[Early Structural Valve Deterioration of Bioprosthetic Mitral Valve in a Dialysis Patient].

Choice of prosthetic valve during valve replacement in dialysis patients is still controversial. There is a known risk of early structural valve deterioration of bioprosthesis in dialysis patients, whereas mechanical prosthesis is associated with a higher risk of bleeding and thrombotic events. A 68-year-old dialysis-dependent woman, who had undergone bioprosthetic mitral valve replacement at the age of 66, was admitted to our hospital because of general malaise and hypotension during dialysis. Echocardiography revealed severe mitral stenosis and regurgitation due to restricted motion and dense calcification in prosthetic valve leaflets, which indicated early structural valve deterioration. Redo mitral valve replacement using a mechanical valve was performed, and the patient gradually recovered. However, she eventually died of intracranial hemorrhage three months after the surgery.

[Mitral Valve Replacement and Cardiac Resynchronization Therapy for Mitral Regurgitation with Left Ventricular Noncompaction:Report of a Case].

Left ventricular noncompaction (LVNC) is a rare congenital abnormality resulting from an arrest of the normal process of myocardial compaction. LVNC has been known as a disease of infants, however, some surgical cases of LVNC in adult have been reported. A 61-year-old man who was diagnosed as dilated cardiomyopathy due to LVNC was admitted to our hospital because of dyspnea. Echocardiography revealed severe mitral regurgitation and diffuse left ventricular hypokinesis, and the hypokinetic wall consists of a thin compacted epicardial layer and a thicker noncompacted endocardial layer. Mitral valve replacement using a mechanical valve and cardiac resynchronization therapy were performed. The patient was easily weaned from cardiopulmonary bypass with medium-dose inotropic support and scheduled intra-aortic balloon pumping( IABP). Postoperative course was uneventful, and he was discharged in good condition on the 29th postoperative day.

[Endovascular Repair of Infected Thoracic Aortic Aneurysm whose Shape Changed during Treatment of Infection].

We report a successful case of infected thoracic aortic aneurysm treated by endovascular repair. An 82-year-old woman, presenting with intermittent back pain and low-grade fever, was transferred with the diagnosis of infected thoracic aortic aneurysm. High inflammatory reaction and a thickened aortic wall around the aneurysm confirmed the diagnosis. We performed infection control first because enhanced computed tomography (CT) scanning revealed aneurysm was a low-density mass, which denied aortic pseudoaneurysm or rupture. After administration of broad-spectrum antibiotics, low-grade fever was relieved and inflammatory reactions were decreased. CT performed on the 11th hospital day showed the low-density mass was decreased in size. However, CT performed on the 35th hospital day revealed penetrating atherosclerotic ulcer( PAU) into the low-density mass, which was consistent with saccular aortic aneurysm. The patient underwent thoracic endovascular aortic repair( TEVAR). Postoperative course was uneventful and she was discharged on 22nd postoperative day. Oral administration of antibiotics was continued for 6 months after discharge. Eight months after TEVAR, CT revealed disappearance of the aneurysm. The patient showed no recurrence of infection at 5 years of follow-up.

[Reconstruction of the posterior mitral annulus using a crescent-shaped collar; a novel technique for mitral valve replacement in the severely calcified annulus; report of a case].

A 74-year-old female who had been on hemodialysis for 4 years developed congestive heart failure. Severe mitral valve stenosis and tricuspid regurgitation were thought to be causes of her heart failure. She underwent a replacement of severely calcified mitral valve and an annuloplasty of tricuspid valve. We excised both mitral leaflets, however, just a 21 mm sizer could pass through the annulus. Because posterior annular calcification was so severe we could not palace sutures. Therefore, we placed noneverted horizontal mattress sutures from the left ventricle to the atrium on the anterior annulus, and everted horizontal mattress sutures on the posterior left atrial wall. A crescent-shaped felt patch was sutured to the posterior left atrial wall for annular reconstruction. Then the prosthetic valve was fixed onto this felt patch, resulting a 25 mm ATS valve was seated successfully at a supraannular position. Although the patient died from a sepsis on postoperative day 14, the prosthetic valve functioned normally without any perivalvular leakage.