[Semi-acute Surgery for Ventricular Septal Perforation After Unsuccessful Intra-aortic Balloon Pumping Support:Report of a Case].

Ventricular septal perforation( VSP) after acute myocardial infarction( MI) is a serious condition that requires surgical treatment. However, good outcome is not always obtained. The mortality rate of VSP is particularly high in cases whom emergency surgery is performed early in the course of the disease, and the timing of surgery is known to affect prognosis. In this case report, the patient assisted with intra-aortic balloon pump. VSP closure surgery (a modified David-Komeda technique) underwent 8 days after MI onset. Except for mild residual shunt, the patient experienced no adverse event during postoperative course and was discharged 30 days after the surgery. This case illustrated timing of surgery as well as adequate mechanical cardiopulmonary assistance and surgical technique is important.

[Branched Thoracic Endovascular Aortic Repair for Aortic Arch Aneurysm Following Severe Combined Valvular Disease:Report of a Case].

A 79-years-old frail man with severe combined valvular disease was referred to our hospital. Furthermore, chest computed tomography( CT) showed a saccular aneurysm in the aortic arch. We chose two staged repairs for risk reduction. As a first stage double valve replacement and tricuspid annuloplasty were performed. Three months later, we performed successful branched thoracic endovascular aortic repair( TEVAR) used physician modified Najuta which had hydrogel-reinforced fenestrations to provide a more secure connection with the bridging graft than fenestrations alone. Staged surgery with branched TEVAR used physician modified Najuta is a useful strategy in patients who have complex cardiac disease combined with aortic arch aneurysm.

[Suspected Left Ventricular Pseudo-false Aneurysm of a Huge Size Combined with Sustained Ventricular Tachycardia;Report of a Case].

A 74-year-old man was transferred to our hospital for heart failure and ventricular tachycardia. Left ventricular aneurysm of a huge size( 6×9 cm) was found on the imaging test, and was suspected to be a pseudo-false aneurysm because of its thick wall with small orifice. Occulusion of the right coronary artery (#1) was revealed by coronary arteriography and the diskinetic aneurysm in the inferior wall was revealed by left ventriculography. The surgical treatment was needed, because of the high risk of rupture. He successfully underwent Dor operation with endocardial cryoablation and left ventricular ejection fraction (LVEF) was found to be improved by postoperative left ventriculography. He discharged on 56 days after operation. Ventricular pseudo-false aneurysm is rare and the treatment is controversial.

[Stenosis of the Right Coronary Limb of Interposed Artificial Graft 28 Years After Cabrol Technique;Report of a Case].

Cabrol technique is one of the modified Bentall procedures. However, it has become nearly obsolete over the years because of reports of stenosis, thrombosis, and occlusion of the interposed graft. A 76-year-old man, who had undergone Cabrol technique 28 years before, presented with worsening exertional dyspnea and, was diagnosed with mitral valve regurgitation and tricuspid valve regurgitation. Preoperative angiography revealed stenosis of the right limb of the interposed artificial graft, and he underwent coronary artery bypass grafting (CABG) in addition to mitral valve replacement (MVR) and tricuspid annuloplasty (TAP). Patients who underwent procedures such as Cabrol technique and Piehler technique using interposed artificial grafts reconstructing coronary arteries, should be regularly checked with imaging examinations.

Surgery for detached coronary ostial anastomosis 21 years post-Bentall procedure.

Though a high frequency of postoperative complications after an original Bentall procedure has been reported, several procedures that reduce the incidence of complications have been developed. Complications relating to anastomoses of the interposed graft are infrequent but life-threatening. This report describes a case of a 61-year-old man who presented with heart failure secondary to bilateral detachment of coronary ostial anastomoses and graft stenosis 21 years after undergoing a modified Bentall procedure. These complications were successfully repaired by reconstructing the conduit and coronary arteries.

[Aortic annulus repair with xenogeneic pericardial flap after extensive debridement in active prosthetic valve endocarditis associated with an aortic annular abscess].

Prosthetic aortic valve endocarditis(PVE) is one of the devastating diseases and some cases present with extensive annular destruction requiring complex surgical repair. We report 2 cases of PVE with more than one-half of aortic annular destruction after complete debridement of the infected tissue. In these patients we successfully performed mechanical valve implantation following annular repair using a square piece of xenogeneic pericardium that was soaked in highly concentrated vancomycin solution. To increase rigidity of an annulus, a square piece of xenogeneic pericardium was interposed into abscess cavity with some single interrupted sutures. Sutures were placed along the abscess cavity and tied to the fragile tissue carefully. Both patients were discharged from hospital and have been doing well without any signs of recurrent endocarditis at a year postoperatively. This procedure might enable us to avoid patch closure of the abscess cavity in some severe PVE patients.

Combination of familial Barlow's disease with bilateral axillary artery aneurysms in two brothers.

We encountered two brothers with a combination of Barlow's disease and bilateral axillary artery aneurysms who were operated on during their third decade of life. A symmetrical form of true bilateral axillary artery aneurysms is uncommon. Recurrent mitral regurgitation was presented in the older brother with an endocardial defect in the left atrium, suggesting connective tissue fragility. A hereditary connective tissue disorder was strongly suspected because of the similar presentation and an unusual cluster of pathologies in siblings. Careful follow-up is required to detect recurrence of mitral regurgitation or aneurysm formation in other vessels.

[Surgical treatment of traumatic pseudoaneurysm of the brachiocephalic artery; report of a case].

Traumatic injury to the great vessels may be one of the highly lethal states. In many of these cases, the lesion was confirmed at the aortic isthmus. We report a case of successful surgical treatment of the traumatic pseudoaneurysm of the brachiocephalic artery. Pre-operative 3-dimension computed tomography (CT) showed an aneurysm at the left dorsal of the artery. At surgery, the proximal portion of the brachiocephalic artery, the right common cartid artery and the right subclavian artery were clamped with the simple extracorporeal shunting between the aortic arch and the distal of the right common cartid artery for maintaining the blood flow to the brain. A longitudinal dissection was found at the left dorsal position when the aneurysm was opened. The aneurysm was removed and interposed using an artificial vessel. After surgery, no neurologic complication or aftereffects were revealed, and the cerebral infarction due to the procedure was not detected by the brain CT.

Surgical repair of complicated coronary arteriovenous fistula and coronary artery aneurysm in an elderly patient after 26 years of conservative therapy.

We describe a rare case of surgical repair of a coronary artery aneurysm with arteriosclerotic changes accompanied by coronary arteriovenous fistula (CAVF) after 26 years of conservative therapy. A 71-year-old woman, diagnosed with CAVF 26 years previously, was admitted to our hospital for general fatigue and dyspnea on exertion. Physical examinations revealed that the CAVF originated from the distal portion of the left circumflex artery (LCX), draining into the coronary sinus (CS); it affected the coronary artery aneurysm with arteriosclerotic changes and was calcified from the left coronary main trunk to the distal portion of the LCX. Treatment without resection of the calcified coronary aneurysm was suggested because of fear of excessive bleeding. The CAVF was closed directly from inside the dilated coronary sinus under cardiopulmonary bypass. The dilated ostium of the left coronary artery was closed using a Xenomedica patch. Coronary artery bypass grafting was performed in the left anterior descending artery (LAD) and posterolateral branch (PL) of the LCX using saphenous vein grafts. Postoperatively, the coronary aneurysm was spontaneously thrombosed for low blood flow. The bleeding might have been uncontrolled if the arteriosclerotic and calcified coronary aneurysm had been incised. Therefore, we successfully thrombosed the calcified coronary aneurysm without resection, after reducing the systemic blood flow to the coronary aneurysm and sustaining the coronary blood flow, performed with CABG.