Decalcification of Anterior Mitral Valve Leaflet to Repair Moderate Nonrheumatic Mitral Valve Stenosis with Severe Aortic Valve Stenosis / 日本心臓血管外科学会雑誌

A 78-year-old woman was referred to our hospital because of progressive exertional dyspnea due to nonrheumatic severe aortic valve stenosis and moderate mitral valve stenosis with mitral annular calcification. We subsequently performed aortic valve replacement and mitral anterior leaflet decalcification. During surgery, we found that the cause of mitral valve stenosis was calcification of A2 aortic curtain-medial trigon through aortic valve annulus and resected calcification with SONOPET. The postoperative echocardiography revealed good mitral valve motion with mild mitral valve stenosis.

Cardiac Tamponade due to Detachment of the Aortic Valve Commissure / 日本心臓血管外科学会雑誌

A 68-year-old man was taken to our hospital by ambulance due to syncope. He was in shock with cardiac tamponade. Pericardial drainage was performed. Aortic valve regurgitation gradually increased and surgery was performed at 25 days after onset. Surgical finding showed that there was a detachment of the commissure between the right and non coronary cusps of the aortic valve. An intimal tear was detected in the same place and aortic root replacement was required. The patient had a good recovery and he was discharged 14 days after surgery.

A Successful Case of Ascending Aorta-Abdominal Aorta Bypass in a Patient with Atypical Coarctation / 日本心臓血管外科学会雑誌

A 69-year-old woman was admitted with severe hypertension and intermittent claudication. The results of further examination, showed that the hypertension and intermittent claudication were due to stenosis of the descending aorta and we diagnosed atypical aortic coarctation. We performed median sternotomy and ventrotomy with side-to-end anastomosis a woven Dacron graft and the ascending aorta. The graft was passed through the lesser omentum, and mesocolon and to abdominal aorta. The postoperative state was stable, and the hypertension and intermittent claudication were remarkably ameliorated. Many cases of extra-anatomical bypass were reported, and the ascending aorta-abdominal aorta bypass was useful method and, very successful with no complications in this case.

Ruptured Coronary Artery Aneurysm with a Fistulous Communication / 日本心臓血管外科学会雑誌

A 68-year-old woman was referred to our hospital with arrhythmia and cardiomegaly. She lost consciousness in the waiting room. After urgent hospitalization, cardiac ultrasonography showed cardiac tamponade, and urgent pericardial drainage was performed. A ruptured coronary aneurysm with a fistulous communication was diagnosed by CT scan and coronary angiography. Under extracorporeal circulation, ligation of the unusual coronary vessels and resection of the aneurysm were performed. The postoperative course was uneventful and she was discharged on the 25th postoperative day. No ischemic signs were observed on treadmill test at one year after surgery. Most congenital coronary aneurysms are asymptomatic; however, once rupture occurs, it is important to diagnose this condition rapidly and treat surgically.

Successful Surgical Repair of Left Main Coronary Artery Total Occlusion with Aortitis Syndrome / 日本心臓血管外科学会雑誌

We report the successful repair of left main coronary artery obstruction with aortitis syndrome. She was a 39-year-old woman and was admitted to Saiseikai Kumamoto Hospital because of angina pectoris. Her bilateral radial artery pulsation was not palpable. Total occlusion of the left main coronary artery (LMT) and bilateral subclavian artery was detected by angiography. Patch enlargement of the LMT was performed using a Distaflo (Impra Carbon PTFE) graft. Postoperative coronary angiography showed an adequate LMT diameter and sufficient blood flow.

A Case of Papillary Fibroelastoma of the Left Ventricular Septum Complicated with a Rheumatic Valve / 日本心臓血管外科学会雑誌

A 50-year-old man was referred to our hospital with a tumor in the left ventricle. He had suffered from rheumatic fever when 14 years old. He had shown signs of chronic heart failure due to atrial fibrillation and rheumatic valves (ASr, MSr) for 10 years. There was a history of unaccountable fever and rash, so infective endocarditis was suspected and echocardiography was performed. It showed a homogeneous mass with a diameter of approximately 10mm, fixed directly to the left ventricular septum 20mm below the aortic valvular ring. At operation, the tumor was excised together with endocardium and a part of the muscular coat. The rheumatic aortic and mitral valves were replaced with a 21mm SJM AHP and a 27mm SJM MTK mitral valve, respectively. Tricuspid annuloplasty (TAP) (De Vega 29mm) was also performed. Histopathological examination of the tumor revealed benign papillary fibroelastoma. It suggested that the tumors were secondary to mechanical wear and tear, and represent a degenerative process due to rheumatic valve disease.