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Article in Japanese | WPRIM | ID: wpr-738311


The patient was a 68-year-old man. In January 2017, he underwent aortic valve replacement (Carpentier-Edwards Perimount Magna, 25 mm, Edwards Lifescience Corporation, Irvine, USA) for aortic stenosis and coronary bypass surgery with two saphenous vein grafts (SVG-#7 and SVG-4PD) for asymptomatic myocardial ischemia. He was treated as an outpatient by a local physician for at least a week during November 2017, with a principal complaint of mild fever, but no other significant symptoms. Transthoracic echocardiography suggested prosthetic valve endocarditis, so he was referred to the author's hospital. The day after admission, he had symptoms of thoracic discomfort, and emergency cardiac catheter examination showed a lesion thought to be due to a thrombus in the left main coronary trunk ; so, thrombus aspiration was carried out. However, no improvement in blood flow was achieved, so balloon angioplasty was carried out, with the aim of improving blood flow in the left circumflex artery, where coronary artery bypass grafting had not been performed. Improvement in blood flow was achieved, and a culture was carried out using the aspirated thrombus. Streptococcus pasteurianus was detected in the culture.

Article in Japanese | WPRIM | ID: wpr-361897


A 53-year-old woman complained of symptoms of congestive heart failure and was admitted to a local hospital. Transthoracic echocardiography showed pericardial effusion and left ventricular aneurysm. The patient was transferred to our hospital for examination for treatment. Coronary angiography demonstrated triple vessels disease. The patient underwent left ventricular reconstruction and coronary bypass grafting. The operative findings showed no adhesion between the aneurysm and the pericardium. The pathological examination after operation indicated a ventricular pseudo-false aneurysm. The differentiation of left ventricular pseudo-false aneurysm from pseudo-aneurysm can be difficult.

Article in Japanese | WPRIM | ID: wpr-367133


We report a successful open heart reoperation of a 14-year-old girl with Alagille syndrome. The patient underwent a living related donor liver transplantation at the age of 9 years in another hospital because of liver failure due to a paucity of interlobular bile ducts. Two years later, because of progression of her aortic valve stenosis, Ross operation and CABG were performed in the same hospital. Afterwards, her neoaortic valve regurgitation developed due to aortic root dilatation and myocardial ischemia developed by anastomosis site stenosis. She started to experience frequent angina attacks. She underwent AVR and redo CABG in our institution in April 2002. Her pre- and postoperative liver function was normal and no special procedure for the liver was needed, and she was discharged on the 18th postoperative day with no complications. In this country, few open heart surgeries for liver transplant recipient have been performed, and no case of reoperation has yet been reported. If pre- and postoperative liver function are normal, pre- and postoperative management of open heart surgery for a transplant may be perfomed conventionally.

Article in Japanese | WPRIM | ID: wpr-366654


A rare case of descending thoracic aortic coarctation caused by fibromuscular dysplasia is reported. A 74-year-old woman was referred to our institution because of congestive heart failure, hypertension, acute renal failure and pressure gradient between upper and lower extremities. Aortography revealed 90% stenosis of the descending mid-thoracic aorta. Descending-descending aortic bypass was performed under femoro-femoral partial cardiopulmonary bypass. The post-operative course was uneventful and the pressure gradient across the coarctation was disappeared. The patient discharged on the 28th postoperative day without any problems. The pathohistological findings revealed fibromuscular dysplasia in the media and intima of the aortic wall.

Article in Japanese | WPRIM | ID: wpr-366599


We report a successful case of graft replacement for ascending and aortic arch aneurysm which developed 5 years after CABG. A 75-year-old woman, who underwent emergency CABG (LITA-LAD, SVG-RCA) 5 years previously, was admitted to our hospital due to an abnormal shadow on chest roentogenogram. Aortogram and coronary angiogram revealed ascending and aortic arch aneurysm and patent LITA and SVG. Graft replacement of the ascending and total aortic arch was carried out using four branched grafts (Gelweave 26/10/8/8<sup>*</sup>8). Cardiopulmonary bypass was established with right axillary arterial perfusion and bicaval cannulation. Cardiac arrest was obtained with cold blood cardioplegia using both retrograde and antegrade techniques. Selective cerebral perfusion was used for brain protection. The patient was discharged without any complication on the 27th postoperative day.