[A Cardiac Metastasis from Colorectal Cancer discovered due to Palpitation and Dyspnea:Report of a Case].

A 61-year-old woman presented to our hospital with complaints of palpitation, dyspnea, and complete atrioventricular block. A tumor filling the right atrium was detected by computed tomography (CT)and echocardiography. Since the symptoms were severe and there was a risk of sudden death due to pulmonary embolism, tumor resection was performed. Pathological results suggested that the tumor was well-differentiated metastatic adenocarcinoma originating from colorectal cancer. Since the tumor could not be completely removed, radiation therapy was performed after the operation. Cardiac metastases from colorectal cancer are relatively rare and are occasionally seen in autopsy cases, but infrequently in surviving cases. Regular follow-up is therefore required.

Revisiting the Aortic Valve Calcium Score in Evaluating the Severity of Aortic Stenosis in Japanese Patients　- A Single-Center Study.

Background: In patients with aortic stenosis (AS), measurement of aortic valve calcification (AVC) using computed tomography (CT) is recommended in cases where echocardiographic measurements are inconclusive. However, sex-specific AVC thresholds proposed in the guidelines for predicting severe AS (women: 1,200 arbitrary units [AU]; men: 2,000 AU) are based on studies from Western countries. Methods and Results: We retrospectively included 512 Japanese patients with at least moderate AS who underwent transthoracic echocardiography and CT. AVC was quantified using the Agatston method. AVC was positively correlated with peak aortic jet velocity and mean transvalvular gradient (mPG), and negatively correlated with aortic valve area (AVA) and the AVA index (AVAi). In 257 patients with concordant AS grading (152 severe AS [AVAi ≤0.6 cm2/m2, mPG ≥40 mmHg], 105 moderate AS [AVAi >0.6 cm2/m2, mPG <40 mmHg]), receiver operating characteristic curve analysis of AVC predicting severe AS yielded an area under the curve of 0.91 (95% confidence interval [CI] 0.87-0.95; P<0.001) in women and 0.86 (95% CI 0.75-0.98; P<0.001) in men. The optimal thresholds (women: 1,379 AU; men: 1,802 AU) were close to those proposed in the guidelines. The diagnostic accuracy of the thresholds in the guidelines was similar to that of the optimal thresholds. Conclusions: The sex-specific AVC thresholds proposed in international guidelines can be applied to Japanese AS patients, yielding similar diagnostic accuracy as the optimal cut-off derived from the study patients.

[Aortic Valve Replacement 36 Years after the First Mitral Valve Replacement with Björk-Shiley Prosthetic Valve;Report of a Case].

A 67-year-old woman was admitted with exertional dyspnea. She had undergone mitral valve replacement with Björk-Shiley prosthetic valve (convexo-concave type) 36 years previously for stenosis and regurgitation in another institute. An echocardiography showed a severe degree of aortic stenosis, and the implanted mitral valve function is normal. We performed aortic valve replacement with a bioprosthetic valve and no prophylactic reoperation for the implanted mitral valve. The postoperative courses were uneventful. The patient was discharged from the hospital in good clinical condition. Postoperative echocardiography showed the prosthetic valves were normal. The close follow-up should be needed to prevent fatal valve dysfunction.

[Debranching and Endovascular Repair for Kommerell's Diverticulum with Right-sided Aortic Arch;Report of a Case].

Right-sided aortic arch (RAA) is a rare congenital disorder. A 87-year-old man with chest pain was diagnosed with a right-sided aortic arch and Kommerell's diverticulum by computed tomography (CT). The diverticulum had a maximum diameter of 57 mm, and surgical intervention was chosen because of the possibility of rupture and dissection. We performed thoracic endovascular aortic repair( TEVAR) with a commercially available device, consisting of bypass grafting of the supra-aortic branches. The postoperative courses were uneventful. The patient was discharged from the hospital in good clinical condition. Postoperative CT showed complete exclusion of the diverticulum without endoleak and device migration. Debranching TEVAR for Kommerell's diverticulum was safe and effective.

[Total Arch Replacement with Open Stent Grafting Technique for an Aberrant Subclavian Artery Cousing Dysphagia;Report of a Case].

An aberrant right subclavian artery (ARSCA) is a relatively rare congenital anomaly of the aortic arch branches. A 63-year-old man suffered from dysphagia, and was referred to our hospital. Computed tomography (CT) revealed an aortic aneurysm (Kommerell's diverticulum) and ARSCA which routed behind the esophagus. We performed total arch replacement with the open stent-grafting technique via median sternotomy. ARSCA was anastomosed to 1 branch of the arch graft at the right side of the trachea, which released esophageal compression. Postoperatively dysphagia disappeared and CT scan indicated successful reconstruction of the distal arch and ARSCA. The open stent-grafting technique is considered to be effective for aortic disease with ARSCA.

[Further Surgery for Mitral Stenosis 12-years after Mitral Valve Repair;Report of a Case].

A rare case of mitral stenosis after mitral valve repair for non-rheumatic mitral regurgitation is presented. An 81-year-old woman who had undergone mitral valve repair using an annuloplasty ring 12 years earlier, was referred to our hospital because of dyspnea during exertion. As echocardiography revealed severe mitral stenosis, and redo surgery was carried out. During the surgery, fibrous tissue covered the annuloplasty ring and extended onto both leaflets of the mitral valve, which narrowed its orifice, by rendering the leaflets stiff and immobile. It was not possible to remove the fibrous tissue covering the mitral valve without damaging the leaflets. Hence, the annuloplasty ring and both leaflets were excised. The mitral valve was replaced with a 27 mm Magna Mitral Ease, and subsequently, postoperative course was uneventful.

[Removal of biventricular thrombi for dilated cardiomyopathy in a patient with acute heart failure].

We report a rare case of a 49-year-old man with biventricular thrombi associated with idiopathic dilated cardiomyopathy (DCM). The patient was admitted with congestive heart failure and pneumonia. Echocardiography revealed mobile "ball-like" biventricular thrombi associated with significantly impaired left ventricular function and severe mitral/tricuspid valve regurgitation. The biventricular thrombi were removed and subsequently, a mitral annuloplasty, as well as papillary muscle approximation and tricuspid annuloplasty were performed. The postoperative course has been uneventful over a period of 2 years and neither thromboembolic events nor recurrence of congestive heart failure has been observed.

[Mitral annuloplasty and coronary artery bypass grafting (CABG) with on-pump beating via left thoracotomy for ischemic mitral valve regurgitation with patent internal thoracic artery( ITA) grafts after CABG;report of a case].

A 69-year-old man was admitted with progressive congestive heart failure due to ischemic mitral valve regurgitation. He had previously undergone coronary artery bypass grafting( CABG) using bilateral internal thoracic arteries( ITAs) and saphenous vein grafts( SVG). An angiogram revealed patent bilateral ITAs and stenosis of the SVG affecting the left circumflex (LCX) branch, which persisted despite repeated catheter intervention. Patent ITA grafts were located immediately beneath the sternum. We performed a mitral annuloplasty and CABG( SVG-LCX) simultaneously with on-pump beating via left thoracotomy. Postoperative course was uneventful and mitral valve regurgitation disappeared with patent SVG-LCX.

[Aortic root replacement with a freestyle stentless valve for prosthetic valve detachment caused by aortitis syndrome; report of a case].

A surgical case of a 65-year-old man with aortitis syndrome is presented. The patient had undergone aortic valve replacement for aortic valve regurgitation with a mechanical prosthesis, followed by a re-do operation (valve fixation) for prosthetic valve detachment 6 months after the 1st operation. Three months after the 2nd operation, perivalvular leakage due to valve detachment was detected again. Aorticroot replacement with a Freestyle stentless valve( full root technique) was performed. Prednisolone was given postoperatively, and no valve detachment nor pseudoaneurysm formation has been noted for 8 years.