[Infective Endocarditis Caused by Abiotrophia defectiva Required Double-valve Replacement Using the Manouguian Procedure].

A 39-year-old man was presented with infective endocarditis caused by Abiotrophia defectiva. Transesophageal echocardiography revealed extensive vegetation and destruction extending from the aortic valve to the aortic-mitral curtain and mitral valve accompanied by severe regurgitation of the aortic and mitral valves. After removal of vegetation, double-valve replacement were performed with double patch and mechanical prosthesis using the manouguian procedure.

Emphysematous aortic arch aneurysm infected with Salmonella: A case report.

Infected aortic aneurysm is a relatively rare disease that is extremely difficult to manage, resulting in a poor prognosis. We rescued a patient with Salmonella-infected aortic arch aneurysm surrounded with a specific and massive emphysema, despite experiencing aortic rupture, including delayed esophageal perforation after surgery.

Blunt cardiac rupture due to kicking on the lateral side of the right chest.

Blunt cardiac rupture can be caused by an indirect blow to the heart during sports. Clinicians should consider the possibility of cardiac injury regardless of the severity of trauma. Confirming the diagnosis and reaching a decision to operate as soon as possible is the only way to rescue the patient.

Combined treatment for a large primary cardiac sarcoma: a case report.

BACKGROUND: Undifferentiated pleomorphic sarcoma (UPS) as a primary cardiac tumor is rare, with extremely poor prognosis owing to high recurrence and invasion. We encountered a patient who presented with a primary cardiac tumor incarcerating the mitral valve and who was in a shock state. CASE PRESENTATION: A 41-year-old man was transported emergently to our hospital owing to acute respiratory distress and hemoptysis. He was diagnosed with acute left heart failure caused by a large mass in the left atrium (LA) that obstructed cardiac blood flow, as revealed by imaging study findings, and he underwent an emergency open-heart surgery for tumor resection. He was pathologically diagnosed with UPS invading the muscle layer of the LA. However, after receiving combined therapy for local recurrence and distant metastasis, including proton beam radiotherapy and chemotherapy with molecularly targeted drugs, he could return to work for 2 more years after surgery. CONCLUSION: In this study, we reported the case of a patient who was in a state of shock state owing to the presence of UPS in the LA. The patient underwent an emergency surgery and received combined therapy. He survived for 2 more years after an initial diagnosis, without active local recurrence and distant metastasis.

[Severe aortic valve stenosis combined with a large brain tumor; report of a case].

We report a case of severe aortic valve stenosis with a large benign brain tumor (meningioma), which was successfully treated with simple replacement with a mechanical valve under extracorporeal circulation (ECC). A large meningioma is considered as a risk in an operation under ECC because it may increase intracranial pressure and cause bleeding. In this case we chose a simple method of aortic valve replacement for the purpose of shortening the ECC time. Under warfarin control, the patient is in a stable condition with good cardiac function and without any neurological symptom at 8 years after the operation.

[Three cases of cardiac tumor; an approach to excise a large tumor in the left atrium].

Tumors originated from the heart are very rare disease and their clinicopathological state has not been fully recognized. Cardiac tumors are most frequently found in the left atrium. An initial treatment is a surgical excision of tumors entirely including their pedicles. And regardless of benign or malignant tumors, it is most important to remove them completely. However, a complete resection of cardiac tumors in the left atrium becomes more difficult in cases of larger sizes or wide expanding of the pedicles. In such cases, we recommend to choose a right-sided approach to the left atrium, so that it enables to be easier to examine all areas of the left atrium for a complete resection of cardiac tumors. We have excised successfully in three cases of larger cardiac tumors originated from the left atrium employing a right-sided left atriotomy.

Life-threatening acute heart failure due to primary cardiac undifferentiated pleomorphic sarcoma.

A 41-year-old man was admitted with acute heart failure and shock status. An echocardiogram showed a mobile tumor obstructing blood flow through the mitral valve with a stalk on the posterior left atrium (LA) wall. Emergent open-heart surgery was performed to resect the tumor (77×36×30 mm). Histological examination confirmed that it was an undifferentiated pleomorphic sarcoma. Unfortunately, positron emission tomography performed five months after surgery demonstrated a local recurrence around the right pulmonary vein and LA. We performed proton beam radiotherapy to treat the local recurrence, and it was effective. The patient has survived more than one year since the first life-threatening heart failure episode.

Troponin elevation after radiofrequency catheter ablation of atrial fibrillation: relevance to AF substrate, procedural outcomes, and reverse structural remodeling.

BACKGROUND: Although radiofrequency ablation creates myocardial necrosis leading to troponin T (TnT) release into the systemic circulation, the significance of TnT elevation after atrial fibrillation (AF) ablation is unknown. OBJECTIVE: To demonstrate a possible mechanism of reverse structural remodeling in the left atrium (LA) by evaluating postprocedural TnT elevation. METHODS: This study included 106 patients with an enlarged LA (paroxysmal AF, n = 43; persistent AF, n = 63). All patients underwent pulmonary vein isolation alone in the index procedure. Left atrial volume indexed to body surface area (LAVi) was measured by echocardiography before ablation and 6 months after sinus rhythm restoration. Patients were divided into responders (n = 53) and nonresponders (n = 53) based on a cutoff value of 23% reduction in LAVi. The TnT level was measured 12 hours postprocedure. RESULTS: LAVi decreased from 43 ± 13 to 33 ± 12 mL/m(2) (P < .0001). The TnT level was higher in responders than in nonresponders (1.31 ± 0.34 µg/L vs 0.88 ± 0.29 µg/L; P < .0001) and correlated linearly with percent reduction in LAVi (R = .54; P < .0001). Also in multivariate analysis, the TnT level was the only independent predictor for responders (odds ratio 90.1; 95% confidence interval 14.95-543.3; P < .0001). The TnT level in patients who required a repeat procedure (n = 30) was lower than that in patients who did not require a repeat procedure only in the persistent AF group (0.92 ± 0.38 µg/L vs 1.16 ± 0.37 µg/L; P = .01). CONCLUSION: Greater elevation of the TnT level was related both to favorable outcomes after ablation and to greater reversal of structural remodeling. Postprocedural TnT level may be reflective of the preservation of healthy LA myocardium.

Sex difference in peripheral arterial response to cold exposure.

BACKGROUND: In Japan, there is a symptom commonly referred to as "Hie-sho", which is a feeling of coldness or chill in a particular part of the body, and it can sometimes be unendurable. This phenomenon is known to occur more frequently in women. The present study used synchrotron radiation micro-angiography (SRMA) to examine the hypothesis that this feeling is derived from a sex difference in the vascular response to coldness. METHODS AND RESULTS: The hind limb of male (Group M) and female (Group F) Wistar rats was exposed to cold and the tissue temperature was recorded. SRMA with a spatial resolution of 26 microm was used to measure arterial diameter. The reduction in temperature brought on by cold exposure was significantly larger in Group F than in Group M (p<0.05). SRMA showed that the arteries were dilated by cold exposure in both groups; however, the percentage dilatation in response was statistically small in Group F (69+/-40%) compared with Group M (118+/-73%) (p<0.05). CONCLUSION: Arteries in the limbs of female rats did not expand as much as those of the males in response to cold exposure, which may explain why women feel the cold more than men.

Cigarette-smoke-induced vasoconstriction of peripheral arteries: evaluation by synchrotron radiation microangiography.

BACKGROUND: Although cigarette smoking is thought to constrict peripheral vessels, details have not been clarified because of the limitation of spatial resolution in conventional X-ray angiography systems. Synchrotron radiation microangiography can identify small arteries down to 50 microm in diameter. METHOD AND RESULTS: Male Wistar rats (n=9) were made to smoke a cigarette using the modified Griffith snout exposure system. Angiography of the rat hind limb was performed before, during, and 15 min after smoking. Arteries were classified into 3 groups based on the pre-smoking diameter: Group S: <100 microm, Group M 100-200 microm, Group L: >200 microm). In Groups M and L, arteries were constricted with smoking (mean diameter 140-106 microm; p<0.001, 260-162 microm; p<0.00001, respectively), whereas no constriction was noted in Group S (82-83 microm). Constricted arteries in Groups M and L returned to pre-smoking levels at 15 min after cessation of smoking. CONCLUSION: The acute changes brought about by cigarette smoking in rat peripheral arteries could be identified by synchrotron radiation microangiography. Cigarette smoking exclusively constricted arteries greater than 100 mum in diameter, which means there is vessel-size dependency of the impairment.

[Stickler syndrome with rapidly progressive mitral valve regurgitation: report of a case].

A 36-year-old man with Stickler syndrome who underwent mitral valve replacement for rapidly progressive mitral regurgitation due to prolapse of an anterior leaflet. Stickler syndrome is a relatively rare condition caused by a defective collagen gene and characterized by high myopia, sensorineural-hearing deficit and flattened facial features. The prevalence of mitral valve prolapse in Stickler syndrome is reported to be much higher than in the general population because of its connective tissue dysplasia. Mitral regurgitation rapidly and refractorily progresses. Prompt surgical treatment should be recommended to mitral regurgitation in Stickler syndrome, and mitral valve replacement with a prosthetic valve is a better selection than mitral valve plasty for tissue fragility.

Complex intimal flaps in acute aortic dissection.

A 43-year-old man was emergently admitted and diagnosed as acute aortic dissection (Stanford type A). While being prepared for emergent operation he fell into hemodynamic hazard with repeated ventricular fibrillation and loss of consciousness. Massive aortic regurgitation and coronary disturbance due to a back-and-forth movement of an intimal flap through the aortic valve were the causes of the cardiogenic catastrophy. In addition, a completely torn intimal flap was intussuscepted into the origin of the brachiocephalic artery. This was thought to disturb the cerebral perfusion. Acute aortic dissection with such complex intimal flaps is very rare. In such cases cardiopulmonary bypass should be established to maintain the patient's cardiac function as soon as possible after diagnosis and the operation should be performed with sufficient brain protection.