surgery for Functional Mitral Regurgitation or Dilated Cardiomyopathy in Patients with Non-transplant Candidates].

Surgery for functional mitral regurgitation (FMR) and dilated cardiomyopathy (DCM) remains a challenge. We reviewed our efforts;anterior (i.e. physiological) relocation of papillary heads and muscles(PHO) in 54 patients with FMR and simplified ventricular restoration of uni-directional Dor or Frozen-Apex restoration in 22 patients with DCM. Actuarial survival 4 years after the PHO was 92±6% with improved left ventricular (LV) function and well controlled FMR. Results of the simplified restoration was also promising with no hospital death and just 1 cardiac death late postoperatively, with good symptom relieve and maintained LV function. Surgical outcome for FMR or DCM may be further improved.

"Frozen Apex" Repair of a Dilated Cardiomyopathy.

We try to make surgical ventricular restoration simpler and more adjustable to safely enhance ventricular function. In eight patients with DiDonato type III dilated cardiomyopathy, we applied a few short-axis purse-string sutures to the endocardial side of the left ventricular apex ("Frozen-Apex" restoration) to make a smaller, cone-shaped apex, based on the concept that the left ventricular apex is important in its existence, but not in its function. The procedure took less than 15 minutes in all the patients. There was no hospital or late death with the follow-up of 549 ± 389 days. Mid-late postoperatively, New York Heart Association functional class changed from 3.5 ± 0.8 (preoperative) to 1.6 ± 0.6 (P = 0.000 vs preoperative), left ventricular diastolic diameter from 64 ± 16 to 61 ± 15 mm, systolic diameter from 57 ± 15 to 50 ± 17mm (P = 0.070), ejection fraction from 27 ± 10 to 40 ± 16% (P = 0.014). Diastolic function as assessed by the ratio of the early to late ventricular filling velocities, the ratio of mitral annular early diastolic velocity to early mitral inflow velocity, and estimated right ventricular pressure remained at the similar level to preoperative one. The new ventricular restoration was associated with better systolic left ventricular function without deteriorating diastolic one. It may improve the outcome of the treatment of selected patients with dilated cardiomyopathy.

Epicardial 15-MHz Echocardiography for Effective Repair of Coronary Arteriovenous Fistula.

In the era of catheter intervention, the surgical repair of coronary arteriovenous fistula needs to be free from residual shunt. Intraoperative epicardial 15-MHz echocardiography helps to find the residual shunt after ligation or obliteration of anomalous vessels. Here we report our method of the echo-assisted surgical repair of coronary arteriovenous fistula in 7 adult patients. The method made the operation for coronary arteriovenous fistula free from residual shunt, but care should be taken to the development of new vessels after the operation.

Successful coronary revascularization using the PAS-Port system in a patient with Takayasu's arteritis and Behcet's disease.

Coronary artery disease is rare in patients with Takayasu's arteritis or Behcet's disease. We report the case of a patient with concomitant Takayasu's arteritis and Behcet's disease who had angina pectoris develop due to severe narrowing of the left main coronary artery. The patient underwent revascularization with saphenous vein grafts with the assistance of the PAS-Port Proximal Anastomosis System (Cardica, Inc, Redwood City, CA). In conclusion, the PAS-Port Proximal Anastomosis System seems to be a safe and effective method of facilitating revascularization, particularly when severe calcification of the ascending aorta precludes cross-clamping during off-pump coronary artery bypass grafting.

Skeletonized Radial Artery Graft Prepared With Phosphodiesterase-III Inhibitors Indicates Favorable Results Compared With Pedicled Radial Artery Graft in Angiographic Studies.

OBJECTIVES: : The technique used to harvest the radial artery was modified, with improved results. Skeletonized radial artery conduits prepared with phosphodiesterase-III inhibitor were compared with pedicled conduits by angiography. METHODS: : Isolated coronary artery bypass graft surgery that used the radial artery for conduits was performed on 83 consecutive occasions from March 2003 to February 2004. The mean age of the patients was 68 ± 7 years; 65% were male. The radial arteries were harvested randomly for skeletonized (group SPD and group SPa) or pedicled (group PPD). A phosphodiesterase-III inhibitor, olprinone hydrochloride, was used as an antispastic agent during harvesting of the radial artery for both in groups SPD and PPD. Papaverine was used in group SPa. Postoperative angiograms were performed within 1 month. Diameters of the radial artery were scaled at proximal, mid, and distal sections and averaged. Optical stenosis was measured as a percent stenosis value. RESULTS: : There were no significant differences among groups SPD, SPa, and PPD in morbidity or mortality rates. Graft patency rates were 97.4% in group SPD, 98.6% in group SPa, and 95.4% in group PPD (P = 0.67). Diameters of the radial artery conduits were significantly wider in group SPD compared with group PPD (P < 0.001). Spasm and stenosis were less frequent in group PPD (P < 0.05). CONCLUSIONS: : Skeletonized radial artery grafting prepared with a phosphodiesterase-III inhibitor indicated favorable results in angiographic studies.

Changes of the beat amplitude power after partial left ventriculectomy and coronary artery bypass grafting.

Partial left ventriculectomy (PLV) was originally introduced as a new surgical approach by patients with an end stage of cardiac disease. Coronary artery bypass grafting (CABG) is a standard procedures used in cardiac surgery. Multichannel ECG (MECG) measurements and body surface mapping (BSM) were used to analyse the normalised beat amplitude power maps (BAM) that reflect an overall cardiac activity. The resulting BAMs show that the amplitude of cardiac signals decrease for approximately 30% after the PLV and stay in the same level during the postoperative monitoring interval while after CABG no significant changes in BAM have been observed. In addition the electrodes from the body surface area above the left ventricle, where surgery was performed, show significant changes in beat amplitudes.

Rupture of a smoldering mycotic aneurysm of the thoracic aorta into the lung.

A 65-year-old man was a diagnosed with meningitis and bacteremia, as Streptococcus pneumoniae was isolated from spinal fluid and blood cultures. After three weeks of antibiotic therapy, computed tomography revealed a ruptured aneurysm of the descending thoracic aorta. The aneurysm had appeared during the first episode of meningitis but had remained silent for two years. The patient underwent in situ Dacron graft replacement and his postoperative course was uneventful with no infectious complication.