[Left ventricular pseudoaneurysm at the apex--a case report of successful resection of the enlarging pseudoaneurysm following mitral valve replacement, which was caused by closed mitral commissurotomy 23 years ago].

A 47-year-old male with pseudoaneurysm of the left ventricle secondary to mitral valve replacement was herein reported because of its unique etiology. The pseudoaneurysm was presumably resulted from the mitral valve dilator wound at the apex of the left ventricle, which was produced by closed mitral commissurotomy 23 years ago. To our knowledge, it seems to be a rare reported case with pseudoaneurysm of the left ventricle caused by closed transventricular mitral commissurotomy.

Treatment of a giant coronary artery aneurysm in an adult with a history of Kawasaki disease by resection and bypass grafting: report of a case.

We report herein the case of a 22-year-old man with a history of Kawasaki disease who developed a giant calcified aneurysm of the left main coronary artery. The aneurysm was successfully resected and coronary bypass surgery was performed using the bilateral internal thoracic arteries. The resected aneurysm, the maximal diameter of which was 27 mm, showed heavy calcification of the inner layer and extended into the adjacent coronary arteries, producing a significant narrowing of the lumen of both the left main trunk (50%) and the anterior descending branch (50%). Extensive intimal calcification presumably prevented normal luminal development and produced a significant narrowing as the patient grew into adulthood. A cause for stenotic lesions developing in the coronary artery adjacent to a coronary aneurysm in adults with a history of Kawasaki disease is suggested here by the resected aneurysm seen in this patient. Thus, adult patients with giant coronary artery aneurysms and significant stenotic lesions of the coronary artery associated with Kawasaki disease may require aneurysmectomy in addition to bypass surgery.

Reduction of beta-adrenergic receptors in atrial cell membranes of patients following mild to moderate heart failure.

The density of cardiac beta-adrenoceptors (Bmax) was measured in eighteen patients [2 with atrial septal defect (ostium secundum), 4 with aortic valve disease, 3 with mitral valve disease, 1 with aortic and mitral valve disease, 5 with a history of myocardial infarction, and 3 with angina pectoris] following mild to moderate cardiac failure. Measures were obtained by cardiac catheterization prior to cardiac surgery and also during the surgical procedures. On the basis of symptoms immediately preceding surgery, the severity of the condition in each patient was categorized as either Class I (n = 5) or Class II (n = 13) following the New York Heart Association (NYHA) functional classification system. The Bmax was measured using right atrial appendage tissue obtained during cardiac surgery. [125I]-iodocyanopindolol was used for the assay. The Bmax of atrial cell membranes in patients with NYHA class II was significantly lower than that of class I (34.1 +/- 2.5 vs 55.4 +/- 9.3 fmol/mg protein, M +/- SE, p < 0.05). Correlation coefficients between the Bmax and hemodynamic parameters measured just prior to cardiac surgery were examined, but only that between Bmax and the minimum value of the time derivative of left ventricular pressure (max negative dp/dt) was significant (r = -0.552, p < 0.05). Further study is needed to understand and clarify the relationship between Bmax and dp/dt min.

Malignant thymoma associated with liposarcoma of the mediastinum--a case report.

Malignant thymoma occurring concurrently with mediastinal liposarcoma in a 49-year-old man is described. The patient underwent an incomplete resection of the mediastinal mass followed by irradiation therapy and additional chemotherapy. He died about 9 months after the detection of a mediastinal mass on chest X-ray films and the immediate cause of death was superior vena cava syndrome. The incidence of primary liposarcoma of the mediastinum alone is extremely rare. Only a few more than 20 with such a lesion have been documented in Japan. A review of the literature of patients with mediastinal liposarcoma and thymoma associated with malignancies revealed no case of an association of thymoma and liposarcoma.

Simultaneous bilateral renal artery reconstruction and intraoperative renal protection. A case report.

A 22-year-old Japanese man with bilateral renal artery stenosis associated with hypertension underwent successful surgery of simultaneous bilateral renal artery reconstruction under conditions of intraoperative renal perfusion with St. Thomas Hospital solution which is used for cardioplegia in open heart surgery. Circulation in the left kidney was interrupted for 58 minutes and that of the right kidney for 35 minutes. The patient fully recovered with no serious impairment of renal function. In addition to these stenotic lesions of the renal artery, there were medial necrosis of the aorta and fibromuscular dysplasia of the superior mesenteric artery. Administration of SQ14,225, an angiotensin I converting enzyme inhibitor, was effective in controlling hypertension during the preoperative period.

Raghib's syndrome: a report of two cases.

We treated two patients with a rare developmental complex. The persistent left superior vena cava draining into the left atrium (PLSVC into LA) was associated with an absent coronary sinus and an atrial septal defect. Ligation of PLSVC and patch-repair of the atrial septal defect were successfully performed in one stage. The atrial septal defect was located in the upper and posterior aspect of the interatrial septum and appeared to be an unique type of atrial septal defect. In the other patient, additional multiple cardiac defects were associated with this syndrome, including ventricular septal defect, pulmonary stenosis, tricuspid insufficiency, and complete transposition of the great arteries. Palliative Blalock procedure was used for this patient. The PLSVC into LA was discovered accidentally in both cases during heart catheterization and it was clearly demonstrated by venography. For a preoperative recognition of PLSVC, computed tomograms of the heart are of great assistance. Surgical correction of the persistent superior vena cava was emphasized for treatment of this syndrome.

Impalement wounds of the head and chest by reinforced steel bars with recovery: an unusual case report.

A 31-year-old male who sustained completely penetrating impalement wounds of the head and chest by reinforced steel bars in a fall at a ferroconcrete building construction with a miraculous survival is reported. The bars were successfully removed; a surgical mallet was required to loosen the bar impacted in the patient's head. After 12 days he was discharged, and he has returned to construction work and is well 3 years postinjury.

Successful resection of an aortic arch aneurysm using a temporary trifurcation bypass graft.

Resection of a syphilitic aortic arch aneurysm in a 62-year-old woman was accomplished using a trifurcation temporary bypass system. The bifurcation graft was sutured end-to-side to the ascending thoracic aorta, to the brachiocephalic trunk and to the left common carotid artery, respectively. The attached third limb end was anastomosed end-to-side to the infrarenal abdominal aorta. This technique enabled a large shunt into the abdominal aorta. Occlusion of the iliac arteries proved to be effective in coping with hypotension while attending to the bypass and the volume replacement. The post-operative recovery was uneventful and the patient has remained well after 43 months.

Post-traumatic aortic rupture of the thoracoabdominal junction: a case report.

Twenty-five years after a blunt chest trauma, sudden expansion of a traumatic aortic aneurysm induced a dysphagia and chest pain in a 57-year-old man. Resection of the aneurysm and patch repair of the rupture site utilizing a thoracoabdominal temporary bypass was successful. The location of aortic laceration at the thoracoabdominal junction was most unusual as compared with traumatic aneurysms usually seen in the thoracic aorta.

Bilateral popliteal artery entrapment syndrome--report of a case.

A 15-year old female presented with bilateral popliteal artery entrapment syndrome. The left popliteal artery was completely occluded and thromboendarterectomy was performed. Angiography on passive dorsiflexion revealed compression of the right popliteal artery, although it was free of symptoms and of normal caliber. End-to-end anastomosis in the normal anatomical position without division of the medial head of the gastrocnemius muscle was performed on both sides.

Surgical aspects of regional myocardial blood flow and myocardial pressure.

The surgical technique of cardiopulmonary bypass with either an empty beating or an empty fibrillating ventricle produces marked changes in the regional blood flow and oxygen demand of the left ventricle. This paper describes the changes which occurred in the regional perfusion of both the normal and the hypertrophied left ventricle during these conditions and relates them to the known changes in oxygen demand. It also correlates the changes in flow with the measurable changes in myocardial tissue pressure-systolic when the heart is beating and continuous when fibrillating. The various types of filbrillation had identical effects on both regional tissue pressure and regional flow. The subendocardial blood supply was adequate or more than adequate under each of these conditions so long as the coronary perfusion pressure was maintained at an adequate level. A low perfusion pressure during ventricular fibrillation of any type led to a marked reduction in flow to the subendocardial portion of the left ventricle: The presence of ventricular hypertrophy accentuated this danger.