[Mitral Valve Replacement for Eclipsed Mitral Regurgitation with Multiple Episodes of Acute Exacerbation and Remission].

Eclipsed mitral regurgitation is a relatively new disease concept reported in recent years, of which is not fully elucidated. A 73-year-old female had repeated episodes of heart failure of unknown cause. During cardiac catheterization and echocardiography performed, mitral regurgitation suddenly worsened and improved in a few minutes. The patient was diagnosed as having eclipsed mitral regurgitation with multiple episodes of acute exacerbation and remission. Although mechanism of exacerbation remains unclear, morphological change of the left ventricle is likely to be a major cause, and mitral valve replacement seems better than plasty for prevention of recurrent heart failure. The patient underwent valve replacement using a bioprothesis and was discharged from the hospital on her own 24 days after surgery. Six months after the operation, she has been doing well without recurrence of heart failure.

[Acute Aortic Dissection with Rapidly Enlarged Aneurysm after Methicillin-resistant Staphylococcus Aureus Bacteremia].

The patient is a 62-year-old man. He was referred to our hospital from a nearby clinic with a complaint of chest and back pain, and was urgently admitted with a diagnosis of Stanford type A (Debakey typeⅢbR) acute aortic dissection. During the course of his treatment, he developed a urinary tract infection caused by methicillin-resistant Staphylococcus aureus (MRSA). Thereafter, the patient developed bacteremia, and follow-up computed tomography( CT) showed a rapidly enlarging descending aortic aneurysm and a left external iliac artery( EIA) aneurysm. On day 49 after admission, thoracic endovascular aortic repair, left EIA resection, and right EIA-left femoral artery bypass were performed. However, a contrast-enhanced CT scan on day 70 of hospitalization revealed a type Ia endoleak and enlargement of the descending aortic aneurysm, so the patient underwent replacement of the descending aorta on day 84. Postoperatively, the patient needed time for recovery, but was discharged on day 158. Three years after discharge, there has been no recurrence of infection, and the patient has been visiting our outpatient clinic. We report a case of acute aortic dissection with rapidly enlarged aneurysm after MRSA bacteremia. This serious condition was succesfully cured with continued antibiotic treatment, two surgical resections and revascularization.

Type A Acute Aortic Dissection in a Patient with Patent Ductus Arteriosus.

Cardiac or aortic surgeries requiring cardiopulmonary bypass in combination with patent ductus arteriosus in adults present a special problem that requires a tailored approach. We report a case of ruptured type A acute aortic dissection in a 73-year-old woman with patent ductus arteriosus. In this case, we highlight that transpulmonary direct ductus arteriosus closure and subsequent frozen elephant deployment with total arch replacement are reasonable and reliable treatments for type A acute aortic dissection in a patient with patent ductus arteriosus.

Chronic contained rupture of abdominal aortic aneurysm that developed from chronic abdominal aortic dissection.

A chronic contained rupture is an extremely rare subtype of abdominal aortic aneurysm rupture. We report the case of a 59-year-old man with a medical history of traumatic lumber fracture 7 years ago. He presented to us with an asymptomatic irregular abdominal aortic aneurysm, and surgery was performed 1 week after he was hospitalized. Based on the medical history, imaging, blood tests, and pathologic results, we determined that the chronic contained rupture progressed from a localized abdominal aortic dissection. This case illustrates the need to follow the morphology of aortic aneurysms if chronic abdominal aortic dissection is observed.

Ruptured type A aortic dissection with saddle pulmonary embolism-like appearance on computed tomography angiography.

We present a case of ruptured type A acute aortic dissection with pulmonary trunk compression by mediastinal hematoma. This condition mimicked a pulmonary embolism on the early arterial phase of computed tomography angiography, whereas the correct diagnosis was determined from the late arterial phase and unenhanced computed tomography. We highlight the importance of carefully interpreting triphasic computed tomography angiography to assess the status of aortic dissection.

[Adhesion Prevention Effect of Circular Pericardial Drainage].

Pericardial adhesions can pose serious problems during cardiac reoperation. Here, we report three cases where circular pericardial drainage (CPD) was performed during the initial surgery and no pericardial adhesions were found during reoperation. All three patients had initially undergone an aortic valve replacement with CPD. Case 1:An 80-year-old female was reoperated this time for an aneurysm of the ascending aorta. A replacement of the ascending aorta was performed. Case 2:A 76-year-old male underwent a second aortic valve repair indicated for prosthetic valve infection. Case 3:The patient was an 82-year-old female. This time, mitral valve replacement, indicated for severe mitral valve stenosis, was performed. In these three cases, there were almost no adhesions in the CPD route. The diaphragmatic pericardial surface, the oblique sinus of pericardium, and the lateral side of the left ventricle were also adhesion-free. CPD can effectively drain postoperative pericardial hemorrhage and thus prevent pericardial adhesions.

Calcified Aortic Wall Removal for Dysphagia Aortica Caused by Chronic Traumatic Aortic Pseudoaneurysm.

In this study, we report a case of a 45-year-old man with dysphagia aortica secondary to chronic traumatic aortic pseudoaneurysm of the aortic isthmus. He had been involved in a motor vehicle accident 27 years earlier. Computed tomography demonstrated a severely calcified aortic pseudoaneurysm of the aortic isthmus that compressed the esophagus extrinsically. An invasive surgical procedure involving a graft replacement and removal of the calcified aortic wall released the esophageal compression and completely improved the patient's symptoms. To the best of our knowledge, a case of dysphagia aortica caused by calcified pseudoaneurysm has never been reported.

[Three-dimensional Anatomical Anastomosis in Total Arch Replacement].

The ascending aorta and the aortic arch curve 3-dimensionally from the right front of the heart to its left rear. If this curve is replaced or connected with a straight artificial graft, the curve will lose its natural shape. Here, we reconstructed the ascending aorta and the aortic arch with 2 different types of grafts, and devised a 3-dimensional(3D) structure by anastomosis. "3D anastomosis" first involves reconstructing the ascending aorta and the aortic arch with separate grafts. An oblique incision was then made at the proximal stump of the aortic arch graft so that its tip pointed to the right side of the patient. Similarly, an oblique incision was made at the distal stump of the ascending aorta graft so that its tip pointed to the anterior position of the patient. Then, the 2 grafts were anastomosed in a twisted manner of 90 degrees. Therefore, a 3D form was created from the right front of the heart to its left rear. We achieved good results in 14 patients using this method.

[Usefulness of echocardiography for detecting prosthetic valve dysfunction; report of a case].

A 78-year-old woman with a history of mitral valve stenosis underwent open mitral commissurotomy in 1976. In 1990, she underwent mitral valve replacement (Medtronic-Hall 29 mm), tricuspid annuloplasty(DeVega method), and pacemaker implantation for bradycardiac atrial fibrillation. However, in June 2012, she developed anemia of unknown cause. Prosthetic valve dysfunction was suspected, because intermittent changes in the left ventricular inflow was detected by echocardiography. Fluoroscopy actually confirmed the presence of prosthetic valve dysfunction. Therefore mitral valve re-replacement(ATS Medical, Inc. 29 mm) and tricuspid annuloplasty (Cosgrove ring 30 mm) were performed. Monitoring the changes in the left ventricular inflow is recommended when prosthetic valve dysfunction in a single leaflet is suspected.