[Surgical treatment for infective endocarditis].

OBJECTIVE: Surgery for infective endocarditis (IE) is technically demanding, especially the one for active IE. METHODS: Operations were performed in 21 patients with a mean age of 52.2 +/- 18.8 years. Fifteen patients were male, and 6 were female. There were 15 patients with active IE and 6 patients with healed IE. Isolated pathogens were Streptococcus in 8 cases, Staphylococcus in 3, and Enterococcus in 2. Two patients had prosthetic valve endocarditis. When the lesions affected the aortic valve, aortic valve replacement (AVR) was performed. When the lesions affected the mitral or tricuspid valves, valve repair was the treatment of choice. RESULTS: Six patients underwent AVR and 15 patients underwent a mitral valve operation (mitral valve repair in 13, replacement in 2). In 2 patients, mitral valve repair was changed to replacement, judged by intraoperative transesophageal echocardiogram. One patient underwent isolated tricuspid valve repair. Total survival and survival free of reoperation at 45 months was 95.2%. The grade of mitral regurgitation (MR) decreased from 3.7 +/- 0.1 to 0.2 +/- 0.1, and that of tricuspid valve regurgitation (TR) recovered from 3.5 +/- 0.5 to 1.0 +/- 1.0 at 21 +/- 15 months after the operation. CONCLUSIONS: Valve repair operations were useful in the mitral and tricuspid valve positions, even in the presence of active IE. Both mechanical valve and bioprosthesis showed good results after AVR for IE.

Simultaneous cardiac operations with pulmonary resection for lung carcinoma.

OBJECTIVES: A procedure remains to be established for managing patients with both cardiac and pulmonary diseases requiring surgical interventions. We review our experience with 6 patients having cardiac disease and lung cancer surgically treated simultaneously to determine whether simultaneous surgery is safe and effective. METHODS: Subjects were 6 men with a mean age of 64 +/- 10 years undergoing cardiac surgery combined with pulmonary lobectomy from January 1986 through June 2000. Cardiac procedures consisted of coronary artery bypass in 3, coronary artery bypass plus left ventricular aneurysm repair, aortic valve replacement, and minimally invasive direct coronary artery bypass surgery in 1 patient each. All underwent lobectomy. RESULTS: No early deaths occurred. Bleeding complications occurred in 2 patients and lymph node dissection was incomplete in 3. Two died of carcinoma-related events, 1 at 28 and the other at 84 months after surgery. One died suddenly from a cardiac-related event 42 months after surgery. Only 1 patient is currently alive and disease-free at 104 months after surgery. CONCLUSION: Simultaneous surgery can be conducted with acceptable mortality. The occurrence of bleeding complications and incomplete lymph node dissection, however, indicates combined procedures only in patients requiring simultaneous surgery due to their disease or unable to tolerate a second operation.

[A case of Poland's syndrome with giant bulla resected by using autologous fascia lata].

We reported a case of giant bulla with Poland's syndrome, only left pectoral major and minor muscles defect. A 58-year-old man was admitted to our hospital with shortness of breath on exertion. Computed tomographic scan revealed right giant bulla in emphysematous lung. The giant bulla was resected by linear stapler with autologous fascia lata. Though minor air leakage persisted for 5 postoperative days, the postoperative course was uneventful. It could be effective to reinforce staple line by using autologous fascia lata in emphysematous bulla without any infectious problem.

[Minimally invasive coronary artery bypass grafting and percutaneous coronary angioplasty in the patient with left main disease and chronic renal failure].

This paper describes the utility of the minimally invasive CAB procedure as an adjuvent therapy to allow angioplasty for left main stenosis. A 73-year-old male who had chronic renal failure and left main coronary disease underwent a combined therapy with minimally invasive CABG and PTCA. The operation was reformed with a 9 cm incision. The fifth costal cartilage was removed. Internal thoracic artery (ITA) was dissected from the left side of the chest wall and anastomosed to the midportion of the left anterior descending coronary artery (LAD) with 7-0 with 7-0 Prolene. He was extubaded a few hours after the operation and resumed his dialysis schedule. On the fifth postoperative day he was electively returned to the catheterization laboratory, where he underwent successful angioplasty of the LMT to Lcx after patency of the LITA-LAD graft had been verified. He was discharged from our hospital ten days postoperatively.