A Case of Constrictive Heart Failure Caused by Primary Malignant Pericardial Mesothelioma / 日本心臓血管外科学会雑誌

A 67-year-old man was admitted with right heart failure. He had severe peripheral edema of his lower limbs. The heart failure was treated by diuretics, but after 3 months, he was re-admitted with facial edema and pleural effusion. At this time, the pericardium thickened diffusely and rapidly, constricting the heart. Pericardiectomy was performed to alleviate symptoms of heart failure. The thickened pericardium firmly adhered to the epicardium, from which it was inseparable. A partial pericardiectomy was done. The diagnosis was not confirmed during operation, but primary malignant pericardial mesothelioma was diagnosed on immunohistological examination with carletinin. The patient died from massive pleural effusion and heart failure on the 22nd postoperative day. Primary malignant pericardial mesothelioma is an extremely rare pathology, which is difficult to diagnose and has a poor prognosis. However, this pathology is the disease which we should always mention as a cause of constrictive pericarditis.

Mitral Valve and Left Atrial Myxoma Operation Using a Combined Superior Transseptal Approach / 日本心臓血管外科学会雑誌

The combined superior transsseptal approach (CSTA) has been used for 12 mitral or left atrial myxoma operations. This approach provided excellent exposure of the mitral valve or myxoma. This approach was compared with the transseptal and left atrial approaches in 1 and 3 cases, respectively. There were no differences in operative time, cardiopulmonary bypass time, anoxic time, bleeding volume, blood transfusion volume and postoperative arrhythmic complications. We use CSTA for cases with tricuspid valve disease, small left atrium, reoperation and left atrial myxomas.

Two Successful Surgical Cases of Total Anomalous Pulmonary Vemous Connection with the Ascending Vertical Vein Posterior to the Left Pulmonary Artery in Neonate / 日本心臓血管外科学会雑誌

The supracardiac type is the most common total anomalous pulmonary venous connection (TAPVC) and is thought to be relatively rarely accompanied by pulmonary venous obstruction. An ascending vertical vein usually passes anterior to the left pulmonary artery, connecting to the brachiocephalic vein without obstruction. Now we report two cases in which the vertical vein passed between the left pulmonary artery and left bronchus with severe pulmonary vein obstruction in neonate. The cases are 12-day and 8-day males both of which were diagnosed mainly by UCT and underwent a succesful emergency operation. The former case with more severe pulmonary congestion than the later, had slower improvement of respiratory function and mild pulmonary hypertension after operation. The ascending vertical veins of both cases are compressed between left pulmonary artery and left main bronchus and then the pulmonary venous obstruction will appear and increase pulmonary hypertension. Resultant distention of the pulmonary artery will cause greater compression of the vertical vein. This will create a “hemodynamic vise.” For these cases, an earlier operation is required at the point of post-operative recovery.