[Surgical Repair of Right Atrium Perforation due to Brockenbrough Procedure:Report of a Case].

A 62-year-old woman had a history of catheter ablation three times in the past for atrial fibrillation underwent the fourth catheter ablation. Atrial septum was punctured by Brockenbrough procedure. Two 8 Fr sheaths were inserted into left atrium. But blood was not drawn from the sheaths, and right atrial imaging confirmed that sheaths penetrated into cardiac sac. Pericardial fluid gradually increased and state of shock was seen due to cardiac tamponade. Drainage was performed through sheaths and hemodynamic condition was stabilized. It was judged that urgent surgical repair was necessary. When cardiopulmonary bypass was attached and right atrial incision was made under cardiac arrest, two sheaths were piercing from right atrial to pericardial transverse sinus on the dorsal side of ascending aorta. After removing the sheaths, the perforation was closed directly inside and outside right atrial wall. The postoperative course was generally good.

[Pedunculated and Mobile Right Atrial Thrombus Moderately after Mitral Valve Plasty and Tricuspid Valve Annuloplasty:Report of a Case].

An 81-year-old female underwent mitral valve plasty and tricuspid annuloplasty using an artificial annulus for mitral valve insufficiency and secondary tricuspid valve insufficiency at our hospital. Echocardiography 5 months later showed no abnormal finding. Eight months after the operation, however, a pedunculated and highly mobile mass in the right atrium was found, and the patient was admitted to our hospital. Its shape was really uncommon, and it was difficult to differentiate between a thrombus and a tumor. We subsequently performed a surgical removal. The resected mass was filled with many starshaped spherical tissues which were partially organized white thrombi histologically. Damage to the right atrial endocardium during previous surgery could be the cause.

[Constrictive Pericarditis Associated with Pericardial Hematoma:Report of a Case].

A 59-year-old man was admitted to our hospital due to keto-acidosis. Electric cardiogram showed history of myocardial infarction. Cardiac echogram showed severe left ventricular hypokinesis, thickened pericardium and pericardial effusion. Right ventricular pressure curve showed dip and plateau pattern, and coronary angiography showed severe three vessel disease. So, we diagnosed with constrictive pericarditis accompanying pericardial effusion and ischemic heart disease. After cardiac catheterization, as the hemodynamics was getting worse, we inserted intraaoric balloon pumping (IABP) immediately and performed an emergent operation. The heart was compressed by hematoma and thickened pericardium. The surrounding tissue of hematoma was organized including fibrous tissue. We resected hematoma and pericardium, and the cardiac function was improved remarkably. His postoperative course was uneventful. The cause of hematoma was thought to be intrapericardial bleeding after cardiac infarction. He had cardiac tamponade and constrictive pericarditis, and the diagnosis of this case was considered to effusive constrictive pericarditis.

Hypothermia Inhibits the Expression of Receptor Interacting Protein Kinases 1 and 3 After Transient Spinal Cord Ischaemia in Rabbits.

OBJECTIVES: Necroptosis, a form of regulated necrosis, might be a potential mechanism of delayed paraplegia; therefore, its role in transient spinal cord ischaemia was investigated by immunohistochemical analysis of necroptosis related protein receptor interacting protein kinase (RIP) 1, RIP3, and cellular inhibitor of apoptosis protein (cIAP) 1/2. METHODS: This study used rabbit normothermic (n = 24) and hypothermic (n = 24) transient spinal cord ischaemia models and sham controls (n = 6). Neurological function was assessed according to a modified Tarlov score at 8 h, 1, 2, and 7 days after reperfusion (n = 6 each). Morphological changes in the spinal cord were examined using haematoxylin and eosin staining in the sham, 2, and 7 day groups. Western blot and histochemical analyses of RIP1, RIP3, and cIAP1/2, and double label fluorescent immunocytochemical studies of RIP3 and cIAP1/2 were performed at 8 h, 1, and 2 days after reperfusion (n = 6 each). RESULTS: There were significant differences in neurological function between the normothermic and hypothermic groups (median scores 0 and 5 at 7 days, p = .023). In the normothermic group, most motor neurons were lost seven days after reperfusion (p = .046 compared with sham), but they were preserved in the hypothermic group. Western blot analysis revealed the upregulation of RIP1, RIP3, and cIAP1/2 at 8 h in the normothermic group (RIP1, p = .032; RIP3, p < .001; cIAP1/2, p = .041 compared with sham), and the overexpression of RIP3 was prolonged for two days. In the hypothermic group, the expression of these proteins was not observed. The double label fluorescent immunocytochemical study revealed the induction of RIP3 and cIAP1/2 in the same motor neurons. CONCLUSIONS: These data suggest that transient normothermic ischaemia induces necroptosis, a potential factor in delayed motor neuron death, and that hypothermia may inhibit necroptosis.

Primary Cardiac T-Cell Lymphoma Localized in the Mitral Valve.

Primary cardiac lymphoma is a rare cardiac tumor, and usually originates from B cells and involves the right side of the heart. We present an extremely rare case of primary cardiac T-cell lymphoma involving the mitral valve alone. A 58-year-old woman who was positive for human T-cell leukemia virus 1 underwent mitral valve replacement because of severe mitral regurgitation. The postoperative pathologic diagnosis of the mitral valve was T-cell lymphoma. Further evaluation revealed no malignancy, except for the mitral valve. To the best of our knowledge, this is the first case of primary cardiac T-cell lymphoma localized in the mitral valve.

Direct numerical simulation of fluid-acoustic interactions in a recorder with tone holes.

To clarify fluid-acoustic interactions in an actual recorder with opened and closed tone holes, flow and acoustic fields were directly numerically simulated on the basis of the compressible Navier-Stokes equations. To validate the simulation accuracy, the flow field around the windway and sound pressure above the window were measured. The predicted acoustic fields clarify changes of the positions of pressure nodes and anti-nodes in accordance with the state of the tone holes and the Mach number of the jet velocity. The fundamental mechanism of the self-sustained oscillations in a three-dimensional actual recorder is visualized by the predicted acoustic and flow fields. This result is also consistent with the relationship between the jet behaviors and pressure fluctuations based on the jet-drive model. Moreover, the effects of the fine vortices in the jet, which appear at the high Mach number of jet velocity of 0.099, on the sound are discussed. The time difference between the generation of the disturbances and the most intense deflection of the jet is identified and compared with the time delay of acoustic reflection around the window.

Operative modification for the prevention of device-related infection during NIPRO extracorporeal left ventricular assist device implantation.

An operative modification in which the NIPRO left ventricular assist device (LVAD) cannulas are passed through the intraperitoneal cavity is performed as the first-choice standard technique in our institution. Eighteen consecutive patients who underwent NIPRO LVAD implantation as heart transplantation candidates were enrolled in this study. The cannulas were passed through the intraperitoneal cavity in 11 patients (Group IP) and the extraperitoneal space in 7 patients (Group EP). A device-related major infection was defined as bloodstream infection and/or abscess formation in the deep tissue space. Device-related major infection occurred in 6 patients in Group IP and in 6 patients in Group EP. Of these patients, 3 patients in Group IP and 5 patients in Group EP suffered from uncontrollable bloodstream infection and finally died of development into multiple organ failure and/or cerebrovascular accidents. The actuarial rates of freedom from device-related major infection at 6 months after LVAD implantation were 100 % in Group IP and 38 % in Group EP, respectively (p = 0.02). Moreover, the actuarial survival rates after the initial device-related major infection in Group IP could be significantly higher than in Group EP (83 and 67 % at 6 months, p = 0.03). We demonstrated that this operative modification can contribute to prevention of progression of superficial skin infection to critical infection and to extension of the survival duration after the initial device-related major infection.

Total resection of the aortic arch intimal sarcoma using the L-incision technique.

A 26-year-old male suffering from sudden right lower abdominal pain and lumbago was referred to our hospital. Enhanced computed tomography demonstrated bilateral kidneys and spleen infarctions, and a large tumour was found occupying the aortic arch and thoracic descending aorta. We suspected that these infarctions were due to tumour embolization. The aortic arch and thoracic descending aorta were resected with the tumour and then reconstructed using the L-incision technique. A microscopic examination revealed the presence of an intimal sarcoma. The patient was treated with adjuvant chemotherapy and showed a good postoperative course. Neither recurrence nor metastasis has been observed during the 3 years since the operation.

Early mitral valve surgery for chronic severe mitral regurgitation optimizes left ventricular performance and left ventricular mass regression.

OBJECTIVE: The optimal timing of mitral valve surgery for severe mitral regurgitation is controversial. We aimed to evaluate the changes in left ventricular performance using ventricular energetics and left ventricular mass regression after the surgery to determine the appropriate surgical timing in asymptomatic patients with severe mitral regurgitation. METHODS: Fifty consecutive asymptomatic or minimally symptomatic patients who electively underwent the surgery for severe mitral regurgitation were studied retrospectively. Contractility (end-systolic elastance), afterload (effective arterial elastance), and efficiency (ventriculoarterial coupling and ratio of stroke work to pressure-volume area), and left ventricular mass index were measured echocardiographically before and 1 month after surgery. Two-way repeated-measures analysis of variance was used to compare the parameters between patients with (n = 17) and without (n = 33) left ventricular dysfunction (ie, ejection fraction ≤60% and/or end-systolic dimension ≥40 mm). RESULTS: Contractility did not change significantly (P = .94) but the afterload increased significantly (P < .0001) in both groups. Consequently, the efficiency deteriorated significantly (ventriculoarterial coupling, P = .0004; ratio of stroke work to pressure-volume area, P < .0001). Furthermore, the left ventricular mass index improved remarkably in both groups (P < .0001). Alternatively, the patients with normal left ventricular function had greater contractility (P < .0001), less worsened efficiency (P < .0001 and P < .0001, respectively), and a better left ventricular mass index (P = .0002) after surgery. CONCLUSIONS: Early surgery for severe mitral regurgitation preserves left ventricular performance and improves left ventricular mass regression in asymptomatic patients with normal ventricular function.

Ventricular Septal Defect in an Octogenarian: A Case Report of VSD Surgical Repair Concomitant with Coronary Artery Bypass and Valvular Surgery.

Finding an untreated or asymptomatic large ventricular septal defect (VSD) in an elderly patient is uncommon. The present case was an 81-year-old man who suffered from acute myocardial infarction due to three-vessel coronary disease, mitral and tricuspid valve insufficiency, and high-flow perimembranous VSD (Qp/Qs 2.3). Although the patient was elderly and the VSD had been asymptomatic for a long time, we considered that high-flow VSD and valve diseases should be repaired simultaneously with coronary disease. Then, he underwent elective surgery, namely, VSD patch repair concomitant with coronary artery bypass grafting, and mitral and tricuspid annuloplasty. His postoperative course was uneventful. We conclude that, even for an octogenarian, surgical repair of VSD is recommendable, if surgical indications are appropriate.

Cor triatriatum repair to eliminate suffering from paroxysmal atrial fibrillation.

Development of atrial fibrillation is one of the primary indicators of cor triatriatum in adults. Here we describe a case of a patient suffering cor triatriatum coexistent with frequent paroxysmal atrial fibrillation. Paroxysms of arrhythmia were not encountered after surgical correction. Resection of an anomalous membranous septum may have contributed to interrupting the development of ectopic beats, eliminating paroxysmal atrial fibrillation.

Nifekalant hydrochloride terminated electrical storms after coronary surgery.

An "electrical storm" is a life-threatening condition defined as a recurrent attack of ventricular tachycardia or fibrillation. The current report is a case study of a patient who had electrical storms developing unexpectedly after undergoing coronary artery bypass grafting. The electrical storms were terminated dramatically by the administration of nifekalant hydrochloride. We suggest that nifekalant hydrochloride has great therapeutic potential for the suppression of intractable ventricular tachyarrhythmias refractory to amiodarone.