A Case of Successful Valve Repair in Traumatic Aortic Regurgitation Associated with the Dilated Aortic Annulus / 日本心臓血管外科学会雑誌

Here, we present a case of successful aortic valve repair of traumatic aortic regurgitation (AR). A man in his early twenties had a chest blunt trauma due to a bicycle accident 6 years earlier and suffered sternum fracture. He recovered without cardiovascular complications. Three months previously, a new diastolic murmur was detected on medical checkup. Transthoracic echocardiography (TTE) showed severe AR, and the left ventricular end-diastolic-/end-systolic dimension was 69/51 mm. Transesophageal echocardiography showed severe AR with perforation of the non-coronary cusp and dilatation of the aortic annulus (29.6 mm). Aortic valve repair was performed with an autologous pericardial patch and external suture annuloplasty. Postoperative TTE showed normal aortic valve function with trivial AR. He was discharged on postoperative day 11. Three months later, TTE showed trivial AR along with a reduced left ventricular dimension and improved left ventricular ejection fraction.

Aortic Valve Replacement Associated with Essential Thrombocythemia / 日本心臓血管外科学会雑誌

Essential thrombocythemia is a rare disease belonging to the group of chronic myeloproliferative disorders. It displays both thrombogenic and bleeding tendencies due to increased platelet counts, as well as dysfunction. Aortic valve replacement with a 23mm Carpentier-Edwards bioprosthesis was performed for a 74-year-old man with aortic stenosis associated with essential thrombocythemia. No pre-treatment was performed before surgery, though the platelet count was 80×10⁴/μl. During the surgery, activated coagulation time was kept over 400 sec with heparin. There was no difficulty with hemostasis. Aspirin and warfarin were used as antiplatelet and anticoagulant agents after surgery, so the thrombin test results were controlled at around 30%. Since the platelet count reached 130×10⁴/μl, hydroxyurea as chemotherapy was given to suppress the platelet count below 100×10⁴/μl. The operation was completed without major problems and the postoperative course was uneventful. This patient remains in good condition.