[Open heart surgery using cardiopulmonary bypass in a patient with heparin-induced thrombocytopenia(HIT)].

Heparin-induced thrombocytopenia (HIT) is a life-threatening side effect of heparin therapy. We report an open heart surgery with cardiopulmonary bypass( CPB) using argatroban as an anticoagulant for a patient with HIT. A 72-year-old male with a history of percutaneous coronary intervention 5 years ago, was admitted to our hospital due to congestive heart failure and heparin 10,000 units/day was administered. At 10th hospital day, his platelet count was significantly decreased and antibodies positive for type II HIT was found, so he was diagnosed HIT. Echocardiogram and coronary angiography revealed severe functional mitral regurgitation and coronary stenosis. At 24th hospital day we performed coronary artery bypass grafting( CABG) and mitral valve replacement (MVR) with CPB using argatroban as an anticoagulant. During CPB, we monitored the activated clotting time (ACT) to adjust the dose of argatroban. Though the surgical procedure itself was uneventful. We required about 4 hours to achieve adequate hemostasis after CPB. Postoperative course was uneventful.

[Effusive constrictive pericarditis successfully treated by partial pericardiectomy with left thoracotomy; report of a case].

A 72-year-old male was admitted to our hospital due to high fever and dyspnea. Echocardiography and bacterial culture of pericardial fluid revealed purulent pericarditis caused by Streptococcus. Despite pericardial drainage and antibiotic therapy, hemodynamic instability due to constriction persisted. At 12th hospital day, partial pericardiectomy with left thoracotomy was performed. After the operation, his hemodynamics improved gradually, and was discharged from the hospital on the 54th post operative day without recurrence of infection nor constriction.

Intralobar pulmonary sequestration supplied by an anomalous aneurysmal artery.

Pulmonary sequestration is a relatively rare condition in which a systemic artery supplies blood to an abnormal lung tissue. Pulmonary sequestration with an aneurysmal systemic artery is extremely rare. We describe the case of a 52-year-old man with intralobar pulmonary sequestration supplied by an aneurysmal systemic artery. Because the nomenclature of pulmonary sequestration is still not clear, we propose that type 1 intralobar pulmonary sequestration be called "systemic arterial supply to the normal lung," as named by many professionals, and for this to be distinguished from pulmonary sequestration.

Successful treatment of a mycotic aortic pseudoaneurysm in a patient with type 2 diabetes mellitus while treating primary aldosteronism with spironolactone.

We describe a diabetic patient successfully treated for an acute mycotic aortic arch pseudoaneurysm with primary aldosteronism. The patient first complained of severe pain in the left upper extremity and left back with high C reactive protein (CRP) and high-grade fever. It was suspected that acute aortic dissection had developed in association with mycotic pseudoaneurysm of the aortic arch because of chest X-ray findings of enlargement of the aortic arch. Computed tomography (CT) of the aortic arch revealed an aortic aneurysm protruding in the superior direction. Staphylococcus aureus was detected in blood culture, suggesting a mycotic aortic aneurysm, and artificial blood vessel replacement of the aortic arch was performed. Intraoperative findings suggested aortic pseudoaneurysm, which consisted of mediastinal rupture of the aorta at the distal arch. Our patient had a 2-year history of type 2 diabetes mellitus and poor blood sugar control, even with twice-daily injection of insulin. Blood pressure was not always well controlled because of primary aldosteronism. Thus, it was speculated that hyperaldosteronism, as well as diabetes-associated atherosclerosis, had persisted for a long time. No reports have described mycotic pseudoaneurysm in the aortic arch in a diabetic patient associated with primary aldosteronism. It is necessary to note that serious vascular complications are possible if aldosteronism is left untreated or is treated insufficiently as essential hypertension.

[Pulmonary vein orifice cryoablation for atrial fibrillation with mitral valve disease using a specially designed cryo-probe].

OBJECTIVES: To evaluate the effectiveness of pulmonary vein orifice cryoablation (PVOC) for atrial fibrillation during mitral valve surgery. METHODS: Twenty-two patients (12 men and 10 women) with mitral valve disease complicated with atrial fibrillation have been treated by PVOC since March 2000. During the mitral valve operations, all four pulmonary vein orifices were ablated using a ball-shaped cryo-probe. A newly designed cryo-probe was used for the last seven patients. Success was defined as atrial defibrillation within 6 months after the operation. RESULTS: The success rate was 72.7% (16/22) of all patients, and improved from 66.6% to 85.7% (6/7) in the patients treated with the new cryo-probe. The mean left atrial dimension was smaller (50.2 +/- 4.1 vs. 61.5 +/- 9.4 mm, p < 0.01), and the duration of atrial fibrillation was also shorter (27.2 +/- 42.8 vs. 138.0 +/- 95.6 months, p < 0.01) in the successful group. CONCLUSIONS: PVOC with mitral valve surgery is a simple and less invasive procedure, so could be an effective option for atrial fibrillation.

[Fulminant myocarditis successfully treated with a left ventricular assist device: a case report].

A previously healthy 28-year-old woman was admitted under a diagnosis of acute myocarditis. Six hours after admission, circulatory support using intraaortic balloon pumping and percutaneous cardiopulmonary support were introduced, because uncontrollable ventricular arrhythmia appeared unexpectedly. Subsequently, decreased peripheral platelet count appeared, in spite of improved hemodynamics. Therefore, a left ventricular assist device was implanted and she was weaned from the percutaneous cardiopulmonary support. On the fifth postoperative day, she was successfully weaned from the left ventricular assist device with full recovery of myocardial function. Myocardial biopsy demonstrated the appearance of acute viral myocarditis. This case suggests that the left ventricular assist device might offer effective circulatory support for acute fulminant myocarditis.

[Post-myocardial infarction ventricular aneurysm and intractable ventricular tachycardia supported by left ventricular assist device: a case report].

A 57-year-old man was admitted under a diagnosis of myocardial infarction. Cardiac catheterization revealed total occlusions of the right coronary artery and the left anterior descending artery, and ventriculography showed aneurysmal change in the anterior and septal segments. Circulatory support was introduced with intraaortic balloon pumping, but intractable ventricular tachycardia developed. Electrophysiological mapping and cryoablation to the myocardium were performed intraoperatively, and then coronary artery bypass grafting with endoventricular circular patch plasty of the left ventricle was carried out. Weaning from the cardiopulmonary bypass was attempted, but a left ventricular assist device was subsequently implanted to support the deteriorated ventricular function. The hemodynamics of the ventricle improved several days after the circulatory support was introduced, and the left ventricular assist device was removed successfully. This case suggests that the left ventricular assist device is an effective method to support recovery from serious complications after myocardial infarction.