ABSTRACT
An 87-year-old woman underwent AVR (CEP 21 mm) for aortic stenosis at age 73 years. Fourteen years later, she was treated with antibiotics for mediastinal abscess, which showed a tendency to shrink and inflammation improved. At that time, no vegetation or aortic regurgitation was observed. Eight months later, the patient was brought to the emergency room with a complaint of respiratory distress. After close examination, a severe transvalvular leakage was found at the aortic valve position. No vegetation was found. Enhanced chest computed tomography (CT) showed an aneurysm of the left sinus of Valsalva. The diagnosis of healed aortic prosthetic valve endocarditis with an aneurysm of the sinus of Valsalva was made. The CEP valve was removed at surgery, and the valve leaflet corresponding to the right coronary cusp was destroyed. The left sinus of Valsalva was dilated and a Perceval was implanted. The patient was doing well postoperatively, but a pacemaker was implanted due to atrioventricular dissection. Transthoracic echocardiography confirmed that there was no problem with prosthetic valve function at the aortic valve position, and CT showed a reduction of aneurysm of the left sinus of Valsalva. The patient was discharged from the hospital on the 30th postoperative day. Aortic valve replacement with Perceval is effective in high-risk cases of prosthetic valve endocarditis.
ABSTRACT
A 48-year-old woman was admitted to our hospital with exertional dyspnea and lower leg edema since 2 months previously. Echocardiogram presented dilation of Valsalva sinus, severe AR (aortic regurgitation) and a supra-annular flap. Enhanced cardiac cycle-gated computed tomography revealed Stanford type A aortic dissection. Primary entry was found just above the aortic valve, the right coronary artery branched from the false lumen, and the commissure between the right and non-coronary cusps was detached. The left coronary artery branched from the true lumen. The false lumen was all patent to the bilateral bifurcations of the common iliac artery. We performed valve sparing partial root remodeling, right coronary artery bypass and total arch replacement after the heart failure management. The operation, cardiopulmonary bypass, aortic cross clamp and selective cerebral perfusion times were 402, 234, 167 and 109 min, respectively. The postoperative course was uneventful, and the patient was discharged 12 days after the operation without any complication. Postoperative CT revealed a well-shaped Valsalva and complete thrombosis of the false lumen on the thoracic aorta. Aortic regurgitation completely disappeared according to a postoperative echocardiogram.
ABSTRACT
Alkaptonuria is a rare genetic disease, in which amino acids and tyrosine cannot be processed. A 72-year-old man with a history of aortic valve stenosis presented with coronary 3-vessel disease. Intraoperative findings included ochronosis, which is pigmentation caused by the accumulation of homogentistic acids in connective tissues, or on the severely calcified aortic valve, the intima of the aorta, and the coronary arteries. The pigmented region of the coronary arteries had significant stenosis. Aortic valve replacement and coronary artery bypass were performed. From these findings and his past history of arthritis, we diagnosed alkaptonuria. The patient had an uneventful recovery.
ABSTRACT
A 66-year-old man was referred to our hospital for the treatment of a right subclavian artery aneurysm. Computed tomography showed a 35-mm aneurysm in the right subclavian artery, and occlusion of the right internal carotid artery. A surgical approach with maintenance of intracranial blood flow was required. During anastomosis of the graft to the native vessel, we clamped the distal and proximal portions of the right subclavian artery, to maintain the blood flow of the right common carotid artery. The INVOS® cerebral oximeter (Somanetics Corp., Troy, MI, USA) was useful in determining the clamping site and surgical strategy. The procedure was completed without complications, and the patient was discharged from the hospital on postoperative day 8 following a good clinical course.
ABSTRACT
A 71-year-old man with Behçet's disease was admitted to our hospital for treatment of a thoracic aortic aneurysm. On admission, there was marked inflammatory response, but blood culture was negative and there was no significant accumulation of gallium scintigraphy. The aorta was shaggy and there were two aneurysms in the descending aorta. We performed endovascular aortic repair for this aneurysm in consideration of the inflammatory aortic aneurysm. After treatment, the patient had paraparesis, however he underwent physical rehabilitation to regain function. He was followed up for 1 year and remains in good clinical condition without anastomotic aneurysm, dilatation or aneurysm at another site.
ABSTRACT
We encountered left main coronary artery hypoplasia in a 14-year-old boy. He had a history of syncope after exercise. Computed tomography revealed hypoplasia of the left main coronary artery and the syncope on exertion was diagnosed as due to myocardial ischemia. We performed off-pump coronary artery bypass (OPCAB) graft using the left internal thoracic artery. The postoperative course was uneventful and chest symptoms were not recognized in daily life. Left main coronary artery hypoplasia is rare, but is associated with adverse cardiac events, including sudden cardiac death. In cases like this, coronary artery bypass graft is indicated.
ABSTRACT
A 62 year-old man presented with severe septic shock complicated by prosthetic graft infection, 7 years after aortic root replacement with a Freestyle stentless valve and graft replacement of the ascending aorta. We initially managed the patient with antimicrobial therapy for 2 months and subsequently surgery was performed, replacing the infected aortic graft with rifampicin-bonded prostheses, and added omentopexy. The infection was cured and has not recurred.
ABSTRACT
A 75-year-old woman presented with dyspnea, and was admitted urgently on a diagnosis of concurrent acute cardiac insufficiency. Because of her low blood pressure and respiratory failure, care was started in the intensive care unit. A transthoracic echocardiogram (TTE) showed severe tricuspid regurgitation (TR). We concluded that her cardiogenic shock was caused by acute right heart failure with severe TR and therefore carried out emergency surgery. We noted expansion of the tricuspid valve ring and shortening of the tendinous cord, and the leaflet was pulled into the right ventricle side. Initially we attempted a tricuspid annuloplasty (TAP), but it proved difficult to control the TR. We therefore performed a tricuspid valve replacement (TVR). The patient was moved from the intensive care unit to a general ward 10 days after the operation, and to another hospital 26 days later.
ABSTRACT
A 68-year-old man visited our hospital with a high fever with chills 4 years after aortic valve replacement. Streptococcal species were cultured with a venous blood culture. An echocardiogram and a cardiac computed tomography (CT) scan revealed a perivalvular abscess (11 mm×15 mm). Because his prosthetic valve functioned well, he was treated with intravenous ampicillin and gentamicin. Cardiac CT scan performed at 6 weeks showed the perivalvular abscess to have disappeared and he was discharged from the hospital. He is free from recurrence of the abscess 20 months after the initiation of therapy.
ABSTRACT
We report the findings in an 82-year-old man diagnosed with acute type A aortic dissection. Computed tomography scan showed that the primary entry site was located in the ascending aorta. This finding was confirmed intraoperatively, and emergency ascending aorta replacement of ascending aorta was performed. He subsequently died on postoperative 7 day due to descending aortic rupture. During autopsy, another entry site was found at the root of the brachiocephalic trunk with a patent false lumen, which might have led to the descending aortic rupture.
ABSTRACT
The prognosis of rhabdomyosarcoma is poor, and its estimated survival is less than year even after radical resection. We report a patient with recurrent rhabdomyosarcoma 11 years after obtaining remission by radical surgical resection and chemotherapy.
ABSTRACT
A 67-year-old man had been followed up in our cardiology clinic for ischemic foot, and routine echocardiography revealed an 8×9mm highly echogenic mass on the mitral posterior leaflet. Because of the high thromboembolic risk, open-heart surgery was scheduled for surgical treatment of the tumor. His preoperative coronary angiogram showed 3 vessel disease. Coronary artery bypass grafting and tumor removal were performed consequently. His postoperative course was uneventful and the lesion was pathologically diagnosed a papillary fibroelastoma. No recurrence has occurred one year after the operation. Surgical treatment of cardiac tumors is mandatory for preventing embolism regardless of the size and location. Most of the tumors on cardiac valves are papillary fibroelastomas and recurrence of this tumor has not been reported so far. When the tumor is attached to a mitral leafet, simple tumor resection, with or without mitral valve repair, is justified instead of performing mitral replacement with en bloc resection of tumors and the entire leaflets.
ABSTRACT
A 46-year-old woman who originally presented acute abdomen was refferect to us. Her CT scan and echogram showed no abnormal findings in her abdomen. However, A 25-mm tumor-like mass was observed in her right atrium and right lower lobe. Based on the concern that the cardiac tumor might be a risk for embolic events, the tumor in her right atrium was resected under cardiopulmonary bypass in a semi-emergency manner. It was diagnosed as malignant lymphoma of B-cell type by histological examination. Two days after operation, she started to have abdominal pain and CT scan showed free air and a significant amount of effusion in her abdomen. Emergency laparotomy was performed and a single perforation with a tumor mass was observed in her small intestine. Segmentectomy was performed and her postoperative course since then was uneventful. Fifteen days after her initial operation, she was referred to the regional hematology center for chemotherapy. Primary cardiac lymphoma was classically defined as an extranodal lymphoma involving only the heart and/or pericardium; however the currently accepted definition is lymphoma with the vast bulk of the tumor intrapericardial even with small secondary lesions elsewhere. According to this recent definition, several cases with extensive extracardial involvements have been reported as primary cardiac lymphoma and our case marginally could be considered primary. Certain cutoffs must be proposed to quantify extracardiac disease in defining primary cardiac lymphoma.
ABSTRACT
A 54-year-old man consulted our hospital because of nocturnal and mild exertional chest pain. Echocardiography demonstrated a mobile mass in the right atrium. There were no abnormal findings on the coronary angiogram. Because of the large size of the mass, surgical removal was carried out and a yellowish, globular tumor, sized 20×15×13mm, attached to the anterior tricuspid leaflet with a short stalk was excised. Postoperative recovery was uneventful. The patient was discharged from the hospital with no symptoms. The diagnosis of papillary fibroelastoma (PFE) was confirmed on histologic examination. PFE is a well-known tumor that usually arises on the heart valves. Although, historically, this tumor has incidentally been discovered at necropsy, clinical case reports have recently increased. However, the vast majority of clinically reported PFEs were the cases of the left side of the heart, for which the operative indication is quite definite because of serious complications such as cerebral or myocardial infarction caused by this tumor, irrespective of size. On the contrary, only a small number (17 cases) of the right heart PFEs have been reported in the literature and its operative indications are unclear. Review with regard to the operative indications for the right heart PFEs was made based on the total of 18 cases including our patient.
ABSTRACT
A 55-year-old man was admitted with anterior chest pain. He had received aorto-renal bypass for left renal artery stenosis at the age of 24. His coronary angiography with ergotamine malate provocation showed 99% stenosis in the left anterior descending artery and circumflex artery and abdominal aortography revealed an aneurysm with a diameter of 4cm at the proximal site of the graft anastomosis. The patient was surgically treated with aneurysmectomy and PTFE grafting (7mm) between abdominal aorta and the already-implanted graft to the left renal artery. His postoperative course was uneventful and no major complication such as renal failure were observed. Anastomotic aneurysm is a fairly common complication associated with arterial reconstruction which is most common in the common femoral artery. This is the first reported case of anastomotic aneurysm complicated by aorto-renal bypass.
ABSTRACT
A 43-year-old woman underwent aortic valve replacement for aortic regurgitation causing aortitis syndrome. The postoperative course had been uneventful and inflammation was controlled by steroid therapy. She developed a moderate degree of dyspnea with cardiomegaly. Two years after the first aorta valve replacement (AVR), severe aortic regurgitation was observed on both echocardiography and aortography. Dehiscence of the prosthetic valve was suspected and an emergency operation was performed. To secure the reimplanted prosthetic valve, we applied the technique of passing felt-pledgeted sutures through the aortic wall in the vicinity to the right coronary cusp and the noncoronary cusp and others through the left coronary cusp with everting mattress sutures. The postoperative course of the second AVR has been uneventful for two months. Since prosthetic valve detachment can occur even if inflammation of aortitis is well controlled, strict management of inflammation is recommended for a prolonged period to prevent reccurence of aortitis and subsequent valve dehiscence.