Total aortic arch replacement under intermittent pressure-augmented retrograde cerebral perfusion.

Kitahori, Kawata, Takamoto et al. described the effectiveness of a novel protocol for retrograde cerebral perfusion that included intermittent pressure augmentation for brain protection in a canine model. Based on their report, we applied this novel technique clinically. Although the duration of circulatory arrest with retrograde cerebral perfusion was long, the patient recovered consciousness soon after the operation and had no neurological deficit. Near-infrared oximetry showed recovery of intracranial blood oxygen saturation every time the pressure was augmented.

Cardiac swinging calcified amorphous tumors in end-stage renal failure patients.

We recently encountered 2 patients with mobile cardiac calcified amorphous tumors who were successfully treated by surgery. Both patients had mitral annular calcification and were on hemodialysis. These tumors showed swinging motion on echocardiography and they grew rapidly. Intraoperatively, the tumors were found to be fragile and they easily detached from their origin. The histologic findings were thrombus with angiogenesis, fibrin, and calcium deposition. This rapid-growing mobile tumor in end-stage renal failure patients is speculated to increase the risk of embolic events and should be included as a special entity of cardiac amorphous tumors.

Clinical application of intermittent pressure-augmented retrograde cerebral perfusion.

Brain protection is important during aortic arch surgery, especially in patients with cerebral ischemia. We clinically applied the effectiveness of a novel protocol of retrograde cerebral perfusion with intermittent pressure augmentation for brain protection in a canine model, as described in a previous report. Although, in our patient the brachiocephalic artery and left subclavian artery were occluded as a result of aortitis, there was a history of right cerebral infarction, recovery of consciousness, and no neurologic sequelae. Near-infrared oximetry showed recovery of intracranial blood oxygen saturation every time the pressure was augmented.

[Acute aortic dissection with left main coronary malperfusion treated with precedent stenting followed by a definitive surgery].

Coronary malperfusion due to acute aortic dissection (AAD) is a relatively rare, but fatal condition. We experienced a case of acute myocardial infarction (AMI) with cardiogenic shock due to compression of the left main trunk (LMT) by a false lumen of an AAD. Percutaneous coronary intervention (PCI) to the LMT was firstly performed, followed by a definitive surgery under a stable hemodynamic condition. Stanford type A AAD is an indication for emergency operation and stenting to the LMT is controversial. However, it might be an essential strategy to perform precedent PCI to the LMT which quickly relieves global ischemia, and achieves hemodynamic stability for the following definitive surgery.

Epicardial electrical isolation of the right atrial appendage on the beating heart with an infrared coagulator.

To determine the clinical efficacy of application of infrared energy to the beating heart as a means of creating electrical blocks, an original infrared coagulator (KIRC-119; Phomec Inc, Tokyo, Japan) was applied to the atrium of a patient with atrial fibrillation. A postoperative electrophysiologic study was performed to confirm its efficacy. The coagulator was applied epicardially to the beating heart concomitant with an on-pump beating heart coronary artery bypass graft procedure. Sinus rhythm was restored during the operation, and the electrophysiologic study revealed that a bidirectional block had been created on the right atrial appendage. The infrared coagulator may facilitate performance of the epicardial Maze procedure on the beating heart.

Noonan syndrome associated with anomalous coronary artery and other cardiac defects.

This case-report describes an 11-month-old infant, who had been diagnosed with Noonan syndrome with a variety of associated anomalies. Multiple cardiac anomalies were present, consisting of dysplastic pulmonary valve, symmetric biventricular hypertrophy, atrial septal defect and right ventricular outflow tract (RVOT) obstruction, in which the pressure gradient measured 73 mmHg, and anomalous coronary artery. Systolic anterior motion of the mitral valve (SAM) was present, without remarkable clinical significance. RVOT transannular repair with non-cusped xenograft along with resection of hypertrophied right ventricular outflow myocardium. Left ventricular outflow tract (LVOT), which had no clinical sign of obstruction, was left untouched, expecting the RVOT repair also effectively release LVOT dynamic obstruction. The postoperative echocardiography revealed residual SAM without significant pressure gradient through LVOT.

Mitral valve replacement in a 15-month-old infant with infective endocarditis.

This report describes a 15-month-old child without particular heart problems, presenting prolonged high-grade fever, an impaired level of consciousness, right hemiparesis and cutaneous lesion on admission. Medication was started according to the initial diagnosis of bacterial or viral meningitis, however, congestive heart failure was suddenly observed 15 days after the admission. Echocardiography revealed a mass in the right atrium, and mitral valve regurgitation due to the irregularly thickened and aneurysmal anterior leaflet with a perforation, consistent with infective endocarditis. Mitral valve replacement with a mechanical prosthesis was performed and the postoperative course was uneventful.