[A case of mitral valve aneurysm associated with infective endocarditis].

A case of mitral valve aneurysm associated with infective endocarditis is reported. The patient is a sixty-four year old male suffering from shortness of breath under slight exertion. He has been febrile since receiving dental treatment five months ago. The patient came to the hospital due to a continuous fever above 39 degrees C. Hematological studies suggested inflammation, and an echocardiogram revealed moderate dilatation of the left atrium, mild MR, and moderate AR. At the time of the operation, a protuberant lesion, shaped like a dome and having a size of 10 x 12 mm in diameter was found at the anterior mitral leaflet toward the left atrium. The resected specimen of the saccular lesion had a smooth surface, and the ceiling of the aneurysm was extremely thin. Microscopic study showed that the inner cavity of the lesion was covered by endothelial cells. In addition, there was granulomatous degeneration with neo-vascularization. The inferior surface of the resected valve tissue and chorda was characterized by active inflammation associated with the assembly of neutrophils and colony formation of gram-positive cocci. It was concluded that the mitral valve aneurysm was caused by weakened tissue of the anterior mitral leaflet due to sibilant inflammatory change, which resulted in protuberance of the leaflet toward the left atrium caused by left ventricular pressure.

[A case of Klinefelter's syndrome with acute mitral regurgitation caused by idiopathic chordal rupture].

It has been reported that the incidence of mitral valve prolapse was remarkably increased in patients with Klinefelter's syndrome. Some cases which have been previously reported were associated with hemodynamically significant transvalvular regurgitation, however, none of them underwent a surgical treatment such as valvular replacement. Here we report a case of Klinefelter's syndrome which underwent MVR for mitral regurgitation caused by idiopathic chordal rupture. Pathological microscopic examination showed topical and minor myxomatous changes on the free edge of the leaflet and no inflammatory changes such as in infectious endocarditis. It is, therefore, suggested that an echocardiographic follow-up should be carried out in case of Klinefelter's syndrome during its life and also in the case treated by a prophylactic therapy for endocarditis with antibiotics. And when, unfortunately, surgical treatment is required, valve replacement would be preferable to valvuloplasty because of a fragility of leaflet.

[New method for enlargement of narrowed aortic annulus: intra-arterial aorto-infundibuloplasty].

A new procedure of "intra-arterial aorto-infundibuloplasty" for the narrowed aortic annulus is described. Aortic valve replacement can be performed through the aorto-pulmonary and infundibular septal incision which is eventually enlarged by a single patch.

[Late results of coronary heart surgery. Late graft patency in coronary bypass procedure].

The graft patency was evaluated by a contrast enhanced computed tomography (CT) and/or digital subtraction angiography (DSA) in the follow up of aorto-coronary bypass surgery. One hundred and eighty-four patients included in this study received a total of 331 grafts. The Elipse S/200 Scanner for CT and Siemens Angiotron system for DSA were used for this study. Early in the study, selective coronary angiography were performed and the results were interpreted in 331 grafts and 86 grafts to evaluate the diagnostic reliability of CT and DSA for graft patency, respectively. While the CT scans correlated with angiographic assessment of graft patency showed 98% of sensitivity, 100% of specificity, and 98% of predicted accuracy, the DSA showed 95% of sensitivity, 100% of specificity and 95% of predicted accuracy, respectively. The patency rate in the early postoperative period was 94%, and the cumulative patency rate during follow up of 5 years was 93%, respectively. In summary, CT and DSA can provide useful information regarding graft patency in the long term follow up of aorto-coronary bypass surgery.

[Heart valve replacement with the Ionescu-Shiley bovine pericardial xenograft. Hemodynamic evaluation and early clinical follow-up of 170 patients].

The Ionescu-Shiley bovine pericardial xenograft (ISPX) has been widely accepted clinically because of its superior hemodynamic characteristics and low incidence of thrombogenicity. After confirmation by our own experiment of its superior valve performance, we have adopted in clinical application of this valve since August of 1979, and implanted 189 of this valve in 170 patients up to November of 1981. The overall mortality rate including of hospital and follow up death was 14.1%. The pressure gradient and calculated orifice area of ISPX were compared to those of Hancock xenograft (HX), and the valve characteristics of ISPXs was found to be better than those of HX. The cardiac function following implantation of this valve apparently showed improvement. No incidence of thromboembolic episode or malfunction was observed, however, prosthetic valve endocarditis (PVE) was encountered in four patients and two died. This incidence of PVE in ISPXs was not significantly higher in comparison to that in other type of prosthetic valve. However the low incidence of thromboembolic episode as well as acceptable valve performance were confirmed by our study, the durability and susceptibility to PVE has to be carefully observed in the longer follow up.

[Giant left atrium in mitral valve disease: a new plication procedure to relieve the compressions of left ventricular wall left bronchus and right lung].

The giant left atrium associated with mitral valve disease frequently produces postoperative hazardness in relation to hemodynamic and respiratory management. We have defined the most serious disorders induced by the presence of giant left atrium in three categories as follows. First, hemodynamic disturbance by the compression of left ventricular wall by downward extension of left atrium (type I), secondly, respiratory disturbance yielded by the compression of left main bronchus by upward extension of left atrium (type II), thirdly, compression of right middle lobe by rightward extension of left atrium (type III). A new procedure of para-annular, superior and right-side plication methods were derived as the procedure to relieve those compressions induced by giant left atrium. Up to the present, 47 patients with giant left atrium underwent surgery, twelve of valvular procedure only and thirty-five of valvular as well as plication procedure. The incidence of postoperative low output syndrome and respiratory failure were evaluated. The plication procedure showed marked decrease in the incidence of low output syndrome and respiratory failure postoperatively, eventual significant decrease in mortality rate. We conclude that plication procedure is very effective for the treatment of compression in the presence of giant left. atrium.