[Intractable Atrial Arrhythmia after Maze Procedure].

Maze procedure has achieved high cure rates and become the surgical golden standard for the treatment of atrial fibrillation. But, atrial arrhythmia after maze procedure is often persistent and drug-resistant. In these cases, diagnosis by electrophysiological study (EPS) and treatment by catheter ablation (ABL) are useful. In our hospital, maze procedure has been actively performed for mitral valve surgery with atrial arrhythmia. We examined the cases that required ABL after maze procedure in our hospital. We reported 2 such typical cases where ablation of cavo-tricuspid isthmus line (CTI) in the right atrium and left superior pulmonary vein-left atrial appendage space( LSPV-LAA ridge) in the left atrium was effective.

[Severe Coronary Artery Spasm after Coronary Artery Bypass Grafting;Report of a Case].

Coronary artery spasm after coronary artery bypass grafting(CABG) is rare and often fatal. There is no established treatment for perioperative coronary spasm because of the rare and not fully understood complications. We report a 67-year-old male, who experienced perioperative spasm of native coronary arteries and the left thoracic artery graft following CABG. Several transcatheter intracoronary injections of isosorbide sulfate failed to relieve the spasm completely. After 5 days' circulatory support with intra-aortic balloon pumping, the cardiac function improved and the patient recovered. Echocardiography performed before discharge showed decreased left ventricular systolic function with apical akinesis. Postoperative coronary angiography revealed 4 of the 5 grafts were patent.

[Fifteen-year Follow-up of a Patient with Aortitis, Treated by Sino-tubular Junction Plication Using a Prosthetic Tube Graft for Aortic Regurgitation;Report of a Case].

A 43-year-old woman was diagnosed with aortitis associated with mild aortic regurgitation (AR) at the age of 25, which advanced to a severe grade requiring surgical treatment at age 28. Dilation of the sinotubular junction (STJ) was treated with ascending aortic replacement (Hemashield Gold 24 mm), which reduced AR from severe to mild. The patient conceived 9 years later and delivered a baby by cesarean section at 38 weeks of gestation. By appropriate control of inflammation with steroid, neither deterioration of the aortic valve nor cardiac function has been noted during the 15 years of follow-up after surgery.

Reliability and benefit of estimated continuous cardiac output measurement using shunt-side SpO2 monitor in hemodialysis.

INTRODUCTION: Estimated continuous cardiac output (esCCO) is a novel technology that enables non-invasive and continuous monitoring of cardiac output. We compared the concordance in accuracies among esCCO measurements in the shunt limb and non-shunt limb. METHODS: In this single-center prospective observational study, we include Japanese patients who underwent dialysis at our center between April 27, 2021, and February 28, 2023. Clinical accuracy of esCCO was evaluated in the shunted and non-shunted bilateral digits. Agreement between the measurements was analyzed using Lin's congruent correlation and Bland-Altman analysis. RESULTS: For 43 individuals, Lin's concordance correlation coefficient was 0.9887 (95% confidence interval of 0.9886-0.9887) indicating good agreement. The values of esCCO measured in the shunt and non-shunt limbs were compatible. The percentage errors for the 43 patients with arterio-venous fistula (AVF) or arterio-venous graft (AVG), 32 with AVF, and 11 with AVG were 9.3%, 9.3%, and 8.9%, respectively. CONCLUSION: esCCO could be used in shunt as well as non-shunt limbs during dialysis, allowing continuous and non-invasive hemodynamic monitoring.

Two-stage operation for isolated pulmonary valve infectious endocarditis with Candida parapsilosis.

We report a case of isolated pulmonary infectious endocarditis (IE) with Candida parapsilosis. A 66-year-old man presented with fever and cough. Echocardiography showed severe pulmonary regurgitation and vegetations on the pulmonary valves. Initially, antibiotics were prescribed against bacterial IE, and the vegetations disappeared; however, the pulmonary vegetations relapsed, and C. parapsilosis was grown from blood cultures. We performed a debridement without a pulmonary valve replacement. There was no recurrence of IE for 3 years, and then the patient developed right ventricular enlargement and severe tricuspid regurgitation due to severe pulmonary regurgitation. Pulmonary valve replacement was performed. Now the patient is free from infection.

Clinical outcomes of medical treatment of acute type A intramural hematoma.

A retrospective study was performed in 30 patients who were treated for type A intramural hematoma from 1999 to 2008, of whom 24 were initially treated without surgical intervention. These 24 patients were followed up for 3.3 +/- 3.5 years (range, 0 days to 10.0 years). Four hospital deaths occurred (hospital mortality, 16.7%), there were 2 late deaths, and 2 other patients needed an operation during the follow-up period. The event-free survival rate (freedom from death or surgery) at 5 years was significantly lower in patients with maximal aortic diameter > or =48 mm than in those with diameters <48 mm (28.6% +/- 17.1% vs. 88.2% +/- 7.8%). Maximal aortic diameter > or =48 mm and computed tomography findings of a small intimal defect were significant predictors of rupture or progression of ascending aortic dissection. The outcome of medical treatment for type A intramural hematoma was acceptable during both the early and late periods, but patients with a relatively large aortic diameter or an intimal defect in the ascending aorta have a high probability of adverse outcome, and must be considered for surgery.