RESUMO
We report a successful case of aortic valve-sparing root replacement for dilated aortic root after a Ross procedure. A 29-year-old male underwent a Ross procedure when he was 11 years old for congenital aortic bicuspid valve. The right ventricular outflow tract was reconstructed using an autologous pericardium as a single leaflet valve. Aortic root dilatation and moderate aortic valve regurgitation were noted. Further investigation with enhanced computed tomography and ultrasonic cardiography revealed good quality of leaflets and sufficient geometric height, and aortic valve-sparing root replacement was performed. In addition, we performed pulmonary valve replacement with a biological valve. The post-operative course was uneventful and the patient was discharged after 8 days with a completely controlled aortic valve regurgitation. No recurrence of aortic valve regurgitation was observed 1 year later. Because surgical outcomes of congenital heart diseases have improved and more patients have an increasing life expectancy, several other problems were revealed, such as the occurrence of aortic root dilatation after a Ross procedure. Aortic roots may dilate due to arterial pressure; however, valve-sparing procedures may be performed if the volume of the leaflets is sufficient.
RESUMO
Cardiac metastasis from cervical cancer is rare. We herein present a case involving a 54-year-old woman with cervical cancer who was undergoing radiotherapy for left supraclavicular lymph node metastasis. The patient was admitted to the hospital because of shortness of breath. Transthoracic echocardiography showed a large mass in the right ventricle. To rescue the patient from circulatory collapse, we surgically resected the intracardiac mass via a right ventricular incision parallel to the posterior descending artery and left anterior descending artery. This approach prevented right ventricular outflow tract obstruction and perioperative pulmonary embolization, which could have led to death. The intracardiac mass was diagnosed as squamous cell carcinoma. After hospital discharge, the patient underwent chemotherapy. An echocardiography performed 3 months postoperatively showed recurrence of the cardiac metastasis, and the patient died 5 months later. Cardiac metastasis in the right ventricle can present as pulmonary embolization. Although rare, most cases of metastasis from cervical carcinoma to the heart have an extremely poor prognosis.
RESUMO
The patient was a 68-year-old woman. She was diagnosed with uterine cancer after experiencing irregular genital bleeding. Contrast-enhanced computed tomography showed a 30 mm left ventricular mass and splenic infarction, and head MRI showed multiple cerebral infarctions. The patient was suffering from systemic embolism caused by the cardiac mass, and we decided to perform cardiac mass removal prior to uterine cancer treatment. A yellowish-white thrombus-like mass attached to the mitral valve, subvalvular tissue, and left ventricular endocardium was removed by a trans-septal approach under cardiopulmonary bypass. Pathological examination revealed that the mass was a fibrin-based thrombus with almost no inflammatory findings, we diagnosised non-bacterial thrombotic endocarditis (NBTE). Postoperatively, the patient developed Takotsubo cardiomyopathy, and treatment for uterine cancer, was delayed. Hypercoagulability was not controlled well, and she developed recurrence of left ventricle vegitation, acute arterial occlusion of the lower extremities and inferior vena cava thrombosis, making active intervention for uterine cancer difficult. The patient was treated palliatively and died on POD 36. NBTE tends to be characterized by multiple small growths, but giant vegetation may also occur as in this case. Unless the primary disease causing the hypercoagulability is treated, recurrence of NBTE is possible, and prompt treatment of the primary disease is required.