[Coronary Artery-Left Atrial Fistula Complicated by a Left Atrial Myxoma:Report of a Case].

We report our experience with a case of a left atrial mass coexisting with a coronary artery-left atrial fistula. The abnormal vessels extended from the right coronary artery and left circumflex artery to the tumor in the left atrium and were aggregated within the tumor. An efflux of the contrast media was also noted from the tumor into the left atrium. Tumor resection and ligation of the abnormal vessels were performed as surgical interventions. The outcomes were favorable. The tumor was pathologically diagnosed as a myxoma, but its association with the abnormal vessels was unknown.

[Surgery in Elderly Patient for Coronary Arteriovenous Fistula and Giant Coronary Artery Aneurysm Associated with Cardiac Failure;Report of a Case].

An 82-year-old woman visited the hospital with the chief complaint of dyspnea on light exertion. Computed tomography (CT) showed a coronary artery aneurysm and coronary arteriovenous fistulas. The pulmouary flow/systemic flow (Qp/Qs) ratio was 1.4, and the left-to-right shunt rate was 31%.Two anomalous vessels were identified. One arose from the right coronary artery, formed an aneurysm, and drained into the coronary sinus, while the other originated from the distal circumflex branch and drained directly into the coronary sinus. The aneurysm measured 50×45 mm. The anomalous vessel from the right coronary artery was ligated at the sites of flow from the right coronary artery and at the site of drainage into the coronary sinus. The circumflex artery was ligated at the last branch and at the site of drainage into the coronary sinus. The aneurysm was incised and the vessel flowing into the aneurysm was sutured closed. Postoperative CT showed no anomalous blood vessel and the circumflex artery was visualized up to the last branch.

[One-stage Surgery for a Non-Marfan Elderly Patient with Aortic Regurgitation and Pectus Excavatum].

We describe a case of 1-stage surgery comprising aortic valve replacement and thoracoplasty that was performed on an elderly patient with a good result. An 85 -year-old man visited our hospital with the chief complaint of chest discomfort. Examination revealed aortic regurgitation and pectus excavatum. Respiratory dysfunction, pulmonary hypertension, and cardiac failure were observed. We considered that pectus excavatum could affect breathing and circulation after surgery;therefore, we decided to perform a 1-stage surgery comprising aortic valve replacement and thoracoplasty. The costal cartilage and xiphoid process were resected, and median sternotomy was performed. The internal thoracic artery and vein were preserved. Aortic valve replacement was performed per the usual method. The resected costal cartilage was placed back at its site and the periosteum was sutured. The medially resected sternum was fixed and lifted with Kirschner wire. The patient recovered without any complication.

Durability-enhanced two-dimensional hole gas of C-H diamond surface for complementary power inverter applications.

Complementary power field effect transistors (FETs) based on wide bandgap materials not only provide high-voltage switching capability with the reduction of on-resistance and switching losses, but also enable a smart inverter system by the dramatic simplification of external circuits. However, p-channel power FETs with equivalent performance to those of n-channel FETs are not obtained in any wide bandgap material other than diamond. Here we show that a breakdown voltage of more than 1600 V has been obtained in a diamond metal-oxide-semiconductor (MOS) FET with a p-channel based on a two-dimensional hole gas (2DHG). Atomic layer deposited (ALD) Al2O3 induces the 2DHG ubiquitously on a hydrogen-terminated (C-H) diamond surface and also acts as both gate insulator and passivation layer. The high voltage performance is equivalent to that of state-of-the-art SiC planar n-channel FETs and AlGaN/GaN FETs. The drain current density in the on-state is also comparable to that of these two FETs with similar device size and VB.

A Rare Case of Complete Stent Fracture, Coronary Arterial Transection, and Pseudoaneurysm Formation Induced by Repeated Stenting.

This report describes a rare asymptomatic case of complete stent fracture, coronary arterial transection, and pseudoaneurysm formation in response to repeated stenting. The proximal and distal ends of transected coronary artery were closed, and distal bypass was performed. Coronary arterial transection can occur in patients with repeated stenting as a long-term adverse event.

Chimney technique for aortic dissection involving an aberrant right subclavian artery.

We report a case involving a ruptured acute type B aortic dissection originating from an aberrant right subclavian artery (ARSA). A thoracic stent-graft was deployed in the distal arch close to the origin of the ARSA; the entry site at the origin of the ARSA was embolized with metallic coils. Perfusion of the left subclavian artery was preserved without a surgical bypass by using a chimney graft. This procedure is a feasible and less invasive treatment for high-risk sternotomy patients and is an effective strategy for acute aortic dissections involving an ARSA.

[Long-term survival after complete resection of primary cardiac undifferentiated sarcoma;report of a case].

A 34-year-old man experienced lower limb ischemia due to tumor emboli as an initial symptom. Histopathologic examination of the embolic material revealed undifferentiated sarcoma. By echocardiography the original tumor was arising from the posterior mitral leaflet, and therefore, excision of the mitral valve resulted in complete resection of the sarcoma. Mitral valve replacement was performed, and his postoperative course was uneventful. He did not receive postoperative adjuvant therapy. The patient has been undergoing positron emission tomography and electrocardiography on an outpatient basis to check for signs of recurrence. However, no signs of recurrence have been detected for 7 years postoperatively, and the patient leads an active life.

Endovascular repair of distal arch aneurysm with double-chimney technique.

We report 2 cases of distal arch aneurysm treated by thoracic endovascular aneurysm repair (TEVAR) with the "double-chimney technique." This technique permitted the implantation of a thoracic stent graft in the ascending aorta over the arch branches while preserving perfusion of innominate and left common carotid arteries without debranching bypasses. The procedure is a feasible and less invasive treatment for distal arch aneurysm with a short proximal neck (<2 cm to the origin of the innominate artery) in patients at high risk when undergoing sternotomy and in emergent cases.

A case of cardiac rupture subsequent to myocardial infarction diagnosed in emergency room.

A 72-year-old woman was transferred to the emergency room because of left anterior chest pain with cold sweating. Electrocardiography revealed recent anterior myocardial infarction. Echocardiography showed akinesis of the mid-ventricular septum to the apex by apical view, a small amount of pericardial effusion and collapse of the right ventricular wall, indicating cardiac tamponade, by subcostal view. These echocardiographic findings strongly suggested cardiac rupture subsequent to the myocardial infarction. Emergent operation was successfully performed to repair the ruptured left ventricle.