Surgical techniques for infectious endocarditis of the mitral valve with hypertrophic cardiomyopathy in Costello syndrome.

Costello syndrome is a rare congenital disease caused by activating germline mutations, and it is often associated with cardiac abnormalities. A 17-year-old male with a history of Costello syndrome presented with persistent fever. Vegetation attached to anterior mitral leaflet was detected, and antibiotic therapy was administered as treatment for infectious endocarditis. However, it was difficult to manage his heart failure owing to the worsening of mitral valve regurgitation. Therefore, mitral valve repair with vegetation resection was performed. His hypertrophic cardiomyopathy and systolic anterior motion of mitral anterior leaflet caused left ventricle outflow tract obstruction. A floating stitch on the anterior mitral leaflet from the posterior ring annulus was effective. Herein, we report a successfully repaired case of infectious endocarditis on the mitral valve with hypertrophic cardiomyopathy complicated by Costello syndrome. .

Plaster technique for filling up a future entry at the suture hole in type A aortic dissection.

Although the surgical technique for acute type A aortic dissection dramatically improved in recent years, the postoperative mortality and morbidity rates remain high. After the emergency surgery for acute type A aortic dissection, a small tear in the aorta may result in dilation of the false lumen in the future. Some tears originate from the suture line on the anastomosis. This report introduces the novel "plaster technique" that involves using a single interrupted suture with felt and plastering a minimum dose of BioGlue into the suture hole. Similar to patients with acute aortic dissection, we found that the plaster technique using a felt pledget and minimum dose of BioGlue is effective for fragile aortic walls. Moreover, it is a simple, safe, and durable technique to strengthen the suture line. Supplementary Information: The online version contains supplementary material available at 10.1007/s12055-022-01351-0.

Beating pulmonary vein sign during catheter ablation.

The beating of a pulmonary vein during cardiac catheterization is a rare phenomenon caused by the heart beating through the pericardial effusion when a cardiac tamponade occurs. This "beating pulmonary vein" sign is useful for early detection of a tamponade before circulatory collapse occurs.

Late-phase left ventricular pseudoaneurysm after three-time mitral valve surgery.

Rupture of the left ventricular posterior wall is a fatal complication during mitral valve replacement (MVR), and rupture mainly occurs intraoperatively and up to several days after MVR, but it rarely occurs in the late phase, such as several years postoperatively. Late rupture occasionally presents as left ventricular pseudoaneurysms (LVPAs). A 40-year-old man who had a three-time history of mitral valve surgery for infectious endocarditis was incidentally found to have a left ventricular aneurysm with no symptoms. He underwent closure of a LVPA with MVR. Although there are various surgical techniques to close LVPAs after mitral valve repair, it is still a challenging problem. Here, we report the case of a patient who successfully underwent LVPA repair with MVR and describe the technique.

Late detection of communication between juxtaposed atrial appendages.

A 40-year-old woman underwent an atrial septal defect closure 4 years before presentation. During the operation, juxtaposition of the atrial appendages was found simultaneously but no obvious communication was found between the appendages. She recently experienced desaturation on exercise, and the residual communication was found between the juxtaposed atrial appendages. The residual communication was closed from the right to the left atrium. Herein, we report the rare case of juxtaposition of the atrial appendages with residual communication between them after an atrial septal defect closure.

"Millefeuille Technique" by Using Excised Intimal Layers in Repair of Type A Aortic Dissection.

Surgical outcomes for acute Type A aortic dissection (AAD) have dramatically improved in recent years due to prompt diagnosis, improved surgical technique and perioperative management. A single needle hole can become a new entry point in AAD cases with such a fragile wall, so a mixed technique using minimal surgical stitches and glue is required for a good outcome. The 'Millefeuille' technique involves multiple layers with a prosthetic graft, intimal layer, additionally inserted surplus intimal layer with BioGlue, adventitial layer, and felt. This technique may help to prevent needle hole re-entry.

Pericardioperitoneal and pericardiopleural windows: A drainage technique for the treatment of recurrent cardiac tamponade. A case report.

INTRODUCTION: Given that pericardial effusion may sometimes lead to cardiac tamponade and chronic heart failure, its management seems absolutely essential. In case of a poor response to medical therapy, surgical drainage of the effusion is required. Although some drainage procedures for pericardial effusion (e.g., temporary puncture, pericardiopleural drainage, and pericardioperitoneal drainage) are currently used in clinical practice, their long-term efficacy remains unclear. PRESENTATION OF CASE: We present a case of a 58-year old female with recurrent pericardial effusion secondary to systemic lupus erythematosus. Since she was relatively young and on steroids, long-term patency of pericardial fenestration needed to be insured without any device. Hence, we created 2 pericardial windows, pericardioperitoneal and pericardiopleural, via a single-incision subxiphoid approach to allow the effusion to drain into the abdominal and thoracic cavities. DISCUSSION: It is important to efficiently manage pericardial effusion because it can lead to more serious conditions such as cardiac tamponade and chronic heart failure. Our technique, which involves making a small incision, can reduce the risk of recurrence. CONCLUSION: Simultaneous creation of pericardioperitoneal and pericardiopleural windows is simple and can be feasibly performed to prevent the recurrence of pericardial effusion.

Coronary artery aneurysm complicated by pneumothorax with a history of Kawasaki disease.

Kawasaki disease (KD) is a common vasculitis disorder of childhood. It can sometimes complicate coronary artery aneurysms, and treatment is required depending on the condition of stenosis. A 20-year-old man was referred for surgery with a coronary artery aneurysm and stenosis in the left coronary artery as sequelae of KD. He had a surgical history of left pneumothorax and bullae remaining on the right lung. We simultaneously performed off-pump coronary artery bypass for coronary artery stenosis and bullectomy. Coronary artery aneurysms with KD complicated by pneumothorax are rare, and we treated them using one-stage surgery.

Cor triatriatum in adulthood with mitral valve regurgitation and atrial fibrillation.

Cor triatriatum is a rare congenital heart disease. A 57-year-old woman had cor triatriatum with severe mitral valve regurgitation (MR) and atrial fibrillation (AF). We performed mitral valve repair, left atrial appendage resection, and maze procedure by resection of the anomalous septum in the left atrium. As a result, MR was controllable and AF disappeared after the operation. Although there is no established maze procedure with cor triatriatum, removing the septum was effective to complete it.

[Covering Suture Line Using Bovine Pericardium during Mitral Valve Replacement for Third Time Infectious Endocarditis;Report of a Case].

A 33-year-old man presenting with fever, fatigue, and delirium was diagnosed with infectious endocarditis(IE). He had already undergone surgery for IE twice;initial valve repair 4 years ago and mitral valve replacement(MVR) 1 year later. He has refractory atopic dermatitis, which was considered to be the cause of his repeated IE. Initially, antibiotics were administered but the infection was not controlled. Therefore, we decided to perform the 3rd surgery. MVR was performed, and using bovine pericardium, we covered valve cuff and suture felts to separete these parts from blood stream. Postoperative echocardiography showed good prosthetic valve motion without transvalvular regurgitation or paravalvular leak. He was discharged on the 39th postoperative day and has been doing well for 2 years since.

Total resection of an infected aortic arch aneurysm caused by Mycobacterium avium: a case report.

BACKGROUND: Infected aortic arch aneurysms caused by Mycobacterium avium are rare in immunocompetent individuals. Promptly recognizing these aneurysms is important because delays in treatment result in aneurysm rupture and a high fatality rate. Although Salmonella species, Streptococcus species, Staphylococcus aureus, and S. epidermis are commonly found in immunocompetent individuals, to our knowledge, infected aortic arch aneurysms caused by M. avium have not yet been reported. CASE PRESENTATION: We report the case of a 63-year old immunocompetent man who underwent total arch replacement following infection by the nontuberculous mycobacteria M. avium. The procedure involved total aneurysmal resection and arch replacement with a rifampicin-bonded gelatin-sealed woven Dacron graft. He was discharged without complications and remained asymptomatic after 30 months. CONCLUSION: In this brief report, we outline and discuss the rare successful case of total arch replacement using total aneurysmal resection and rifampicin-bonded gelatin-sealed woven Dacron graft for an infected aortic arch aneurysm resulting from M. avium in an immunocompetent patient.

Hemorrhagic Pericardial Cyst Complicated with Constrictive Pericarditis.

Pericardial cysts are rare abnormalities and are usually asymptomatic. Although several case reports on their diagnosis and treatment have been published, those on hemorrhagic pericardial cysts remain limited. We herein report the case of a 70-year-old man with a hemorrhagic pericardial cyst complicated with constrictive pericarditis 2 years after the initial diagnosis.

[Incomplete Surgical Resection of a Right Ventricular Hemangioma with Asymptomatic Gradual Enlargement for more than a Decade;Report of a Case].

We encountered a case of a cardiac hemangioma protruding into the inner cavity of the right ventricle from the right ventricular free wall. The tumor gradually enlarged over 11 years (from 35 mm to 78mm) without presenting any symptoms. However, when it extended to the right ventricular outflow tract, non-sustained ventricular tachycardia occurred, and emergency surgery was required. The tumor was diagnosed as a cavernous benign hemangioma. Complete resection was not possible, and the part involving the right ventricle remained. This residual tumor caused postoperative ventricular arrhythmia, and an implantable cardioverter defibrillator was required. We concluded that non-surgically treated cardiac hemangiomas carry the risk of non-resectability, regardless of malignancy.

[Aortic Valve Replacement of Quadricuspid Valve with Regurgitation].

Congenital quadricuspid aortic valve is a very rare malformation. In most cases it has been found incidentally at aortic valve surgery or at autopsy. It frequently causes aortic regurgitation, which may become manifest in adulthood and require surgical treatment. We reported 4 cases of aortic regurgitation with quadricuspid aortic valve. In all cases, aortic valve replacement was preformed with prosthetic valve, and their postoperative courses were uneventful. Two were Hurwitz's classification type b, one was type a and the last patient was type c. Although quadricuspid aortic valve is a rare anomaly, its potential for severe valve failure in adulthood should be kept in mind.

Hybrid versus open repair of aortic arch aneurysms: comparison of postoperative and mid-term outcomes with a propensity score-matching analysis.

OBJECTIVES: Operative strategies for repairing aortic arch aneurysms should be re-evaluated following recent technical advances. METHODS: Of 364 patients who underwent aortic arch repair between 2002 and 2014, 58 were high-risk subjects who received isolated hybrid arch repair (HAR) via median sternotomy (type I n = 32, type II n = 1 and type III n = 25). During this period, excluding patients with type A dissection or extensive aneurysms, 124 patients received isolated open arch repair via median sternotomy. The patients in the HAR and open arch repair groups were compared. A propensity score-matching analysis was applied to adjust for baseline risk factors. RESULTS: The patients in the HAR group were older (77 years ± 6 vs 69 ± 9, P < 0.0001), exhibited a greater rate of malignancy (21 vs 4.8%, P = 0.0022) and had higher logistic EuroSCORE values (31 ± 18 vs 20 ± 15, P < 0.0001) than those in the open arch repair group. Following propensity score matching creating 38 matched pairs, the differences in preoperative risk diminished. Operative complications, including the mortality rate (2.6 vs 0%), were similar between the groups. Apart from the lower rates of cardiopulmonary bypass (CPB) and circulatory arrest, there was no apparent superiority of HAR with respect to patient recovery. The mean follow-up duration was 52.5 months, during which the rate of freedom from aortic events in the HAR and open arch repair groups was 79 and 99% at 24 months, respectively (P < 0.0001). CONCLUSIONS: HAR achieves equivalent short-term results to standard open arch repair, with a decreased need for CPB. However, considering the inferior mid-term outcomes of this procedure, its indications should be limited to high-risk patients.

Impact of the intraoperative use of fibrinogen concentrate for hypofibrinogenemia during thoracic aortic surgery.

Thoracic aortic surgery often causes massive bleeding due to coagulopathy. Hypofibrinogenemia is one of the major causative factors, but the utility of the intraoperative administration of fibrinogen concentrate has not yet been proven. The aim of this study was to estimate incidence of hypofibrinogenemia and to evaluate efficacy of using fibrinogen concentrate intraoperatively. The perioperative serum fibrinogen levels (SFL) had routinely been measured in consecutive 216 thoracic aortic surgeries performed from 2010 to 2012. Fibrinogen concentrate was principally used for hypofibrinogenemia (< 150 mg/dl of SFL) at cardiopulmonary bypass (CPB) termination. The patients who received fibrinogen concentrate (FIB group) were compared with the patients who did not received (non Fib group). There were 147 patients (68%) in FIB group at a dose of 5.5±3.5 g. The SFL were dramatically decreased with values of 164±71 mg/dl at CPB termination, compared to the preoperative SFL of 352±131 mg/dl. In the FIB group, the intraoperative and postoperative SFLs were 139±53 and 262±75 (mg/dl), respectively. Thus the SFL was recovered quickly by the administration. 110 cases (51%) showed hypofibrinogenemia at the termination of CPB. The predictors of hypofibrinogenemia were preoperative SFL < 250 mg/dl, emergency surgery and thracoabdominal aortic surgery. Hypofibrinogenemia frequently was observed at the termination of CPB during thoracic aortic surgery. Administering intraoperative fibrinogen concentrate appears to be a useful option to treat coagulopathy.

Influence of the characteristics of Japanese patients on the long-term outcomes after aortic valve replacement: results of a microsimulation.

OBJECTIVES: The aim of this study was to explore the influence of the characteristics of Japanese patients on the long-term outcomes after aortic valve replacement with either mechanical or biological prostheses by means of a microsimulation. METHODS: A microsimulation model was used to simulate the lives of patients living in Japan and in the United States after aortic valve replacement. The background mortality data taken from the 21st complete life table of Japan and the bleeding hazard determined from a meta-analysis of long-term results in Japanese institutions were used to simulate Japanese patients. The life expectancy, event-free life expectancy, and lifetime risk of structural valve degeneration were calculated. A sensitivity analysis for various bleeding hazards was performed. RESULTS: Regarding the event-free life expectancy, the age crossover points between the two valve types were 64-65 and 57-58 years for Japanese and American patients, respectively. Regarding the life expectancy, the age crossover points were 88-89 and 64-65 years, respectively, for Japanese and American patients. The lifetime risk of structural valve degeneration was higher in Japanese patients than in American patients. The sensitivity analysis showed that the age crossover points were sensitive to the hazard of bleeding complications. CONCLUSIONS: The long-term clinical outcomes after aortic valve replacement were simulated with a microsimulation model. The results indicated that the age crossover points in the advantages and disadvantages between mechanical valves and bioprostheses may be higher in Japanese patients than in American subjects.

Prevention of arterial graft spasm in rats using a vasodilator-eluting biodegradable nano-scaled fibre.

OBJECTIVES: Arterial graft spasm occasionally causes circulatory collapse immediately following coronary artery bypass graft. The aim of this study is to evaluate the efficacy of our developed materials, which were composed of milrinone (phosphodiesterase III inhibitor) or diltiazem (calcium-channel blocker), with nano-scaled fibre made of biodegradable polymer to prevent arterial spasm. METHODS: Milrinone- or diltiazem-releasing biodegradable nano-scaled fibres were fabricated by an electrospinning procedure. In vivo milrinone- or diltiazem-releasing tests were performed to confirm the sustained release of the drugs. An in vivo arterial spasm model was established by subcutaneous injection of noradrenalin around the rat femoral artery. Rats were randomly divided into four groups as follows: those that received 5 mg of milrinone-releasing biodegradable nano-scaled fibre (group M, n = 14); 5 mg of diltiazem-releasing biodegradable nano-scaled fibre (group D, n = 12); or those that received fibre without drugs (as a control; group C, n = 14) implanted into the rat femoral artery. In the fourth group, sham operation was performed (group S, n = 10). One day after the implantation, noradrenalin was injected in all groups. The femoral arterial blood flow was measured continuously before and after noradrenalin injection. The maximum blood flow before noradrenalin injection and minimum blood flow after noradrenalin injection were measured. RESULTS: In vivo drug-releasing test revealed that milrinone-releasing biodegradable nano-scaled fibre released 78% of milrinone and diltiazem-releasing biodegradable nano-scaled fibre released 50% diltiazem on the first day. The ratios of rat femoral artery blood flow after/before noradrenalin injection in groups M (0.74 ± 0.16) and D (0.72 ± 0.05) were significantly higher than those of groups C (0.54 ± 0.09) and S (0.55 ± 0.16) (P < 0.05). CONCLUSION: Noradrenalin-induced rat femoral artery spasm was inhibited by the implantation of milrinone-releasing biodegradable nano-scaled fibre or diltiazem-releasing biodegradable nano-scaled fibre. These results suggested that our materials might be effective for the prevention of arterial graft spasm after coronary artery bypass graft.