[Aortic root reconstruction with Edwards Prima PLUS stentless valve].

We report successful treatment of 3 aortic root aneurysm cases with Edwards Prima PLUS stentless valve which has recently been approved in Japan. The patients were 69, 77, and 69 year-old male. All patients showed Sellers' IV degree aortic valve regurgitation. The aortic annulus diameters were 28, 23, and 26 mm, the Valsalva sinus diameters were 46, 53, and 57 mm, and the sino-tubular junction diameters were 32, 50, and 43 mm, respectively by echocardiographical measurement. Aortic root reconstructions with Edwards Prima PLUS stentless valve were chosen for all patients, considering the patient's age, pathological change of the aortic valve, and concomitant cardiovascular procedures. Only root reconstruction was performed in case 1. Ascending aortic replacement and single coronary artery bypass were added in case 2, and pulmonary vein isolation with radiofrequency ablation device and mitral ring annuloplasty were added in case 3. Total surgical duration was 218, 275, and 266 minutes, respectively and their postoperative courses were uneventful. This operation can be an appropriate choice for the selected patient with aortic root aneurysm.

[Modified infarction exclusion technique for surgical treatment of postinfarction ventricular septal rupture].

A ventricular septal rupture (VSR) is a fatal complication after an acute myocardial infarction. Surgical repair with an infarction exclusion technique (IET) has improved the surgical outcome for VSR. However, a residual shunt from the left ventricle to the right ventricle has been still one of the problems associated with this technique. We modified the IET so as to avoid the occurrence of the residual shunt In our modification, interrupted mattress sutures were placed transmurally to obtain a secure fixation of the pericardial patch. As for the interventricular septum, the VSR was enlarged to about 1.5 cm in diameter with a cavitron ultrasonic surgical aspirator to facilitate the placement of transmural sutures from the right ventricle to the left ventricle. We performed VSR repair with this modified IET in 3 patients, and have obtained beneficial results.

[Repair of postoperative residual shunt of postinfarction ventricular septal perforation: report of a case].

A 70 year-old man had the surgical repair of post-infarction ventricular septal perforation (VSP) with infarction exclusion technique. Five days after operation, residual shunt was observed by echocardiogram and he developed cardiac failure. Additional surgery for residual shunt was performed 1 month after 1st operation. The infracted myocardium was firm enough to closed directly, so the Xenomedica patch was sutured on the side of the perforated septum around VSP. The postoperative course was uneventful.

[Initial experience in endoscopic radial artery harvesting].

We report the initial experience of endoscopic radial artery (RA) harvesting (ERA) using Vasoview System. The expected advantages of ERA are superior cosmetic results and fewer wound complications to the conventional open technique. ERA was performed in 33 patients from September 2004 to September 2005. Preoperatively, Allen's test with Doppler imaging was performed in all patients. ERA was successfully performed within 50 minutes except in the first 3 patients (the mean time for harvest: 37 minutes). Direct injury of the RA occurred in 1 patient, but the RA could be used as a graft for coronary artery bypass grafting (CABG) by repairing with end-to-end anastomosis. Only 1 RA graft occluded as determined by the early postoperative angiography. Local dissection of the RA was observed in 2 patients, but no flow disturbance was observed. Delayed wound healing occurred in 1 aged patient. No significant nerve complications were encountered. ERA is easy to adopt and has greater cosmetic advantages.

[Left ventricular pseudo-false aneurysm after a myocardial infarction; application of heart positioner].

We herein present the case of a pseudo-false aneurysm which developed in a patient after a myocardial infarction in the posterior left ventricular wall. A 71-year-old man experienced an acute myocardial infarction due to occlusion in the left circumflex artery. Five weeks after the myocardial infarction, echocardiography and magnetic resonance imaging (MRI) disclosed a pseudo-false aneurysm at the posterior left ventricular wall. A patch closure of the aneurysm and coronary artery bypass grafting (CABG) to both the left anterior descending artery and the left circumflex arteries were successfully performed. At surgery, the Starfish Heart Positioner, a commercially available device that is designed to lift the heart during off-pump CABG, was found to be very useful for exposing the posterior left ventricular wall by lifting and fixing the apex of the left ventricle.