Cardiac surgery for a right atrial myxoma with traumatic intracranial hemorrhage: a case report.

BACKGROUND: The timing of cardiac surgery with cardiopulmonary bypass (CPB) for intracranial hemorrhage is controversial. CASE PRESENTATION: We report the case of an 82-year-old woman who was transferred to our hospital because of a head injury. Brain computed tomography (CT) revealed traumatic intracranial hemorrhage, and transthoracic echocardiography revealed a giant right atrial myxoma. After confirming the disappearance of intracranial hemorrhage on brain CT, cardiac surgery with CPB was performed, which was uneventful. CONCLUSIONS: For an uneventful surgery, the optimal timing of cardiac surgery with CPB in patients with giant right atrial myxoma and intracranial hemorrhage should be based on brain CT.

Renal Vein Thrombosis Occurring in Association with Oral Contraceptives: A Case Report.

Peripheral venous thromboembolism is a well-known complication of hormonal contraception, but reports on its association with visceral vein thrombosis is limited. We report the case of left renal vein thrombosis (RVT) associated with oral contraceptives (OCs) and concurrent smoking. The clinical presentation of this patient was acute left flank pain. Computed tomography revealed left RVT. The OC was discontinued, and we initiated anticoagulation with heparin and switched to edoxaban. Computed tomography 6 months later showed complete resolution of the thrombosis. This report alerts us regarding the importance of OCs as a risk factor for RVT.

Fatal pulmonary thromboembolism caused by idiopathic ovarian vein thrombosis.

Ovarian vein thrombosis (OVT) is observed in the field of obstetrics and gynaecology. It is occasionally diagnosed during the postpartum period or in patients with ovarian malignancy. Few cases of pulmonary thromboembolism (PTE) caused by OVT have been reported previously. We report the case of a 67-year-old woman who presented with fatal PTE due to left OVT during hospitalization for cerebral infarction. The left ovary of the postmenopausal elderly patient showed no tumorous appearance. This case of OVT is extremely rare because of its idiopathic nature and fatal result.

A case of plastic bronchitis after mitral valve surgery in an adult.

Plastic bronchitis is a rare and fatal disease that is characterized by the presence of long dendritic bronchial casts in the airway. It is encountered most frequently in children with congenital heart disease after correction surgery. We reported a case of plastic bronchitis after mitral valve surgery in a 70-year-old woman.

Observations of retinal vessels during intermittent pressure-augmented retrograde cerebral perfusion in clinical cases.

OBJECTIVES: Retrograde cerebral perfusion (RCP) has been used as a cerebroprotective method under hypothermic circulatory arrest (HCA) during aortic surgery. As reported in an animal model in 2005, intermittent pressure-augmented-RCP (IPA-RCP) provides more effective cerebral perfusion than RCP. In 2013, the clinical efficacy of IPA-RCP was described in terms of clinical outcomes and regional cerebral oxygen saturation using infrared spectroscopy. However, the state of cerebral microcirculation during IPA-RCP has not been investigated in humans. The aim of the present study was to investigate cerebral microcirculation during IPA-RCP in humans by assessing the retinal vessels. METHODS: Between 2013 and 2014, 8 consecutive patients underwent elective total replacement of the aortic arch for true thoracic aortic aneurysms. The IPA-RCP protocol consisted of a continuous venous pressure that was intermittently augmented at 45 mmHg for 30 s and then decreased to 20 mmHg for 120 s after isolated HCA for 300 s. The retinal vessels were assessed via non-invasive direct visualization of the cerebral microcirculation using a fundus camera. Assessments were done before cardiopulmonary bypass, during isolated HCA, and during IPA-RCP at 20 and 45 mmHg. Ratio of the diameter of retinal vessels to that of the optic disc was calculated from the diameters of the retinal arteries, veins and optic disc at each time point and was statistically examined. RESULTS: There were no neurological deficits and mortality. When compared with the control group and both IPA-RCP groups, the retinal vessels in the isolated HCA group were collapsed and the peripheral retinal vessels could not be clearly observed. The RVR was significantly larger in the control group and in both IPA-RCP groups when compared with the isolated HCA group. The RVR of the control group was similar to that of both IPA-RCP groups with regard to the retinal arteries and veins. The RVR of IPA-RCP at 45 mmHg was significantly larger than that at 20 mmHg with regard to the retinal veins. CONCLUSIONS: Our study suggested that intermittently augmented venous pressure at 45 mmHg opened the cerebrovenous vessels and enabled adequate cerebral perfusion. IPA-RCP may provide more effective cerebral perfusion under HCA in humans.

Xenopericardial roll graft replacement for infectious pseudoaneurysms and graft infections of the aorta.

BACKGROUND: Which graft material is the optimal graft material for the treatment of infected aortic aneurysms and aortic graft infections is still a matter of controversy. Orthotopic aortic reconstruction with intraoperatively prepared xenopericardial roll grafts without omentopexy was performed as the "initial" operation to treat aortic infection or as a "rescue" operation to treat graft infection. Mid-term outcomes were evaluated. METHODS: Between 2009 and 2013, orthotopic xenopericardial roll graft replacement was performed to treat eight patients (male/female: 6/2; mean age: 69.5 [55-80] yr). Graft material: equine/bovine pericardium: 2/6; type of operation: initial 4/rescue 4; omentopexy 0. Additional operation: esophagectomy 2. Mean follow-up period: 2.6 ± 1.6 (1.1-5.1) years. RESULTS: Replacement: ascending 3, arch 1 (reconstruction of neck vessels with small xenopericardial roll grafts), descending 3, and thoracoabdominal 1. Pathogens: MRSA 2, MSSA 1, Candida 1, E. coli 1, oral bacillus 1, and culture negative 2. Postoperative local recurrence of infection: 0. Graft-related complications: stenosis 0, calcification 0, non-infectious pseudoaneurysm of anastomosis 2 (surgical repair: 1/TEVAR 1). In-hospital mortality: 2 (MOF: initial 1/rescue 1); Survival rate exclusive of in-hospital deaths (~3 y): 100 %, but one patient died of lung cancer (3.6 yr). CONCLUSIONS: Because xenopericardial roll grafts are not composed of synthetic material, the replacement procedure is simpler and less invasive than the standard procedure. Based on the favorable results obtained, this procedure may have the possibility to serve as an option for the treatment of aortic infections and aortic graft infections not only as a "rescue" treatment but as an "initial" treatment as well.

[Purtscher's retinopathy following blunt chest compression].

Following chest or abdominal injury, acute blurring of vision occurs without direct eye injury. This disease is known as Purtscher's retinopathy. A 74-year-old man suffered blunt chest injury by air bag inflation at traffic accident. Next morning, he suddenly complained of visual abnormality. An ophthalmoscopy revealed multiple cotton-wool exudation and retinal edema. He was diagnosed as Purtscher's retinopathy. The symptoms of soft exudation and retinal edema gradually resolved. The visual acuity gradually improved, but not reached to the previous level. We must be aware of this retinopathy, since this is rare but sometimes sight-threatening condition.

Airway obstruction by a retropharyngeal hematoma secondary to thoracic aortic aneurysm rupture.

BACKGROUND: Retropharyngeal hematoma is a rare form of pharyngeal pathology and can present as acute airway obstruction. Among the many causes of retropharyngeal hematoma, thoracic aortic rupture is extremely rare. METHODS AND RESULTS: A 78-year-old female with airway obstruction by a retropharyngeal hematoma secondary to thoracic aortic aneurysm rupture was successfully treated by total aortic arch replacement and open stent-graft insertion. CONCLUSION: Rupture of the thoracic aorta should be considered as a rare but important cause of retropharyngeal hematoma and airway obstruction.