A surgical resection case of myxoma arising from the posterior wall of the left atrium complicated with complete atrioventricular block.

An 80-year-old female was referred to our institution due to transient right upper limb weakness. Transthoracic and transesophageal echocardiography revealed a tumor in the left atrium. The tumor was attached to the posterior wall of the left atrium near the atrioventricular node. Intraoperative pathological examination revealed that the tumor was a myxoma, and complete resection was successfully performed. However, she experienced persistent complete atrioventricular block postoperatively and required pacemaker implantation.

Successful "PETTICOAT" procedure assisted by aortic angioscopy for complicated type B aortic dissection: Case report.

INTRODUCTION: Thoracic endovascular aortic repair (TEVAR) is a useful treatment for acute type B aortic dissection (TBAD). A PETTICOAT (Provisional ExTension to Induce COmplete ATtachment) procedure can be an alternative surgical option for a patent false lumen. Non-obstructive aortic angioscopy is an attractive modality that can visualize the aortic intima for things such as entry or re-entry tears that are difficult to detect with computed tomography (CT). Herein, we describe a successful PETTICOAT procedure assisted by aortic angioscopy for subacute TBAD complicated by lower limb ischemia. PRESENTATION OF CASE: A 63-year-old man who had been treated with conservative therapy for subacute TBAD had intermittent claudication. Enhanced CT revealed a primary entry tear at the distal arch, and the true lumen at the thoracoabdominal level was narrowed by the patent false lumen. Therefore, the PETTICOAT procedure was performed. The postoperative course was uneventful, with normalized lower limb pressure. DISCUSSION: Although PETTICOAT procedure is effective for treating complicated TBAD, there is no consensus on where and how far the proximal stent graft or distal bare stent should be implanted. Non-obstructive aortic angioscopy during PETTICOAT is useful to detect and cover the entry and re-entry tears. The PETTICOAT procedure assisted by aortic angioscopy could contribute to determining the appropriate coverage range of the stent graft. CONCLUSION: Aortic angioscopy could contribute to the surgical success of PETTICOAT procedure for complicated subacute TBAD.

Successful surgery for secondary aortoduodenal fistula based on 18F-fluorodeoxyglucose positron emission tomography/computed tomography findings.

Secondary aortoduodenal fistula (sADF) is a critical late complication of abdominal aortic repair, requiring complete excision of the infected prosthesis. However, this is a highly invasive procedure for the elderly. We describe a case of sADF repair in a 76-year-old woman. Through 18F (fluorine-18)-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography mapping, focal high FDG uptake at the sADF site, right medial limb, and ligated left lateral limb of the prosthesis was detected. The duodenal and prosthetic grafts were partially resected. The proximal and distal anastomotic segments, with no FDG uptake, were retained. The abdominal aorta was reconstructed using a bovine pericardium roll and femorofemoral bypass. Thus, FDG positron emission tomography/computed tomography mapping of the infection site could help in such cases.

Total arch and descending thoracic aortic replacement for massive hemoptysis requiring CPR caused by intrapulmonary penetration of chronic dissecting aortic aneurysm: a case report.

BACKGROUND: Intrapulmonary penetration of the thoracic aorta is a rare, life-threatening complication of a chronic dissecting aortic aneurysm. It causes massive hemoptysis requiring prompt intervention to prevent fatal airway bleeding. A surgical approach that enables diverse surgical maneuvers and intraoperative organ protection is crucial. CASE PRESENTATION: A 62-year-old man, who underwent graft replacement of the ascending aorta for an acute type A aortic dissection 20 months before, developed massive hemoptysis and cardiac arrest. The hemoptysis was secondary to an aortopulmonary fistula from a rapidly expanding dissecting aortic aneurysm. However, a successful return of spontaneous circulation was achieved with cardiopulmonary resuscitation, including establishment of veno-arterial extracorporeal membrane oxygenation. The patient successfully underwent a total arch and descending thoracic aortic replacement. This was achieved by a median sternotomy combined with a left thoracotomy using a straight incision with a rib-cross (SIRC) approach. The patient was uneventfully discharged and remained well for the following 2 years. CONCLUSIONS: When performing a surgical graft replacement for an aortopulmonary fistula with a thoracic aortic aneurysm, the surgical approach chosen is critical. A surgical procedure using a median sternotomy combined with a left thoracotomy and a SIRC approach can be an effective therapeutic option.

Successful concomitant minimally invasive surgery for aortic valve stenosis and right lung cancer via right mini-thoracotomy : A case report.

BACKGROUND: The case of aortic valve stenosis complicated with lung cancer have compelled cardiovascular surgeons to make challenging. We report the first successful short-term outcomes of one-stage minimally invasive aortic valve replacement and video-assisted thoracoscopic surgery lobectomy through right mini-thoracotomy in a patient with synchronous bicuspid severe aortic valve stenosis which was unsuitable for transcatheter aortic valve implantation and right lung cancer. CASE PRESENTATION: A 76-year-old man with severe aortic valve stenosis was diagnosed with lung cancer of the right upper lobe with stage IA2. Considering the potential risk of tumor metastasis, a one-stage surgical therapy for right lung cancer and type 0 bicuspid aortic valve stenosis was required; however, transcatheter aortic valve implantation was unsuitable due to a bicuspid aortic valve with severe calcification. Therefore, concomitant minimally invasive aortic valve replacement and lobectomy via right mini-thoracotomy were performed. The postoperative course was uneventful. CONCLUSION: Concomitant aortic valve replacement and right lobectomy via right mini-thoracotomy may reduce surgical invasiveness, leading to early recovery. This surgical strategy is a useful option, particularly for patients with aortic valve stenosis complicated with right lung cancer.

A Case of CABG in a Patient with High Risk of Coronary Obstruction during TAV-in-TAV.

A 94-year-old man who underwent transcatheter aortic valve (TAV) replacement 6 years ago was admitted because of exertional dyspnea. Transthoracic echocardiography revealed severe aortic regurgitation owing to TAV dysfunction. The patient was considered to have a high risk of occlusion of the sinus of Valsalva during TAV-in-TAV. Therefore, we performed TAV-in-TAV concomitant with coronary artery bypass grafting (CABG). The postoperative course was uneventful, and computed tomography 9 months later revealed patency of both the grafts. Concomitant CABG could be considered as one of the options in patients with a high risk of coronary occlusion during TAV-in-TAV.

Successful redo aortic valve replacement using Perceval valve in a patient with prosthetic valve endocarditis complicated by acute cerebral infarction.

INTRODUCTION: and importance: For treatment of prosthetic valve endocarditis (PVE), redo-aortic valve replacement (AVR) is usually required. However, the recurrence of PVE continues to be a serious problem that needs a solution. CASE PRESENTATION: An 83-year-old woman who had undergone AVR for aortic infective endocarditis 12 years ago was diagnosed with PVE complicated with acute cerebral infarction. Urgent redo-AVR was performed. After complete removal of the prosthesis, Perceval S valve was implanted successfully. There were no postoperative neurological deteriorations, and the echocardiogram showed no recurrence of PVE. CLINICAL DISCUSSION: Theoretically, the fewer prostheses left in the heart, the lower the risk of PVE recurrence. CONCLUSION: In patients with PVE, redo-AVR using the Perceval valve may be a suitable option since Perceval reduces the prosthesis in the heart compared with conventional redo-AVR.

Successful hybrid TEVAR for distal anastomotic pseudoaneurysm and coarctation following previous palliative left subclavian artery to descending aorta bypass: A case report.

INTRODUCTION: Anastomotic pseudoaneurysm is one of the most common but catastrophic complications in coarctation of the aorta (CoA); this is equally true even if the initial surgery is not directly related to the coarctation. Redo open heart surgery is usually required for the pseudoaneurysm; however, redo surgery remains challenging with high morbidity and mortality rates. PRESENTATION OF CASE: A 38-year-old woman with CoA, who had undergone left subclavian artery (LSCA) to descending aorta bypass 21 years prior, was referred to us for the treatment of distal anastomotic pseudoaneurysm. Zone 2 thoracic endovascular aortic repair (TEVAR) with LSCA debranching was performed to exclude the distal anastomotic pseudoaneurysm and expand the CoA using a stent graft. The patient completely recovered and resumed work without delay. DISCUSSION: In patients who require surgical treatment for both pseudoaneurysm and CoA, hybrid TEVAR can be an alternative surgical option instead of conventional open repair. CONCLUSION: TEVAR for concomitant pseudoaneurysm and native CoA is feasible and less invasive, especially for young patients who have to resume work early after surgery.

[Tips for Use of Chordal Guide System for Easy Adjustment of Appropriate Artificial Chordae Length in Patients Undergoing Minimally Invasive Mitral Valve Repair].

OBJECTIVES: In patients who require minimally invasive mitral valve repair (MICS-mitral), it is difficult to determine the appropriate length of artificial chordae, position, and number of artificial chordae. The Memo 3D Rechord, a complete prosthetic ring associated with a temporary chordal guide system comprised of yellow loops that function as a reference guide for automatically determining the height of neo-chordae. We sought to evaluate our tips for use of this system. METHODS: Five patients (1 male, mean 68 years old) who underwent MICS-mitral using artificial chordae with the Memo 3D Rechord were evaluated. Prior to surgery, we assessed the prolapse position using 3-dimensional( 3D) echocardiography to decide the number and positions of the artificial chordae. Polytetrafluoroethylene (PTFE) sutures were passed through the papillary muscles and the free margin of the prolapsed leaflet, then appropriate positioning of the PTFE chordae was performed using a saline test. The PTFE chordae were passed through the loops and the free margin of the prolapsed leaflet was brought to the posterior annulus. Then, the PTFE sutures were tied and the temporary loop system removed. RESULTS: All patients had posterior leaflet prolapse. The number of the artificial chordae was 2 in 3 patients, and 1 in 2. The base of the artificial chordae was attached to the anterior papillary muscle in 3patients and posterior in 4. Additional indentation closure was required in 1 patient. All mitral valve repairs were performed successfully. Postoperative echocardiography mitral regurgitation( MR) grade was trivial in 5. CONCLUSIONS: Using our technique, it was possible to decide the appropriate length and position of the artificial chordae and MICS-mitral for leaflet prolapse with the Memo 3D Rechord is a simple and reproducible method.

Effects of an intrathecal TRPV1 antagonist, SB366791, on morphine-induced itch, body temperature, and antinociception in mice.

PURPOSE: Transient receptor potential vanilloid 1 (TRPV1) not only is activated by multiple stimuli but also is involved with histamine-induced itch. The effects of TRPV1 on morphine-induced itch are unknown. We examined the effects of intrathecal administration of TRPV1 antagonist on morphine-induced itch, body temperature, and antinociception for mice. METHODS: Each C57/BL6j mouse was intrathecally administered with one of the following solutions: morphine, SB366791 (as the TRPV1 antagonist), morphine + SB366791, saline, or vehicle. For each mouse, each instance of observed scratching behavior was counted, the body temperature was measured, and the nociceptive threshold was determined using the tail-immersion test. RESULTS: SB366791 dose-dependently reduced the scratching behavior induced by the administration of morphine. SB366791 and the morphine + SB366791 groups did not manifest an increase in body temperature. Antinociceptive effects were observed to occur dose-dependently for morphine but not for SB366791. Compared with morphine alone, the administration of morphine + SB366791 did not reduce significant antinociceptive effects. CONCLUSION: We propose that an intrathecal TRPV1 antagonist, SB366791, reduced morphine-induced itch without causing hyperthermia and did not suppress morphine-induced antinociception for mice.

A case of severe headache attributed to vertebral artery dissection.

BACKGROUND: Vertebral artery dissection (VAD) sometimes has no specific symptoms and is difficult to differentiate from other forms of headache. CASE PRESENTATION: A woman in her thirties had a severe, throbbing left-sided headache. A migraine without aura was suspected and zolmitriptan was administered, which alleviated the symptoms. The woman was consequently deemed to have a migraine without aura. Despite the lack of abnormal neurological findings and showed no abnormalities on cranial computed tomography, her symptoms were not typical for migraines and showed little improvement with therapy. She therefore underwent a cranial magnetic resonance imaging (MRI) examination, which revealed VAD, for which she was transferred to the department of neurosurgery for conservative treatment. CONCLUSION: The possibility of vertebral artery dissection should be considered in the differential diagnosis of severe secondary headaches, and prompt diagnosis and treatment based on detailed MRI and magnetic resonance angiography examinations should be performed.

[Recipient of living kidney transplantation during which heparin-induced thrombocytopenia (HIT) was suspected: a case report].

A 67-year-old woman with a diabetic renal failure was scheduled for a living kidney transplantation. Heparin was first used during hemodialysis 5 days before operation. Thrombocytopenia was found immediately after induction of general anesthesia, and the diagnosis of HIT was wade based on clinical symptom and 4 T's scoring. The surgery was continued because of the progress of donor surgery. Argatoroban was administered based on APTT measurement as an anticoagulation therapy during and after the operation. Although deep vein thrombosis was found 13 days after the operation, the transplanted kidney was established successfully. It is necessary to take a great caution in HIT development after heparin use.

Differential diagnosis of breast mass image-forming lesions based on changes in depth-width ratio and internal echo intensity by hand-held probe compression.

PURPOSE: Regarding mass image-forming lesions, the 2005 Guidelines for Ultrasonic Diagnosis of Breast Diseases, published by the Japan Society of Ultrasonics in Medicine (JSUM), includes the evaluation of tumor compressibility, which is visually assessed by the degree of deformation caused by applying external pressure to the tumor. However, this is only a subjective estimation under real-time observation; consequently, quantitative evaluation of tumor deformation and the percentage change in internal echo intensity was attempted based on changes in the depth-width ratio and in the internal echo intensity on hand-held probe compression. We evaluated the usefulness of these measurements in the differential diagnosis of benign and malignant tumors. METHODS: The subjects were 139 patients (89 benign and 50 malignant cases) who underwent breast ultrasonography with a 10-MHz (from 4-to 10-MHz) linear probe. The deformation index (D.I.) of the tumor was defined as: [1 - (depth-width ratio with 3.0 ± 0.6-kg-weighted compression)/(depth-width ratio without compression)] × 100 (%). The rate of change in internal echo intensity was defined as the echo intensity with compression divided by the echo intensity without compression × 100 (%). RESULTS: There was a significant difference in the D.I. between benign lesions (35.5% ± 14.7%) and malignant lesions (15.4% ± 6.2%) (P < 0.001). The cut-off ratio in differentiating benign from malignant lesions was approximately 25%. The rate of change in echo intensity of benign lesions (149.7% ± 34.3%) was significantly higher than that of malignant lesions (122.9% ± 19.9%) (P < 0.001). CONCLUSION: Using an electronic linear probe, quantitative indexes including the D.I. and the rate of change in internal echo intensity could be obtained with the help of a weight meter, and could prove effective for the differential diagnosis of breast mass-image forming lesions.