[Ascending Aortic Replacement and Aortic Valve Replacement in a Patient with Cold Agglutinins].

Cold agglutinins are commonly found in healthy individuals. Cold agglutinins bind to red blood cells at low temperatures, such as during cardiovascular surgery. Agglutination leads to hemolysis and embolism. A 73-year-old man with cold agglutinins disease underwent ascending aortic replacement and aortic valve replacement. As there was no agglutination reaction at 34 degrees centigrade in preoperative testing, we performed the operation under cardiopulmonary bypass and cardioplegia at a temperature above 34 degrees centigrade. He was discharged without any complications.

[Stanford Type A Aortic Dissection with Tricuspid Regurgitation in a Patient with Situs Inversus Totalis].

Situs inversus totalis is a congenital anomaly characterized by a mirror image transposition of the normal visceral organs, which makes it difficult to perform aortic surgery accurately. Stanford type A aortic dissection in patients with this condition is very rare and difficult to assess and manage. We report a case of Stanford type A aortic dissection with situs inversus totalis. The patient presented with severe tricuspid regurgitation with annulus enlargement due to chronic atrial fibrillation, requiring ascending aortic replacement and tricuspid annuloplasty. These procedures were performed after the operator swapped the left and right positions during the operation. Postoperative course was uneventful. By carefully checking the preoperative computed tomography images and changing the operator's position during the operation, it is possible to safely perform Stanford type A aortic dissection surgery in patients with situs inversus totalis.

[Extended Sandwich Patch Technique through Right Ventriculotomy in Patient with Septal Perforation Developed after Off-Pump Coronary Artery Bypass Grafting;Report of a Case].

A 72-year-old diabetic man was diagnosed with acute myocardial infarction of the anterior wall and underwent emergency off-pump coronary artery bypass grafting. He was diagnosed with ventricular septal perforation(VSP) 3 days after the operation. We urgently performed surgical repair of VSP with "extended sandwich patch technique through right ventriculotomy". There was no shunt recurrence. This technique is considered to offer safe, simple and leak-free repair even in an acute phase of VSP.

Outcomes after aortic valve replacement for aortic valve stenosis, with or without concomitant coronary artery bypass grafting.

OBJECTIVES: To assess the effects of concomitant coronary artery bypass grafting (CABG), we analyzed the outcomes after aortic valve replacement (AVR) for aortic stenosis (AS) with and without coronary artery bypass grafting (CABG) at our institution. METHODS: Between 2002 and 2014, 605 consecutive patients underwent AVR for AS. Of these, the 275 who received isolated AVR (Group A) and the 122 who received both AVR and CABG (Group AC) patients were enrolled, after the exclusion of 8 patients who underwent reoperation and 200 who received other concomitant surgery. AVR and all bypass anastomoses were performed under intermittent retrograde cold blood cardioplegia. Multivariate analysis was used to assess any association of concomitant CABG with morbidity and mortality. Kaplan-Meier analysis was used to assess all-cause mortality. RESULTS: No significant difference in 30-day mortality was found between Group A and Group AC (1.5% vs. 0.8%, P = 1.000). Nor did post-discharge survival differ significantly between the two groups (P = 0.20). Likewise, multivariate analysis showed that concomitant CABG was not associated with significantly greater in-hospital or mid-term mortality. Operative morbidities were comparable between the two groups, in terms of stroke (1.8% vs. 3.3%, P = 0.466), prolonged ventilation (4.0% vs. 5.5%, P = 0.565), deep sternal infection (1.8% vs. 3.3%, P = 0.466), and acute renal failure (0.4% vs. 1.6% P = 0.176). CONCLUSIONS: Concomitant CABG at the time of AVR was performed without increasing early- or mid-term mortality. This absence of increased risk deserves consideration when choosing between different treatment strategies.

Early and follow-up results of butterfly resection of prolapsed posterior leaflet in 76 consecutive patients.

OBJECTIVE: The present study aims to examine the medium-term results of butterfly resection. METHODS: Of 587 consecutive patients who underwent surgery for mitral regurgitation between January 2002 and August 2012, 162 patients underwent valve reconstruction of a prolapsed posterior leaflet. Quadrangular resection (n = 50, Quadrangular group) was primarily used before November 2006 (when we innovated the concept of butterfly resection). After that, we mainly used butterfly resection (n = 76, Butterfly group). RESULTS: Although there was no sign of systolic anterior motion in the Butterfly group, it occurred in 2 patients in the Quadrangular group. One patient in the Quadrangular group died of stroke at postoperative day 17. The mean follow-up period was 2.2 ± 1.6 years for the Butterfly group and 6.1 ± 2.5 years for the Quadrangular group. During those periods, 2 patients died of noncardiac causes in the Butterfly group and 1 patient died of an unknown cause in the Quadrangular group. One patient in the Quadrangular group required a reoperation for recurrent mitral regurgitation arising from a new lesion of the anterior leaflet. One patient in the Butterfly group required a reoperation for partial dehiscence of suture at the posterior leaflet. The 3-year estimated survivals free from overall death and reoperation for recurrent mitral regurgitation in the Butterfly group and the Quadrangular group were 97% ± 2% versus 96% ± 3% (P = .89) and 95% ± 3% versus 96% ± 3% (P = .75), respectively. CONCLUSIONS: Butterfly resection provides acceptable early and medium-term results.

[Mitral valve repair for mitral regurgitation induced by infective endocarditis complicated with ulcerative colitis; report of a case].

Infective endocarditis is a rare complication of ulcerative colitis. We report on a 22-year-old man, who had been treated of ulcerative colitis for 5 years. He presented with dyspnea on effort. In spite of medical treatment, he developed congestive heart failure. Transthoracic echocardiography showed a large perforation on the anterior leaflet of the mitral valve, and prolapses of the posterior leaflet of the mitral valve with rupture of the chordae. The patient underwent mitral valve repair with an autologous pericardial patch on the anterior leaflet combined with butterfly resection and suture of the posterior leaflet. The postoperative course was uneventful.

Target vessel detection by epicardial ultrasound in off-pump coronary bypass surgery.

OBJECTIVE: The detection of embedded coronary arteries is difficult especially in off-pump coronary bypass surgery. From June 2010, we introduced high-frequency epicardial ultrasound (ECUS) to assess and evaluate embedded arteries during off-pump coronary bypass surgery. METHODS: Between June 2010 and June 2011, a total of 89 consecutive patients underwent isolated coronary bypass surgery at our institution. The patients consisted of 72 men and 17 women with a mean age of 67.9 years. We routinely use the VeriQC system (MediStim, Oslo, Norway) to detect the target vessels in the operation. The patients were assigned to one of two groups, depending on whether ECUS was used in the operation (n = 10, ECUS group) or not (n = 79, non-ECUS group). We analyzed the impact of introducing the ECUS in terms of operative outcome. RESULTS: All patients underwent revascularization using the off-pump technique without emergent conversion to cardiopulmonary bypass during surgery. The total number of distal anastomoses was 299, and 12 target vessels could not be identified either visually or on palpation. Thus, the frequency of the embedded coronary arteries was 4.01% (12/299 cases). The preoperative profiles of the two groups were not significantly different. Operation time was significantly longer in the ECUS group (P = 0.02). There were no significant differences in postoperative outcome between the two groups. CONCLUSIONS: In the present study, in which the target coronary arteries could not be detected either visually or on palpation in 12 (4.01%) of 299 cases, the use of high-frequency ECUS allowed all patients to undergo off-pump coronary bypass surgery without conversion to cardiopulmonary bypass during the operation. High-frequency ECUS is therefore useful in off-pump coronary bypass surgery.

A giant main pulmonary artery aneurysm associated with infundibular pulmonary stenosis.

We report a case of a giant pulmonary artery aneurysm associated with infundibular pulmonary stenosis. Echocardiography disclosed markedly enlarged main pulmonary artery, but no left to right shunt flow at levels of the atrial septum, ventricular septum and the pulmonary artery. Continuous wave Doppler revealed a maximum velocity of 1.5 m/s which corresponded to the pressure gradient between the right ventricle and the pulmonary artery of 9.5 mmHg. Contrast-enhanced multidetector-row computed tomography with a 16-slice scanner revealed pulmonary artery aneurysm with the maximum diameter of 67 mm on axial image.

Pericardial-peritoneal window for chronic exudative pericarditis using a subxiphoidal approach: report of three cases.

From August 1986 to February 2000, three patients were given a pericardial-peritoneal window using a subxiphoidal approach, for pericardial effusion associated with chronic exudative pericarditis. Complete drainage without recurrence was achieved in two patients with a large pericardial-peritoneal window (4 cm diameter) and effusion recurred in another with a small pericardial-peritoneal window (3cm diameter). No complications were encountered. The pericardial-peritoneal window, approached subxiphoidally, is a simple, safe, and effective procedure and applicable in most patients with non-infectious benign pericardial effusion. We herein describe our techniques, clinical characteristics, and the results for three patients undergoing this treatment.

Fenestrated stent-graft for traumatic juxtahepatic inferior vena cava injury.

PURPOSE: To report the use of a fenestrated stent-graft to manage a traumatic rupture of the juxtahepatic inferior vena cava (IVC). CASE REPORT: A 62-year-old man was involved in a traffic accident and hospitalized for severe right leg fractures. Computed tomography also uncovered liver contusion and retroperitoneal hematoma. The next day, he became hemodynamically unstable; a huge retroperitoneal hematoma had developed from a rupture of the juxtahepatic IVC. An emergent procedure to implant a self-expanding fenestrated stent-graft was successful in repairing the IVC injury and maintaining hepatic venous return. The patient recovered and continues in good health with a patent endograft 16 months after treatment. CONCLUSIONS: This experience supports the efficacy of fenestrated endograft implantation for emergent repair of IVC injuries, although proper facilities, an experienced interventional team, and an assortment of devices must be available.