A Calcified Amorphous Tumor from the Aortic Valve to the Tricuspid Valve with Aortic Valve Stenosis / 日本心臓血管外科学会雑誌

We report a rare case of a hemodialysis patient with calcified amorphous tumor (CAT) originating from aortic valve cusp that continues to tricuspid valve, which may be related to aortic annular calcification and aortic valve stenosis. A 79-year-old female with chronic kidney disease on hemodialysis for 16 years was transferred to our hospital with loss of consciousness. Echocardiography revealed aortic valve stenosis and presence of tumor on the aortic valve and tricuspid valve. We suspected the presence of a cardiac tumor or vegetation. We underwent tumor resection of tricuspid valve and aortic valve replacement and coronary artery bypass grafting (SVG-RCA). Pathological findings of the tumor was CAT.

Successful Repair of a Traumatic Aortic Isthmus Pseudoaneurysm Concomitant with Right Diaphragmatic Hernia / 日本心臓血管外科学会雑誌

A 24-year-old woman underwent successful repair of a traumatic pseudoaneurysm of the aortic isthmus concomitant with right diaphragmatic hernia which developed after a traffic accident, and the steering wheel of the crashed car was considered responsible for both lesions. Due to the right diaphragmatic hernia, she could breathe mainly with the left lung only. The aortic isthmus aneurysm was considered to be a pseudoaneurysm, and because of the potential risk of rupture, we performed urgent aortic surgery. Prior to a left thoracotomy, we anastomosed an 8-mm prosthetic graft to the right axillary artery. When the left lung was collapsed in order to perform a femoro-femoral bypass, the SpO₂ level of her right index finger and her cerebral rSO₂ markedly decreased. Therefore, we administered additional perfusion via the right axillary artery, which provided sufficient oxygen to the upper body and brain. The patient underwent Marlex mesh reinforcement of the right diaphragmatic hernia 30 days after grafting, and is doing well 1 year postoperatively.

Renal Transplantation in a Patient with Uremic Cardiomyopathy Resulting in Marked Improvement of Cardiac Function / 日本心臓血管外科学会雑誌

A 71-year-old man who had been on peritoneal dialysis for 6 years was referred to our hospital for renal transplantation from a living donor. Preoperative echocardiography revealed diffuse severe hypokinesis, a left ventricular ejection fraction (LVEF) of 25%, and a pedicled floating mass in the right atrium. He had not exhibited positive symptoms of active endocarditis or metastatic malignant tumor, and the causes of cardiomyopathy seemed to be uremic and/or ischemic factors. Renal transplantation was postponed, and the extirpation of the mass in the right atrium was scheduled. LVEF improved to 48% 2 months following the induction of hemodialysis before the cardiac operation. Pathohistological findings of the extirpated intra-atrial mass showed sphachelus and fibrotic thrombus, which meant asymptomatic healed infective endocarditis. He recovered uneventfully, and underwent a living renal transplantation from living donor 5 months after the cardiac operation. LVEF further improved better to 56%, and his performance status was remarkably improved. These results imply that renal transplantation and hemodialysis in peritoneal dialysis patients with uremic cardiomyopathy can achive improvement of cardiac function and enable a safe cardiac operation.