[Early Structural Valve Deterioration of Bioprosthetic Mitral Valve in a Dialysis Patient].

Choice of prosthetic valve during valve replacement in dialysis patients is still controversial. There is a known risk of early structural valve deterioration of bioprosthesis in dialysis patients, whereas mechanical prosthesis is associated with a higher risk of bleeding and thrombotic events. A 68-year-old dialysis-dependent woman, who had undergone bioprosthetic mitral valve replacement at the age of 66, was admitted to our hospital because of general malaise and hypotension during dialysis. Echocardiography revealed severe mitral stenosis and regurgitation due to restricted motion and dense calcification in prosthetic valve leaflets, which indicated early structural valve deterioration. Redo mitral valve replacement using a mechanical valve was performed, and the patient gradually recovered. However, she eventually died of intracranial hemorrhage three months after the surgery.

[Mitral Valve Replacement and Cardiac Resynchronization Therapy for Mitral Regurgitation with Left Ventricular Noncompaction:Report of a Case].

Left ventricular noncompaction (LVNC) is a rare congenital abnormality resulting from an arrest of the normal process of myocardial compaction. LVNC has been known as a disease of infants, however, some surgical cases of LVNC in adult have been reported. A 61-year-old man who was diagnosed as dilated cardiomyopathy due to LVNC was admitted to our hospital because of dyspnea. Echocardiography revealed severe mitral regurgitation and diffuse left ventricular hypokinesis, and the hypokinetic wall consists of a thin compacted epicardial layer and a thicker noncompacted endocardial layer. Mitral valve replacement using a mechanical valve and cardiac resynchronization therapy were performed. The patient was easily weaned from cardiopulmonary bypass with medium-dose inotropic support and scheduled intra-aortic balloon pumping( IABP). Postoperative course was uneventful, and he was discharged in good condition on the 29th postoperative day.

[Angina Pectoris due to Anomalous Aortic Origin of the Right Coronary Artery;Report of a Case].

A 45-year-old woman was admitted to our hospital because of chest pain on exertion. She was diagnosed to have an anomalous aortic origin of the right coronary artery(RCA) arising from the left sinus of Valsalva, passing between the aorta and the main pulmonary artery. Exercise treadmill test demonstrated significant depression of ST segments in leads II, III and aVF.Because medical treatment was ineffective, reimplantation of the RCA was performed. Dysfunction of the reimplanted RCA occurred, however 3 hours after surgery, and emergency coronary artery bypass grafting was performed using a saphenous vein graft to the RCA. After the 2nd operation, postoperative course was uneventful and multidetector row computed tomographic angiography revealed the patent vein graft and narrowing of the relocated site of RCA.

[Beating Mitral Valve Replacement for Functional Mitral Regurgitation after Cardiac Resynchronization Therapy;Report of a Case].

A 72-year-old man was admitted to our hospital because of dyspnea. He had a history of cardiac resynchronization therapy for congestive heart failure due to dilated cardiomyopathy 6 months previously. Echocardiography revealed severe functional mitral regurgitation which had been mild 6 months before. Because medical treatment was ineffective, on-pump beating mitral valve replacement using a bioprosthesis was performed to prevent reperfusion injury. The patient was easily weaned from cardiopulmonary bypass with low-dose inotropic support and scheduled intra-aortic balloon pump. Then, he was discharged in a good condition on the 37th postoperative day. Beating mitral valve replacement seems to be a good surgical option for patients with poor left ventricular function.

[Double Valve Replacement and Tricuspid Annuloplasty in a Patient with Situs Inversus Totalis and Mirror-image Dextrocardia;Report of a Case].

Situs inversus totalis and mirror-image dextrocardia is a rare congenital anomaly. A 79-year-old man with a history of atrial fibrillation presented to our hospital with chest oppression. Chest X-ray and computed tomography showed mirror-image dextrocardia and situs inversus totalis. Echocardiography revealed severe mitral and aortic regurgitation and mild tricuspid regurgitation. Mitral and aortic valve replacement using bioprosthesises, tricuspid annuloplasty and closure of the left atrial appendage were successfully performed. Surgical procedures were mainly performed by the surgeon standing on the left side of the patient, and by the assistant standing on the right side when necessary. The patient was discharged in good condition on the 23th postoperative day.

[Early outcomes of isolated aortic valve replacement in octogenarians].

We retrospectively studied early outcomes of isolated aortic valve replacement (AVR)in octogenarians. From November 2006 to October 2012, 70 patients underwent AVR and we divided them into 2 groups:group O (24 patients aged 80 years or older, 80~91 years;mean age, 85.0 years);and group Y(46 patients aged younger than 80, 39~79 years;mean age, 69.0 years). There were no significant differences in preoperative comorbidities between the groups, but the logistic EuroSCORE( 13.5% in the group O, 5.3%in the group Y) and EuroSCORE II (4.5% in the group O, 1.7% in the group Y) were significantly higher in the group O. The amount of blood transfusion needed was greater in the group O, but there were no differences between the groups with regard to the operation time, cardiopulmonary bypass time or aortic cross-clamp time. Operative mortality (4.2% in the group O, 2.2%in the group Y)and postoperative complications were not significantly different between the groups. Early outcomes of AVR in octogenarians were good and the newly refined EuroSCORE II showed a good correlation within the studied population.

Left ventricular restoration for ischemic cardiomyopathy--comparison of presence and absence of mitral valve procedure.

OBJECTIVE: Association of mitral regurgitation (MR) with ischemic cardiomyopathy (ICM) increases the degree of heart failure and its surgical management remains controversial. The aim of this study was to report the surgical results in patients with or without MR in association with ICM. PATIENTS AND METHODS: Ninety-two patients with ischemic cardiomyopathy (left ventricular [LV] ejection fraction less than 30% with global akinesis) underwent LV restoration. Pre-operative New York Heart Association (NYHA) functional class was either in class-3 or -4 in all patients. MR was moderate to severe in 38 patients (MR-group) and none or mild in 54 patients (noMR-group). Moderate to severe MR was repaired in addition to the complete coronary artery bypass (CABG) and LV restoration. All patients were followed up and echocardiogram was repeated every 6 months after the surgery. RESULTS: The procedure of LV restoration was selected pre- and intra-operative examination and endoventricular circular patch plasty was performed in 76, partial left ventricle resection in three, and septal anterior exclusion in 13. CABG was performed in 85 patients with mean 2.4+/-1.1 grafts in MR-group and 3.2+/-0.4 grafts in noMR-group (P<0.0001). In MR-group mitral valve plasty was performed in 24 and replacement in 14. Undersized (26 or 28 mm) circumferential mitral ring was used in 16 patients for mitral plasty. Emergent operation required in 15 patients (13 in MR-group and two in noMR group) and the hospital mortality was 18.4% in MR-group and 3.7% in no MR-group. Mitral regurgitation recurred in two patients with posterior ring annuloplasty and they underwent valve replacement. The post-operative NYHA functional class improved to class-1 or -2 in 65 patients and cumulative survival in 5 years including emergent and hospital deaths was 60.9% in MR-group and 70.1% in noMR-group. CONCLUSION: In association of MR to ICM, emergent operation required more often and perioperative mortality rate was high. However, the aggressive combined mitral operation in addition to CABG and LV restoration showed the improvement of clinical symptom and quality of life after the surgery.