[Giant Left Ventricular Aneurysm After Double Patch Closure of Ventricular Septal Perforation Through Right Ventriculotomy].

A 66-year-old man. He had myocardial infarction due to occlusion of the left anterior descending branch, which was subsequently complicated by ventricular septal perforation. Ventricular septal perforation was repaired through right ventricle incision, applying double patches for closure, and injecting glue between the patches. The early postoperative course was good, but the infarcted left ventricular anterior wall remained because of the right ventriculotomy approach. A left ventricular aneurysm was demonstrated on postoperative follow-up echocardiography, which gradually enlarged to become giant. Since symptoms of heart failure such as respiratory distress appeared, left ventriculoplasty was performed 29 months after the perforation of the initial surgery. Since thinned left ventricular wall remains following right ventriculotomy approach, risk of postoperative left ventricular aneurysm should be taken into account.

Right heart failure caused by direct pressure of distal arch aneurysm.

We report a rare case of right heart failure caused by distal aortic aneurysm. Although aortopulmonary fistula is a common complication of giant aortic arch aneurysm, right heart failure caused by mechanical pressure by aneurysm is very rare. A 79-year-old female patient presented dyspnea. Contrast computed tomography (CT) of the thorax delineated a 78 mm aortic arch aneurysm pressing the main to left pulmonary artery and a 40 mm pericardial effusion at maximum depth at posterior side. Echocardiography showed the acceleration flow from main to left pulmonary artery and moderate pulmonary hypertension. Left ventricular function, however, was preserved. We diagnosed right heart failure caused by giant aortic arch aneurysm and performed emergency aortic arch aneurysm replacement. After the operation, pulmonary artery pressure decreased and right heart failure improved.

[Thoracic Endovascular Aortic Repair Via Internal Iliac Artery Conduit].

A 77-year-old man with a history of stent implantation in the right common iliac artery(CIA) and the left external iliac artery(EIA) was admitted to our hospital for a rapid growth of an aneurysm( max 53 mm) at Th11 level of the descending aorta. Although thoracic endovascular aortic repair (TEVAR) was required, there were many problems about access rout. The infrarenal abdominal aorta and the left EIA were severely calcified, and the lumens of the right CIA stent(5.3 mm) and the left EIA stent( 4.3 mm) were small in size. Besides, the left CIA was short(13 mm). Therefore, TEVAR was performed by retrograde approach from the left internal iliac artery( IIA) with a tube graft conduit in the hybrid operation room. IIA is a useful option for an access rout in endovascular aortic repair.

[Two-staged Hybrid Repair for Extensive Aortic Aneurysm;Report of a Case].

A 74-year-old woman progressed to extensive aortic aneurysm after 2 years and 6 months from onset of type B dissection. A computed tomography scan revealed aortic aneurysm from ascending aorta to Th12 level of descending aorta. Her appearance was very frailty. Therefore, we performed 2-staged hybrid repair for this case. First, surgical total arch replacement with elephant trunk via median sternotomy was performed. On the 47th days after the 1st operation, thoracic endovascular aortic repair was performed. The spinal drainage was done for spinal cord protection. Postoperative course was uneventful without any complications. Considering a surgical stress, 2-staged hybrid repair using a stent graft was less-invasive than 1 staged graft replacement.

[Cor Triatriatum Diagnosed in Adulthood;Report of a Case].

A 64-years-old man had cor triatriatum (Lucas-Schmidt type I A) with severe mitral regurgitation and atrial fibrillation. We perfomed resection of the anomalous septum between the accessory chamber and left atrium, and conducted mitral annuloplasty and maze procedure. Arrhythmia were not encountered after surgery. The maze procedure and resection of the anomalous septum with mitral surgery proved to be effective for atrial fibrillation with cor triatriatum.

[Extended total arch replacement with coronary artery bypass grafting( CABG) via left thoracotomy;report of a case].

The operative procedure of extensive aortic aneurysm with ischemic coronary artery disease is controversial. We report a case of arch and descending thoracic aortic aneurysm replacement with coronary artery bypass grafting(CABG)via left thoracotomy. A 70-year-old man followed up by hepatic disease was diagnosed with expanding aortic thoracic aneurysm at the other hospital. He had admission to our hospital for surgical intervention. Computed tomography(CT)revealed arch and descending thoracic aortic aneurysm, and coronary arteriography (CAG) revealed #7 90% and #13 75% stenosis. We performed arch and descending thoracic aortic aneurysm replacement with CABG via left thoracotomy. Replaced synthetic graft and bypass grafts were patent on the postoperative CT. He was discharged at 15th postoperative day with no morbidity.

[Mitral valve repair for papillary muscle rupture; report of a case].

Papillary muscle rupture associated with acute myocardial infarction (AMI) is well known, but it's incidence is rare. We report a case of mitral valve repair with artificial chordae for partial papillary muscle rupture after AMI. A 75-year-old man underwent percutaneous coronary intervention(PCI) for right coronary artery because of AMI about 2 months ago at another hospital, and suffered from dyspnea 1 week after PCI. He had emergency admission to our hospital for cardiac failure. Echo-cardiogram revealed severe mitral regurgitation due to posterior papillary muscle rupture. We performed mitral valve repair with neochorda implantation to left ventricular wall of papillary muscle rupture site and ring annuloplasty. Mitral regurgitation was well controlled on postoperative echo-cardiogram. He was discharged at 25th postoperative day with no morbidity.

[A case of drug-induced eosinophilic pneumonia due to tegafur-uracil(UFT®)].

A 68-year-old female received a left lower lobectomy for lung cancer (adenocarcinoma, pT2N1M0, stage II B). She had a postoperative bronchial fistula that was treated conservatively and cured. Two months after the operation, tegafur-uracil (UFT) 300 mg/day was initiated.She felt dyspnea on exertion after taking UFT for two weeks, and some infiltration shadows were observed on a chest X-ray two weeks later. A chest CT scan revealed unsegmental infiltration shadows at the intermediate areas of the right middle and lower lobes, and an air-bronchogram was observed inside of the shadows. A bronchoscopy was performed. Bronchoalveolar lavage revealed a high fraction rate of eosinophil(24%), and a transbronchial lung biopsy revealed infiltrations of lymphocytes, eosinophils and neutrophils into the intra-alveolar space. However, fibrosis of the alveolar wall was not observed. A drug-induced lymphocyte stimulation test was performed for UFT, resulting positive. She was diagnosed as drug-induced eosinopilic pneumonia due to UFT. After she discontinued UFT and started 30 mg/day of prednisolone, dyspnea and infiltrations on chest X-ray disappeared.

Mapping a nucleolar targeting sequence of an RNA binding nucleolar protein, Nop25.

Nop25 is a putative RNA binding nucleolar protein associated with rRNA transcription. The present study was undertaken to determine the mechanism of Nop25 localization in the nucleolus. Deletion experiments of Nop25 amino acid sequence showed Nop25 to contain a nuclear targeting sequence in the N-terminal and a nucleolar targeting sequence in the C-terminal. By expressing derivative peptides from the C-terminal as GFP-fusion proteins in the cells, a lysine and arginine residue-enriched peptide (KRKHPRRAQDSTKKPPSATRTSKTQRRRR) allowed a GFP-fusion protein to be transported and fully retained in the nucleolus. When the peptide was fused with cMyc epitope and expressed in the cells, a cMyc epitope was then detected in the nucleolus. Nop25 did not localize in the nucleolus by deletion of the peptide from Nop25. Furthermore, deletion of a subdomain (KRKHPRRAQ) in the peptide or amino acid substitution of lysine and arginine residues in the subdomain resulted in the loss of Nop25 nucleolar localization. These results suggest that the lysine and arginine residue-enriched peptide is the most prominent nucleolar targeting sequence of Nop25 and that the long stretch of basic residues might play an important role in the nucleolar localization of Nop25. Although Nop25 contained putative SUMOylation, phosphorylation and glycosylation sites, the amino acid substitution in these sites had no effect on the nucleolar localization, thus suggesting that these post-translational modifications did not contribute to the localization of Nop25 in the nucleolus. The treatment of the cells, which expressed a GFP-fusion protein with a nucleolar targeting sequence of Nop25, with RNase A resulted in a complete dislocation of the protein from the nucleolus. These data suggested that the nucleolar targeting sequence might therefore play an important role in the binding of Nop25 to RNA molecules and that the RNA binding of Nop25 might be essential for the nucleolar localization of Nop25.