Expanding perigraft seroma after ascending aorta replacement.

BACKGROUND: Perigraft seroma is a persistent and sterile fluid confined within a fibrous pseudomembrane surrounding a graft that develops after graft replacement. Development of perigraft seroma is an uncommon complication that occurs after the surgical repair of the thoracic aorta using woven polyester grafts. mechanism underlying perigraft seroma formation remains unclear. CASE PRESENTATION: Herein, we describe the case of 77-year-old man who underwent repeat sternotomy for the treatment of large perigraft seroma 1 year after ascending aorta replacement for acute type A dissection. After removing a cloudy yellow fluid, we covered the prosthetic graft with fibrin glue and wrapped it with a new graft. Bacterial culture and laboratory examination of the fluid confirmed the final diagnosis of perigraft seroma, and there was no evidence of recurrence. The area in which fluid accumulated around the graft shrunk 1 year after surgery. CONCLUSIONS: The cause of a expanding perigraft after repair of the thoracic aorta remains unknown. Physicians should be aware that chronic expanding mediastinal seroma with Dacron grafts is one of the rare postoperative complications of thoracic aortic surgery. Applying fibrin glue to the graft surface might effectively prevent the recurrence of perigraft seroma.

Successful treatment of aortic valve endocarditis caused by Enterococcus casseliflavus: a case report.

BACKGROUND: Enterococcus casseliflavus is rarely isolated from human specimens. To the best of our knowledge, there are no reports on its detailed treatment course and prognosis. Here, we present the first known case of E. casseliflavus endocarditis with a detailed treatment course. CASE PRESENTATION: An 86-year-old Japanese woman was transferred to the emergency department with dyspnoea, wheezing, and lumbago. Her medical history included hypertension, chronic kidney disease, idiopathic interstitial pneumonia, and rectal carcinoma. Physical examination revealed expiratory wheezes and a diastolic murmur (Levine 2/6) at the 4th right sternal border. Chest radiography revealed bilateral interstitial opacities and slight cardiac dilatation. Transthoracic echocardiography demonstrated the presence of mobile vegetation with perforation, prolapse, and regurgitation of the aortic valve. With a suspicion of infective endocarditis, we started administering intravenous ampicillin/sulbactam. Thereafter, blood cultures identified E. casseliflavus through matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry. The antimicrobial treatment was then switched to ampicillin plus gentamicin. The patient underwent aortic valve replacement on the thirteenth hospital day. She was administered intravenous ampicillin and gentamicin for 6 weeks. The patient was discharged 8 weeks after admission. CONCLUSIONS: Our case demonstrated that E. casseliflavus could cause infective endocarditis, which can be successfully treated with a 6-week regimen of ampicillin and gentamicin in combination with proper surgical treatment.

[Surgical Repair of Giant Coronary Artery Aneurysm Associated with Coronary-pulmonary Artery Fistulae;Report of a Case].

A 61-year-old woman was referred to our hospital with a complaint of chest compression. Coronary angiography revealed a giant coronary artery aneurysm, located in the middle of a coronary-pulmonary artery fistula originating from the right coronary artery. Another fistula was also shown between the left anterior descending artery and the pulmonary artery. Surgical correction was indicated due to the risks of the aneurysmal rupture and coronary events. Under cardiopulmonary bypass, suture-closure of the coronary artery aneurysm and ligations of the fistulae were carried. Postoperative coronary angiography showed no aneurysm or fistula, and she was discharged uneventfully on the 12th postoperative day.

[Giant Left Atrial Myxoma Found with Congestive Heart Failure;Report of a Case].

We report a case of giant left atrial myxoma in a 52-year-old woman who developed congestive heart failure. By echocardiography, not only the myxoma but moderate degree of mitral and tricuspid regurgitation was also found. The tumor was extensively attached to the left atrial endocardium, and was excised completely together with the endocardium. No valve surgery was added. Postoperative echocardiography showed no myxoma and no mitral valve regurgitation. She was discharged in good condition on postoperative day 14.

[Severe Calcification on Glutaraldehyde-treated Autologous Pericardium after Mitral Valve Repair by Leaflet Augmentation;Report of a Case].

We report a case of surgical treatment of mitral valve stenosis due to severe calcification on the glutaraldehyde-treated autologous pericardium. A 39-year-old woman presented with progressive dyspnea. She had undergone mitral valve repair by leaflet augmentation with a glutaraldehyde-treated autologous pericardium for mitral regurgitation 3 years before. Transthoracic echocardiography showed mitral valve stenosis with limited movement of the anterior leaflet. At redo surgery, severe calcification was observed of the glutaraldehyde-treated autologous pericardium patch on the anterior mitral leaflet. Mitral valve replacement was performed successfully, and she was discharged on postoperative day 14.

[Surgical Treatment of Right Ventricular Perforation by a Transvenous Electrode Catheter;Report of a Case].

We report a case of surgical treatment of iatrogenic right ventricular perforation. An 86-year-old woman with sick sinus syndrome was treated by insertion of transvenous electrode catheters. She was transferred to our hospital due to chest pain 9 days after the insertion. We found the ventricular electrode catheter had perforated the right ventricle by computed tomography (CT). This perforated lesion was repaired under beating heart using 2-0 monofilament mattress sutures reinforced by felt pledgets. The perforation may have occurred because the apex portion of the right ventricle was fragile. Iatrogenic cardiac trauma is rare, and prompt recognition and treatment are essential.

Cardiac tamponade due to rupture of a giant coronary artery aneurysm with a coronary arteriovenous fistula: a case report.

BACKGROUND: Coronary artery aneurysm (CAA) is defined as dilatation exceeding 1.5 times the width of the normal adjacent coronary artery segments. CAA usually causes few symptoms, and rupture is rare, but can be lethal due to cardiac tamponade when it does occur. CASE PRESENTATION: A 79-year-old woman presented with presyncope and back pain. Emergency surgery was performed based on a diagnosis of cardiac tamponade due to either rupture of coronary arteriovenous fistula or CAA. At surgery, a rupture site was located on the wall of the giant CAA, with a diameter of 55 mm, originating from the ostium of the right coronary artery. Suture closure of the inflow and outflow of the aneurysm was performed, and the aneurysmal cavity was obliterated by multiple sutures. The patient made an uneventful recovery and was discharged from hospital on postoperative day 13. CONCLUSION: On the basis of this case, we propose considering rupture of a CAA as one of the causes of cardiac tamponade.

Thoracic endovascular aortic repair for retrograde type A aortic dissection.

OBJECTIVE: The efficacy of thoracic endovascular aortic repair (TEVAR) for retrograde type A aortic dissection (r-TAAD) with the entry tear in the descending aorta has not been clarified. METHODS: The medical records of 31 patients who underwent TEVAR for r-TAAD at three institutions between May 1997 and January 2016 were retrospectively reviewed. RESULTS: The mean age of the patients (30 men and 1 woman) was 64 ± 11 years. The entry tear was located in the descending thoracic aorta in all patients. Seven patients (23%) had dissection-related complications. The false lumen of the ascending aorta was patent in 13 patients (42%) and thrombosed in 18 (58%). The maximum diameter of the ascending aorta was 45 ± 4 mm. TEVAR was performed in the acute phase in 24 patients (77%) and in the subacute phase in 7 (23%). Only one patient (3%) died of aortic rupture within 30 days after TEVAR. Early aorta-related adverse events were observed in eight patients (26%), of whom five underwent additional interventions. The mean follow-up period was 99 ± 69 months. There were no late aorta-related deaths, although five patients died of other causes during follow-up. Overall survival rates at 1 year, 5 years, and 10 years were 97%, 93%, and 80%, respectively. Late aorta-related adverse events were observed in seven patients (23%), of whom five underwent additional interventions. Aorta-related event-free survival rates at 1 year, 5 years, and 10 years were 58%, 58%, and 51%, respectively. CONCLUSIONS: TEVAR for r-TAAD seems promising in terms of survival. However, the incidence of postoperative aorta-related adverse events is not negligible, so careful selection of patients is important. In addition, close follow-up is mandatory after TEVAR to avoid catastrophic consequences.

Emergency Off-Pump Coronary Artery Bypass Graft Surgery for Patients on Preoperative Intraaortic Balloon Pump.

BACKGROUND: The aim of this study was to investigate early and long-term outcomes of patients with acute coronary syndrome preoperatively requiring intraaortic balloon pump support who underwent emergency off-pump coronary artery bypass graft surgery. METHODS: One hundred and fifteen patients on preoperative intraaortic balloon pump receiving emergency off-pump coronary artery bypass graft surgery over an 11-year period were evaluated. The median age was 71 years (range, 33 to 87). Acute myocardial infarction and unstable angina were present in 54 patients (47.0%) and 61 patients (53.0%), respectively. Left main disease and triple-vessel disease without left main involvement were present in 74 patients (64.3%) and 33 patients (28.7%), respectively. RESULTS: There were 3 perioperative deaths. Complete surgical revascularization was accomplished in 82 patients (71.3%), and in situ internal thoracic artery graft was used in 96 (83.5%). Late survival, freedom from major adverse cardiac and cerebrovascular events, and freedom from repeat revascularization rates at 5 years were 83.3%, 73.5%, and 84.2%, respectively. The Cox multivariate prognostic predictors of total mortality were preoperative renal impairment (hazard ratio [HR] 7.90; 95% confidence interval [CI]: 3.06 to 20.4) and low ejection fraction (HR 0.94, 95% CI: 0.88 to 0.99). The multivariate risk predictors of major adverse cardiac and cerebrovascular events were preoperative renal impairment (HR 2.68, 95% CI: 1.00 to 7.19) and peripheral vascular disease (HR 2.81, 95% CI: 1.05 to 7.51), and complete revascularization was protective (HR 0.39, 95% CI: 0.19 to 0.81). The multivariate risk factor of repeat revascularization was previous percutaneous coronary intervention (HR 3.26, 95% CI: 1.14 to 9.33), and complete surgical revascularization was also protective (HR 0.30, 95% CI: 0.11 to 0.85). CONCLUSIONS: Off-pump coronary artery bypass graft surgery is a feasible option for patients requiring preoperative intraaortic balloon pump support.

[Pulmonary Arterioplasty with Autologous Pericardial Patch for Lung Cancer].

Three patients underwent left upper lobectomy with arterioplasty of left pulmonary artery trunk for lung cancer. For pulmonary arterioplasty, wide wedge resection and patch plasty with autologous pericardium was performed. No in-hospital death or no postoperative complications due to arterioplasty was encountered. The mean follow-up period was 3.6 years and long-term patency of the reconstructed pulmonary artery was confirmed by computed tomography in all patients.