[Giant Anastomotic Aneurysm Associated with Albumin/Glutaraldehyde Sealant as a Late Complication after Acute Aortic Dissection Surgery:Report of a Case].

A 74-year-old woman was taken to our hospital with a chief complaint of chest and back pain. She was diagnosed with Stanford type A acute aortic dissection and underwent ascending aortic replacement. Fifteen months after surgery, a giant anastomotic aneurysm was found at the proximal and distal anastomoses on chest computed tomography (CT), and reoperation was indicated. Following sternal re-entry, anastomotic dehiscence was found where BioGlue, albumin/glutaraldehyde sealant, had been applied during the previous surgery, and caused aneurysm. Severe postoperative adhesion precluded extensive surgery, and redo replacement of the ascending aorta was carried out. Histopathological examination revealed extensive necrosis of smooth muscle cells in the aortic wall at the anastomotic site and a marked inflammatory cell infiltration around the aortic wall and the artificial graft, and association of BioGlue use was suggested. The use of appropriate tissue adhesives to reinforce the dissected aortic wall is important, as well as careful long-term follow-up.

[Early Structural Valve Deterioration of Third-generation Biological Prosthesis].

The third-generation Trifecta valve, Trifecta GT, has been used in Japan since 2012. The Trifecta GT is characterized by the external leaflet mounting, which increases the effective valve opening area and provide excellent hemodynamics. Lehmann et al. reported a good 8-year avoidance rate of 93.3% for structural valve deterioration( SVD) in 1,241 patients. There are three main causes of SVD after valve replacement using bioprostheses:pannus formation in the left ventricular outflow tract, calcification of the valve leaflets, and noncalcified leaflet tears. Goldman et al. reported 11 SVDs in 710 patients who underwent surgical implantation of Trifecta valve, 10 of which were due to calcification of the valve leaflets and only one of which was due to noncalcified leaflet tears. Herein, we report four cases of early SVD due to noncalcified leaflet tears after valve implantation using the Trifecta GT.

[A Giant Papillary Fibroelastoma in the Right Ventricle].

Papillary fibroelastoma (PFE) accounts for approximately 8% of benign primary cardiac tumors. PFE frequently develops in the left heart system, such as the aortic valve and the mitral valve. We report a case of a giant PFE in the right ventricle. The patient was an 83-year-old woman with a history of chronic atrial fibrillation, diabetes, and hypertension. She had experienced palpitation and shortness of breath for several years. A giant mobile tumor was observed in the right ventricle by transthoracic echocardiography, and its extirpation was performed. Intraoperatively, a giant tumor of 3 cm in diameter was observed on the right ventricular side of the posterior tricuspid leaflet. As the tumor strongly adhered to the tendinous cords, it was unavoidable to resect the tendinous cords. Thus, a tricuspid valve repair was performed in addition to the tumor extirpation. The patient was diagnosed with papillary fibroelastoma by pathological examination.

Suture Line Dehiscence after Endovascular Aneurysm Repair in a Patient with Marfan Syndrome.

A 68-year-old man with Marfan syndrome developed de-novo leakage after endovascular aneurysm repair of a Dacron graft. Findings at subsequent reoperation suggested that the rebound force on the endograft generated by marked longitudinal deformation in the Dacron graft may have placed stress on the suture line, leading to partial dehiscence. The Dacron graft seemed to provide a stable proximal landing zone. However, the strong tendency of some endograft devices to return to their original shape may apply stress that affected weakened regions of the native aorta.

Aneurysm growth after late conversion of thoracic endovascular aortic repair.

A 69-year-old man underwent thoracic endovascular aortic repair of a descending aortic aneurysm. Three years later, he developed impending rupture due to aneurysmal expansion that included the proximal landing zone. Urgent open surgery was performed via lateral thoracotomy, and a Dacron graft was sewn to the previous stent graft distally with Teflon felt reinforcement. Postoperatively, four sequential computed tomography scans demonstrated that the aneurysm was additionally increasing in size probably due to continuous hematoma production, suggesting a possibility of endoleaks. This case demonstrates the importance of careful radiologic surveillance after endovascular repair, and also after partial open conversion.

Left ventricular external buttress technique for repair of ventricular septal perforation†.

Because of the difficulty in placing a suture-supporting extension to a non-infarcted area, ventricular septal perforation repair in the presence of large myocardial infarctions can give rise to life-threatening tears or ruptures of the left ventricular free wall. We report a case of successful reinforcement of an infarction area from outside of the left ventricle using a large, thick polytetrafluoroethylene felt patch. After surgery, the patient was weaned from cardiopulmonary bypass without difficulty. Postoperative echocardiography revealed no residual shunting and he was alive without complications 3 years after surgery.

A papillary-ventricular complex repair technique for functional mitral regurgitation.

The objective of this study was to describe a simple and reproducible papillary-ventricular complex technique for repairing functional mitral regurgitation. To avoid a recurrence of mitral regurgitation subsequent to left ventricular remodelling, we performed papillary muscle plication and papillary muscle and head approximation in combination with relocation of the papillary muscle heads to correct any anterior and or posterior mitral leaflet discrepancy and to preserve the papillary-ventricular complex. Preliminary results in 7 patients showed an encouraging functional improvement following surgery. Future long-term controlled studies in a greater number of patients are required to further assess this novel technique.

[Octreotide acetate for persistent cylothorax after descending aorta replacement].

Cylothorax is one of a hazardous complication after thoracic aorta replacement. In this paper, we report effectiveness of octreotide acetate for postoperative persistent cylothorax. A 59-year-old female was referred to our hospital for chest pain. Previously she underwent arch reconstruction following aortic root replacement due to aortic dissection. Computed tomography (CT) revealed acute dissection on dissected descending aorta. Urgent descending aorta replacement was performed. After surgery, massive chylothoracic pleural fluid was drainaged. Although conventional medical treatment was not effective, drainage of chylothoracic pleural fluid significantly decreased after administration of octreotide acetate. Although mechanism has not been fully investigated, octreotide acetate was effective for persistent cylothorax after descending aorta replacement.