ABSTRACT
A 55-year-old woman with fever and consciousness disorder diagnosed as infective endocarditis was transported to our hospital. She had atopic dermatitis. A mobile vegetation at the mitral valve was revealed by the transesophageal echocardiography, and a computed tomography (CT) scan showed cerebral infarction, left renal infarction and suspected embolization of the vegetation. Streptococcus aureus was detected in the blood culture test. We conducted emergent surgery, mitral valve plasty was performed. On the second day after the operation, the hemoglobin began to decrease, and the hemodynamics became unstable. The contrast CT examination revealed arterial bleeding from the left kidney, which had an infarction before the operation. We performed emergent catheter liquid embolization for the superior polar branch of the left renal artery, and the hemodynamics improved thereafter. There has been no report of renal hemorrhage after cardiac surgery for infective endocarditis. This case reminded us that cardiac surgery for infective endocarditis may cause various complications of organs.
ABSTRACT
With the official launch of the new Japanese board of cardiovascular surgery, there are various changes compared to the old system, such as the choice of training period. We conducted a questionnaire survey to find out how U-40 members perceive and understand the new system. Based on the results of the survey, we discussed and presented the current situation and prospects of the new system at the 52nd Annual Meeting of the Japanese Society for Cardiovascular Surgery.
ABSTRACT
We report a successful case of fulminant myocarditis treated with central ECMO with a transapical left ventricular vent (TLVV). A 33-year-old man was diagnosed with fulminant myocarditis with acute biventricular failure. Using a cardio-pulmonary bypass, we introduced central ECMO with ascending aortic perfusion, right atrial venous drainage and TLVV. After ancillary circulation, his cardiac function gradually improved. The endotracheal tube was removed 5 days after the surgery (POD 5), and he was weaned from ECMO on POD 7 and discharged on POD 38. Although there are many cases in which peripheral veno-arterial ECMO (VA-ECMO) is used for fulminant myocarditis, there is a drawback to VA-ECMO : left ventricle (LV) unloading may be incomplete. Insufficient LV unloading may cause pulmonary congestion or disadvantage in myocardial recovery. TLVV can be used as a solution to unload the left ventricle. Central ECMO with TLVV should be useful therapy for fulminant myocarditis.
ABSTRACT
A 76-year-old man with a complaint of dyspnea was diagnosed with acute severe mitral regurgitation due to ruptured chordae tendineae. For improvement of pulmonary congestion, we introduced IMPELLA 5.0® and extra-corporeal membrane oxygenation before valve surgery. After two-days' IMPELLA 5.0® support, mitral valve replacement surgery with a bioprosthetic valve was performed and IMPELLA 5.0® was withdrawn. We report a successful case of a bridge to surgery using IMPELLA 5.0® with mitral valve regurgitation accompanied by acute left heart failure with severe respiratory failure.