A Case in Which Mitral Valve Replacement Was Performed for Recurrent Severe Mitral Regurgitation by Single Leaflet Device Attachment (SLDA) after MitraClip / 日本心臓血管外科学会雑誌

After a MitraClip was implanted for mitral regurgitation (MR), we experienced a case in which mitral valve replacement was performed for recurrent severe MR because of a detached MitraClip. The case was an 82-year-old woman. The MitraClip was implanted for severe MR and regurgitation was controlled to a mild level, but one month after the operation, symptoms of heart failure appeared, and single leaflet device attachment (SLDA) with severe MR was observed on the echocardiogram. As the heart failure symptoms recurred, surgical mitral valve replacement was performed. Because of severe kyphosis, the left atrial approach with a midline sternum incision made it difficult to achieve a good operative field and this was changed intraoperatively to a transseptal approach. The MitraClip was firmly fused with the anterior leaflet A2, so it was judged that removal of the clip was difficult and valve repair was impossible ; it was thus decided to replace the valve. The mark of the MitraClip could be observed on the posterior leaflet, and it appeared to have been inserted for only about 1-2 mm. A bioprosthetic valve was implanted, preserving the posterior leaflet. There were no problems in weaning the patient from cardiopulmonary bypass. The postoperative course was uneventful, and she was discharged on the 14th day after the operation. Valve repair is difficult in a case with a merged SLDA after insertion of a MitraClip, and valve replacement needs to be performed, so it is important to pay attention to the attachment of the MitraClip.

Cardiac Tumor Resection through Right Mini-thoracotomy / 日本心臓血管外科学会雑誌

We herein report a case of cardiac tumor resection through a right mini-thoracotomy. A 48-year-old man exhibited no symptoms. A mass was detected incidentally in the right atrium on computed tomography. We performed resection under cardiopulmonary bypass through a right mini-thoracotomy. Histopathological examination confirmed that this tumor was a lipoma. The patient's postoperative recovery was uneventful. He was discharged on postoperative day 6. As cardiac tumor resection through right mini-thoracotomy is minimally invasive, this approach may be useful for surgery in cases of benign cardiac tumors.

A Case of EVAR for Mycotic Aneurysm Rupture / 日本心臓血管外科学会雑誌

We report a case of mycotic aneurysm treated with endovascular aneurysm repair (EVAR). An 80-year-old man was admitted to a local hospital with high fever and lower back pain. Pyogenic spondylitis and psoas muscle abscess were diagnosed. Klebsiella pneumoniae was confirmed by blood culture. Treatment with intravenous antibiotics was not effective and contrast computed tomography (CT) scan showed an enlargement of the abscess and an abdominal aortic rupture. The patient was immediately transferred to our hospital. Laboratory tests showed an elevated C-reactive protein (12.3 mg/dl) and WBC (10,400/μl). Mycotic abdominal aneurysm rupture was diagnosed by CT scan. He underwent an emergency EVAR with an Excluder® (aorta extender). Intraoperative angiography showed a ruptured abdominal aorta. After operation, he was treated with intravenous minocycline and ampicillin, and the size of the abscess reduced without any endoleak on enhanced CT imaging. After intravenous antibiotics therapy for 4 weeks, we switched to oral antibiotics (minocycline and ciprofloxacin) and continued them for 6 months. As of 2 years after the surgery, there are no signs of infection or recurrence.