[Left Ventricular Thrombectomy in Patients with Dilated Cardiomyopathy Accompanied by Cerebral Embolism:Report of Two Cases].

Left ventricular thrombus( LVT) formation is a known complication of ischemic heart diseases including acute myocardial infarction, dilated cardiomyopathy (DCM) and myocarditis. Among them, few cases involve DCM. Two DCM patients with LVT developed acute cerebral infarction and underwent thrombectomy. Both patients presented with sinus rhythm and neither had previous thromboembolic event. However, their transthoracic echocardiography (TTE) showed left ventricular ejection fractions<35% and left ventricular diastolic diameters≥60 mm, indicating high possibilities of LVT formation. The TTE findings suggest that DCM patients require anticoagulation therapy and frequent imaging examination, even with sinus rhythm and no history of thromboembolic events. Once a thromboembolic event occurs, thrombectomy is urgently needed.

[Treatment of Infective Endocarditis with Mitral Valve Plasty Using only Autologous Leaflets by "Washing and Rubbing Method":Report of a Case].

We performed mitral valve plasty( MVP) with vegetation debridement by rubbing with a small gauze ball and by rinsing with saline( named "washing and rubbing method") for mitral regurgitation( MR) due to active infective endocarditis (IE). A 28-year-old male was referred to our hospital with a two-week history of fever. He had renal impairment and anemia, and echocardiography showed severe MR and two vegetations measuring more than 1 cm on the anterior and posterior mitral leaflets( A2-A3 and P2-P3). Severely damaged leaflets were resected and the vegetations were removed by "washing and rubbing method". After the method, treatment by 0.625% glutaraldehyde solution was added to leaflets for its bactericidal and reinforcing effects. MVP using only autologous leaflets was then performed. "Washing and rubbing method" enabled us to avoid using pericardium (autologous/xenogeneic) and/or artificial chordae in infected sites. MVP using "washing and rubbing method" may improve the long-term prognosis of active IE.

[Cardiac Failure Developing Eleven Years after Coronary Artery Bypass Grafting;Report of a Case].

We report a rare case of cardiac failure for intrapericardial hematoma 11 years after coronary artery bypass grafting. A 59-year-old man was admitted to our hospital with cardiac tamponade. Echocardiography and computed tomography scan showed severe compression of the left ventricle(LV) by a large mass sized about 5×8 cm. Coronary angiography showed total occlusion at circumflex branch (Cx) #11. The mass was diagnosed with intrapericardial hematoma. We performed removal of hematoma in the pericardial cavity, and removed hematoma had 126 g. Considering that the patient had suffered from diabetes mellitus, the localized collection of the hematoma might be explained by possible slow oozing from LV free wall rupture after asymptomatic myocardial infarction at Cx area.

[Surgical treatment of innominate artery aneurysm using temporary bypass to prevent cerebral ischemia].

A 69-year-old woman had an innominate artery aneurysm that was adjacent to the right common carotid artery and the right subclavian artery. The patient had a dominant right vertebral artery and an underdeveloped circle of Willis. At surgery, the proximal site of the innominate artery, the right common carotid artery and the right subclavian artery were clamped with the temporary bypass between the ascending aorta and the distal site of the right brachial artery for maintaining the blood flow to the brain. The innominate artery aneurysm was resected, and a woven Dacron Y-shaped graft, 14×7 mm in diameter, was used for reconstructing the innominate artery, the right subclavian artery and the right common carotid artery. The postoperative course was uneventful and there was no postoperative neurological deficit. Temporary bypass for maintaining cerebral perfusion was useful in preventing cerebral ischemia.

Electron beam cine CT-based evaluation of left atrial function after the maze procedure for mitral valve regurgitation.

OBJECTIVE: There has been little investigation of whether atrial function is equally restored by surgery in patients with mitral regurgitation (MR) and atrial fibrillation (AF) compared to patients in sinus rhythm (SR). PATIENTS AND METHODS: We evaluated left atrium (LA) volume-time curves obtained from electron beam tomography. The study involved 33 patients who had surgical treatment for MR with or without AF and 11 control patients. RESULTS: (1) In patients with SR, LA volume decreased significantly along with a resolution of early regurgitation postoperatively, and the reserve function was well maintained. The LA booster pump function was also well maintained before and after surgery. (2) In patients with AF that resolved after maze surgery, the LA volume was larger than that of the sinus group immediately after surgery, and it did not improve in postoperative periods. These patients had a lower reserve function and a much lower booster pump function despite restoration of SR. CONCLUSIONS: The maze procedure is suggested to be unlikely to achieve restoration of atrial function in patients with MR accompanied by AF, even if SR returns postoperatively. Because patients with SR demonstrated the same LA function as the control postoperatively, surgical indication should be considered for patients with severe MR while their atrial function and SR are maintained.

Repair of mitral periprosthetic leak secondary to severe annular calcification.

Hemolytic anemia due to a periprosthetic leak is a rare complication of valve replacement that has a poor prognosis. Herein are reported the details of two women (aged 62 and 74 years) who had undergone mitral valve surgery four times each; in both cases, a fifth operation was performed because of hemolytic anemia due to periprosthetic leak. An anterior repair of the leaks was performed instead of re-replacing the valve or standard repair, because the extensively calcified annulus led to sufficient space, and viable tissue was available to place direct sutures. Both patients made a rapid and uneventful recovery, with satisfactory short-term results; however, the long-term outcomes remain uncertain.

Midterm results of mitral valve repair with the Carpentier-Edwards rigid ring.

OBJECTIVE: Prosthetic annuloplasty rings play an important role in mitral valve repair. This clinical study was undertaken to evaluate the midterm results obtained with the Carpentier-Edwards rigid ring. METHODS: Between October 1991 and March 2005, 112 patients (mean age 53.0 years) underwent mitral valve repair with a Carpentier-Edwards rigid ring at our institution. Degenerative disease was the most frequent cause and a small number had other conditions such as endocarditis and rheumatic disease. Ten patients were in Carpentier's functional class Type I, 101 patients in Type II and 1 patient in Type III, based on valve pathology. Ischemic mitral regurgitation was excluded. The mean follow-up time was 5.3+/-3.6 years (range: 8 days to 12.3 years). All patients were completely followed by echocardiography. RESULTS: The rigid ring ranged from 26 to 36 mm in diameter and the most common size was 30 mm. Although the mitral orifice area was decreased after mitral valve repair in all patients, none of them required reoperation because of mitral stenosis or left ventricular outflow tract obstruction (systolic anterior motion). Reduction of both systolic and diastolic left ventricular volumes was observed postoperatively. Ejection fractions were preserved in all cases. The actuarial survival rate was 92.0+/-3.0% at 10 years and the reoperation-free rate at 10 years was 96.0+/-2.0%. CONCLUSION: The rigid ring has produced promising midterm results in terms of reoperation-free and survival rates.

Prevalence and avoidance of patient-prosthesis mismatch in aortic valve replacement in small adults.

BACKGROUND: It is still controversial as to whether a small prosthesis should be inserted or a small aortic annulus should be enlarged to minimize patient-prosthesis mismatch (PPM). This retrospective study reviewed our strategy for avoiding PPM. METHODS: Isolated or combined aortic valve replacement was performed in 181 patients, including 24 patients (13.3%) aged less than 65 years with a small aortic annulus (< or = 21 mm) who underwent enlargement of the annulus by the Manouguian (n = 18) or Nicks (n = 6) procedure. In patients aged 65 years or more, a Carpentier-Edwards Perimount pericardial (CEP) valve was implanted with few exceptions. We assessed our strategy for avoiding PPM by comparison with published normal reference values for the indexed effective orifice area. RESULTS: A CEP valve was implanted in 53 patients, and St. Jude Medical (SJM) mechanical valves were used in 128 patients. A standard 21-mm SJM valve was only used in 4 patients and no 19-mm valves were employed. However, 19-mm CEP valves were used in 12 older patients with a small body surface area (1.43 +/- 0.14 m2). No patient receiving an SJM valve had an indexed effective orifice area of 0.85 cm2/m2 or less, and PPM developed in only 2 (3.8%) of 53 patients receiving CEP valves. Consequently, the prevalence of PPM was 1.1%. The 10-year survival rates of patients receiving CEP or SJM valves with or without annular enlargement were similar. CONCLUSIONS: The prevalence of PPM was low in patients more than 65 years old with a relatively small body size who received bioprosthetic valves. In patients less than 65 years old with a small annulus, the method of first choice for avoiding PPM is aortic annular enlargement.

[Mitral valvuloplasty utilizing a posterior leaflet patch for healed infective endocarditis; report of a case].

A 63-year-old man was diagnosed as having grade IV mitral regurgitation (MR). Intraoperative examination revealed perforation (13x7 mm) of the anterior mitral leaflet (AML) and prolapse of the posterior mitral leaflet (PML). The prolapsing part of the PML was resected as a rectangle and the AML perforation was covered with this resected PML patch. A Carpentier-Edwards rigid ring (30 mm) was used to secure the mitral valve annulus after suturing the PML. The patient had an uneventful course after surgery and postoperative echocardiography showed no regurgitation.

Partial anomalous pulmonary venous connection of singular form.

We have recently experienced a rare case of partial anomalous pulmonary venous connection, in a 3-year-old female. The case was diagnosed preoperatively as anomalous left superior pulmonary venous connection with atrial septal defect. Surgery, however, revealed that only the right superior pulmonary vein returned to the left atrium, while the other three pulmonary veins returned to the coronary sinus or innominate vein. No associated atrial septal defect was found. An enlarged coronary sinus was observed. In the present case, three of the four pulmonary veins were found to have anomalous connections, and were hemodynamically close to being total anomalous pulmonary venous connection. We performed unique radical surgery using autologous tissue for multiple anomalous pulmonary venous connections and here report the results, with a short discussion of the literature.