[Successful Repair of a Blow-out Type Left Ventricular Free Wall Rupture after Acute Myocardial Infarction Using a Viscous Diisocyanate Prepolymer].

We report our experience with blow-out type left ventricular free wall rupture after acute myocardial infarction, treated by a sutureless technique using Hydrofit (a viscous diisocyanate prepolymer). A 70-year-old woman suddenly experienced cardiopulmonary arrest during gastrointestinal endoscopic examination. Computed tomography revealed cardiac tamponade, loss of contrast in the posterolateral wall of the left ventricle and contrast medium leakage into the pericardial cavity from the lateral wall of the left ventricle. Under cardiopulmonary resuscitation, the patient was transferred to our hospital. Percutaneous cardiopulmonary support was initiated in the operating room, and median sternotomy was immediately performed. The myocardial tear and necrotic area were sealed with Hydrofit and further covered with BioGlue and TachoSil under cardioplegic heart arrest. Hemostasis was completely achieved, and cardiopulmonary bypass (CPB) was discontinued under intraaortic balloon pumping (IABP) support. At 5 years after surgery, echocardiography showed no pseudoaneurysm formation. This sutureless repair technique using Hydrofit may be useful for a selected case of blow-out type left ventricular free wall rupture.

[Experience of Surgical Repair for Cardiac Trauma].

Cardiac trauma is one of the most lethal injuries. We reported 7 patients with cardiac injuries who underwent surgical repair. They were 4 men and 3 women with a mean age of 64 years. The mechanisms of injuries were blunt trauma by traffic accident in 5 patients and penetrating trauma in 2 patients. The injured cardiac chambers were the right atrium in 2, the right ventricle in 2, the right ventricle and the ascending aorta in 1,the left atrium in 1 and the left ventricle in 1 patient. The wounds of all patients were repaired by direct suture closure. Only 1 patient with injuries in the right ventricle and the ascending aorta was repaired under cardiopulmonary bypass (CPB). The patient with right atrial rupture and concomitant pelvic bone fructure died of retroperitoneal hemorrhage. According to the analysis by Trauma and Injury Severity Score( TRISS), probability of survival(Ps) values ranged from 0.002 to 0.978. A patient with a Ps value of 0.002 died of bleeding. Evaluation of the severity of trauma and injury by TRISS was considered generally reasonable.

[Thoracic Endovascular Aortic Repair for a Descending Thoracic Aneurysm Associated with Pseudocoarctation of the Aorta;Report of a Case].

A 77-year-old man with a descending thoracic aneurysm associated with pseudocoarctation of the aorta underwent thoracic endovascular aortic repair (TEVAR). Computed tomography demonstrated kinking of the descending thoracic aorta. The aneurysm was located distal to a kinking and constricting aortic isthmus. TEVAR was performed because of the patient's comorbidity such as valvular heart diseases and postradiation status for the thoracic Hodgkin disease. TEVAR was successful but small aortic dissection was occurred distal to the stentgraft. Computed tomography at 1 year after TEVAR demonstrated reduction of the aneurysmal diameter and no change in the small dissection. TEVAR is becoming the treatment of first choice for this disease.

[In situ Replacement with Bovine Pericardial Roll Graft for Infected Aneurysm of the Thoracoabdominal Aorta].

A 63-year-old man presented to a nearby doctor with fever and lumbago. Enhanced computed tomography showed a thoracoabdominal aortic aneurysm and enhancement of soft tissue around the aneurysm. He was diagnosed with an infected thoracoabdominal aortic aneurysm and given antibiotics. After 2 weeks, the infection was controlled and he underwent in situ replacement with a bovine pericardial roll graft. A week after the operation, the inflammatory reaction was increased, but the bovine pericardial roll graft was not infected. This suggests that a bovine pericardial roll graft is a suitable material for use in patients with bacterial infections.

[Surgical repair of a subepicardial left ventricular aneurysm in a kidney transplant recipient; report of a case].

A 51-year-old man of the kidney transplant recipient was admitted to our hospital with acute myocardial infarction. Transthoracic echocardiography revealed a subepicardial left ventricular aneurysm that had increased in its size gradually. The operation was performed at 43rd days after myocardial infarction. Subepicardial aneurysm was seen on the posterior wall of the left ventricle. The orifice of the aneurysm was closed with expanded polytetrafluoroethylene (ePTFE) patch. The postoperative course was uneventful in spite of immunosuppressive therapy with ciclosporin. Surgical repair of a subepicardial aneurysm is recommended because of its high rupture rate.

[Successful repair of left ventricular free wall rupture with repeated mydriasis and loss of light reflex].

A 73-year-old woman was transferred to our hospital because of loss of consciousness. Cardiac catheterization showed a left ventricular free wall rupture (LVFWR) due to acute myocardial infarction at the posterolateral region. Shortly after cardiac catheterization, she lost her consciousness again and went into cardiogenic shock. Repeated mydriasis and loss of light reflex was recognized during establishment of cardiopulmonary bypass. Direct suture closure using equine pericardial strips and 4-0 polypropylene mattress sutures was performed under cardiac arrest. The suture site was covered with TachoComb and fibrin glue. Post-cardiac arrest brain injury was prevented by postoperative mild hypothermia. Surgical repair of LVFWR should be performed even when the signs of severe cerebral ischemia are apparent.