Autologous Pericardial Patch Repair for Papillary Fibroelastoma on an Aortic Valve Leaflet.

A 50-year-old man with no history of cardiovascular disease was referred to our hospital because of an abnormal electrocardiogram. Echocardiograms and computed tomograms revealed a 9-mm mass on the underside of an aortic valve leaflet. We chose surgical treatment, to prevent embolic events. The tumor's appearance and intraoperative frozen section were consistent with myxoma. We resected the tumor and its attachment, including the free margin of the aortic valve leaflet, and repaired the defect with use of a glutaraldehyde-treated autologous pericardial patch. The postoperative histopathologic diagnosis was papillary fibroelastoma. Six months later, echocardiograms showed mild aortic regurgitation and no recurrence of the aortic valve mass. Papillary fibroelastoma and myxoma can be difficult to distinguish intraoperatively, yet the diagnosis has considerable influence on the surgical strategy, including whether valve-sparing excision is an option. Therefore, it is necessary to at least suspect both entities if the tumor characteristics are unusual. This case is instructive for surgeons and pathologists.

Analysis of anatomical risk factors for persistent type II endoleaks following endovascular abdominal aortic aneurysm repair using CT angiography.

PURPOSE: To predict persistent type II endoleaks (pT2Es) following endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms, we examined factors related to post-EVAR pT2Es. METHODS: Eighty-four cases of EVAR were analyzed. T2Es that persisted for ≥6 months were defined as pT2Es. pT2Es flowing from an inferior mesenteric artery (IMA) and lumbar artery (LA) were termed pIMA-T2Es and pLA-T2Es, respectively. The anatomical factors concerning the aneurysm, IMA and LAs were assessed in the preoperative CT angiography images. A statistical analysis was performed on the factors associated with pT2Es. RESULTS: The incidence of pT2Es was 25 %. pT2Es were associated with postoperative changes in the aneurysm diameter. A univariate analysis showed that a sac thrombus and the number of patent side branches arising from an aneurysm were significant factors associated with pT2Es. The IMA diameters were significantly larger in cases of pIMA-T2Es. The significant factors associated with pLA-T2Es were a circumferential thrombus, the number of patent LAs and the mean LA diameter. Multivariate analyses indicated that a circumferential thrombus was a protective factor for pT2Es, whereas an IMA ≥2.6 mm and each additional LA branch ≥1.9 mm were powerful risk factors for a pT2E. CONCLUSION: Significant anatomical factors associated with pT2E were found in this study. These factors may be useful in selecting patients for perioperative intervention.

Nonanastomotic rupture of thoracic aortic Dacron graft treated by endovascular stent graft placement.

A 61-year-old man had a Stanford type A acute aortic dissection, and the total aortic arch was replaced with 22-mm knitted Dacron graft in 1996. In 2006, he underwent mitral valve replacement and tricuspid valve repair due to severe mitral and tricuspid valve regurgitation. Although preoperative computed tomography (CT) scan suggested pseudoaneurysm around the Dacron graft replaced with aortic arch, it could not be repaired concomitantly. Four months later, in view of the technical difficulties of an open surgical procedure, the prosthetic graft failure was repaired by endovascular stent graft consisting of a Gianturco Z stent covered with an UBE woven Dacron graft. However, during a follow-up, aneurysm sac diameter increased without any sings of endoleak in follow-up CT scans. Redo endovascular stent graft placement using a Gore-TAG device was performed. Subsequently, shrinkage of the pseudoaneurysmal sac could be observed.

Myocarditis in a pediatric case of pandemic 2009H1N1 influenza.

We report a 6-year-old boy with no major disease history or allergic conditions initially presented with pneumonia, progressed to acute respiratory distress syndrome and acute myocarditis caused by pandemic 2009H1N1 influenza diagnosed with RT-PCR testing, successfully managed with mechanical ventilation and percutaneous cardiopulmonary support system. Marked transient elevation of IgE in acute phase of the disease and the subsequent diagnosis of atopic asthma in our patient suggested a possible role of an underlying allergic condition in the clinicopathological process. Critically ill 2009H1N1-infected patient with acute respiratory failure should carefully be physiologically monitored together with serial assessment of biomarkers aiming at a favorable cardiac outcome by giving the timely diagnosis and intervention.