Aortic Valve Replacement in a Patient with Essential Thrombocythemia / 日本心臓血管外科学会雑誌

Essential thrombocythemia (ET) is an uncommon type of myeloproliferative disorder, characterized by both thrombotic and hemorrhagic diatheses. No clear guidelines exist for the pre- or post-operative management of patients with ET undergoing cardiac surgery. Here, we present a rare case of a patient with essential thrombocythemia and severe aortic stenosis, who needed an aortic valve replacement on cardiopulmonary bypass and who suffered no complications.

A Surgical Case of Acute Aortic Dissection in a Patient with Rheumatoid Arthritis Being Treated with Tacrolimus / 日本心臓血管外科学会雑誌

We report a rare case of acute type A aortic dissection in a patient with rheumatoid arthritis (RA) being treated with tacrolimus. The patient was a 77-year-old woman, who had received implantation of 6 artificial joints and was treated with 3 mg/day of tacrolimus and 10 mg/day of prednisolone. Tacrolimus, one of the immunosuppressive drugs for severe RA, had been applied to her to reduce the amount of prednisolone. An emergency surgery was performed successfully and 20 mg/day of prednisolone was administered for RA instead of her preoperative regimen. Such simplification of RA medication was actually useful to us for managing her difficult postoperative care. Respiratory insufficiency with persistent preural effusion was regulated by non-invasive positive pressure ventilation (NPPV) and pleural drainage. Disuse syndrome was treated with enteral nutrition and rehabilitation. Such care was also useful for her recovery.

Myocardial Angina due to Compression of the Left Coronary Artery by a Large Aneurysm in the Left Sinus of Valsalva / 日本心臓血管外科学会雑誌

Sinus of Valsalva aneurysm is a rare cardiac disorder, and reports of its origin among in the left sinus are scarce. This report describes a 38-year-old man with an isolated extracardiac unruptured aneurysm of the left sinus of Valsalva. The patient presented with chest pain due to compression of the main trunk of the left coronary artery by the aneurysm. The aneurysm was resected, and the aortic root was reconstructed using the Bentall procedure. Concomitantly, coronary artery bypass grafting (LITA-LAD) was added. Postoperative native coronary flow was fully restored, and his anginal symptoms disappeared despite occlusion of the additional LITA-LAD anastomosis. This type of case would be considered to not require concomitant CABG, since the cause of the coronary artery stricture was compression by an aneurysm in the left sinus of Valsalva.

Leaflet Extension Aortic Valvuloplasty and Mitral Valve Replacement for Congenital Bicuspid Aortic Stenosis with Severe Mitral Regurgitation in a Child / 日本心臓血管外科学会雑誌

A baby girl with a low birth weight was given a diagnosis of congenital bicuspid aortic stenosis and mitral valve prolapse. At the age of 40 days, she underwent balloon aortic valvotomy, but significant aortic regurgitation appeared afterwards. Another surgical intervention became necessary by the age of 20 months (weight, 5.7 kg), because of intractable heart failure mostly caused by exacerbated mitral regurgitation. We performed a leaflet extension valvuloplasty for the small bicuspid aortic valve using an autologous pericardium treated by glutaraldehyde. The mitral valve was replaced with an ATS-16AP valve. Although her postoperative course was complicated with mitral paravalvular leakage and poor left ventricular function, she was discharged from hospital 6 months post operatevely. Leaflet extension valvuloplasty is a surgical option for infants with a small aortic annulus, but the procedure could be the only solution in cases when Konno or Ross techniques are not suitable.