Surgical treatment of traumatic rupture of the normal aortic valve.

Blunt trauma followed by aortic valvular insufficiency is a rare occurence. In one case, a male high-school student who had sustained a non-penetrative chest injury suffered from aortic regurgitation resulting from the rupture of the normal aortic valve. A sizable tear in the non-coronary cusp caused aortic insufficiency. The case was treated successfully by surgical replacement of the aortic valve with a No. 21 SJM prosthesis.

[A case report of active infectious endocarditis caused by MRSA with chronic renal failure].

A 62-year-old female, who had chronic renal failure treated by HD, was admitted to our hospital with fever. MRSA was identified by blood culture examination. Echocardiography revealed vegetations attached to the mitral valve. Mitral abscess was detected during operation. Mitral valve replacement was performed. We used ECUM and HD for the chronic renal failure during peri- and postoperative days. The postoperative clinical course was uneventful.

[Successful repair of partial atrioventricular septal defect in a 70-year-old female patient].

A 70-year-old female with partial atrioventricular septal defect underwent a total correction of the anomaly. The patient was in NYHA functional class II. Preoperative cardiac catheterization demonstrated a primum-type atrial septal defect through which 33% of left to right shunt occurred and a cleft of mitral valve causing moderate regurgitation. The operative procedure as our routine for this anomaly consisted of suture of mitral septal commissure and closure of atrial septal defect with autologous pericardial patch. Postoperative examination showed satisfactory competence of mitral valve and improved functional capacity. A successful correction for the case aged more than 66 with this anomaly has not been reported so far in Japanese literature. We conclude that surgical treatment should be basically considered for this anomaly in spite of senility.

An anatomical study of a new method for enlargement of narrowed aortic annulus: intra-arterial aorto-infundibuloplasty.

A new procedure "intraarterial aorto-infundibuloplasty" for the narrowed aortic annulus is described. Aortic valve replacement is performed through an aorto-pulmonary and infundibular septal incision which is eventually enlarged by a single patch, i.e., a two-dimensional patch instead of a three-dimensional patch as in Konno's procedure. An anatomical study showed that a prosthetic valve three sizes larger than the natural annular diameter could be implanted and the natural annular diameter was increased by as much as 42%.

[A case of aneurysm of the inferior left ventricular wall].

Aneurysms of the inferior left ventricular wall represent only a small fraction of all aneurysms that have been reported in surgical series. And in comparison to anterior left ventricular aneurysms, a comparatively higher percentage of reported inferior wall aneurysms was classified as false. A 73-year-old male was admitted for acute inferior myocardial infarction. Three weeks after admission, cardiac catheterization was carried out. Coronary arteriography revealed triple vessel disease and left ventriculography showed an aneurysm of the inferior left ventricular wall, whose feature near the mitral annulus was multiple fenestrations. Left ventricular aneurysmectomy and aortocoronary bypass grafting to the left anterior descending artery were simultaneously performed under cardiopulmonary bypass with moderate hypothermia. The pathological feature was a true aneurysm. The postoperative course was uneventful.

[Total occlusion of proximal left main and right coronary artery].

Total occlusion of the left main coronary artery (LMT) is rarely demonstrated with coronary angiography. All patients with LMT occlusion are of necessity dependent upon collateral circulation from the right coronary artery, which in approximately two thirds of patients is jeopardized because of marked obstruction of the right coronary artery. The ultimate example of collateral flow is provided by the following case. A 64-year-old man, who had total proximal left main and right-coronary artery occlusion, underwent coronary artery bypass grafting. On coronary angiogram, his jeopardized collateral artery was conus branch and only the LAD was graftable for coronary artery bypass surgery. One saphenous vein graft was bypassed to the LAD. Postoperatively, the left ventricular function improved considerably and the ejection fraction of the left ventricle rose to 46% from 23% preoperatively.

[A case of unroofed coronary sinus with mitral and tricuspid valve regurgitation].

A case of successfully treated unroofed coronary sinus associated with mitral and tricuspid valve regurgitation was reported. A 68 year-old male presented with congestive cardiac failure and pancytopenia due to hypersplenism. Investigation by cardiac catheterization and left ventricular angiography showed unroofed coronary sinus (left atrial to coronary sinus fenestration) combined with mitral and tricuspid valve regurgitation without persistent left superior vena cava. The atrial septum was intact. A large left-to-right shunt resulted in right heart failure. Direct suture closure of a coronary sinus defect and double valve replacements by using the SJM prosthetic valves were performed successfully.

Respiratory care of pediatric patients requiring prolonged intubation after cardiac surgery.

Pediatric patients requiring intubation more than 4 days after cardiac surgery can experience many respiratory and other problems. We found that 48 of 264 pediatric patients could not be extubated within 4 days after open-heart surgery because PaO2 was less than 75 torr and PaCO2 was over 45 torr on an inspired oxygen fraction of 0.4. Most of the 48 patients were under 12 months old, had pulmonary hypertension and/or complex cardiac anomalies, and were not hemodynamically stable and/or fully conscious. The intensity of long-term intubation was attributed to cardiovascular or respiratory complications and multiple organ failure. At the time of extubation, water infusion was maintained below 80 ml/kg X day and positive water balance below 15 ml/kg X day. Calories and amino acid were maintained over 70 kcal/kg X day and 1.5 g/kg X day, respectively.