[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.

[Endovascular Repair of Infected Thoracic Aortic Aneurysm whose Shape Changed during Treatment of Infection].

We report a successful case of infected thoracic aortic aneurysm treated by endovascular repair. An 82-year-old woman, presenting with intermittent back pain and low-grade fever, was transferred with the diagnosis of infected thoracic aortic aneurysm. High inflammatory reaction and a thickened aortic wall around the aneurysm confirmed the diagnosis. We performed infection control first because enhanced computed tomography (CT) scanning revealed aneurysm was a low-density mass, which denied aortic pseudoaneurysm or rupture. After administration of broad-spectrum antibiotics, low-grade fever was relieved and inflammatory reactions were decreased. CT performed on the 11th hospital day showed the low-density mass was decreased in size. However, CT performed on the 35th hospital day revealed penetrating atherosclerotic ulcer( PAU) into the low-density mass, which was consistent with saccular aortic aneurysm. The patient underwent thoracic endovascular aortic repair( TEVAR). Postoperative course was uneventful and she was discharged on 22nd postoperative day. Oral administration of antibiotics was continued for 6 months after discharge. Eight months after TEVAR, CT revealed disappearance of the aneurysm. The patient showed no recurrence of infection at 5 years of follow-up.

[Rapid Rise of Trans-oxygenerator Pressure Gradient Accompanied by Rapid Decrease of Platelet Counts During Open-heart Surgery].

A 77-year-old male patient with 2-vessel coronary artery disease and previous myocardial infarction underwent on-pump coronary artery bypass grafting (CABG). Following systemic heparinization, cardiopulmonary bypass using heparin coated circuit was started. Ten minutes after starting the cardiopulmonary bypass, the trans-oxygenerator pressure gradient rapidly increased accompanied by a rapid decrease of platelet counts. Emergency replacement of cardiopulmonary bypass circuit with a non-heparin coated one was performed because the development of heparin induced thrombocytepenia (HIT) was strongly suspected. On-pump CABG was accomplished as planned, and the postoperative course was uneventful. HIT might be ruled out as HIT specific antibodies were not detected in the intraoperative serum samples.

Staphylococcus aureus and repeat bacteremia in febrile patients as early signs of sternal wound infection after cardiac surgery.

BACKGROUND: Sternal wound infection is a devastating complication of cardiothoracic surgery that carries high postoperative morbidity and mortality rates. We explored whether our current program of extensive bacteriological examination including repeat blood cultures may contribute to the early diagnosis of sternal wound infection. METHODS: We retrospectively analyzed 112 patients who were subjected to our bacteriological examination protocol including within 90 days after cardiothoracic surgery. Univariate and multivariate analyses were made in order to identify risk factors for sternal infection. RESULTS: The median patient age was 75 years, and 65 patients were male. In 35 cases (31.2%) the blood cultures showed the presence of bacterial infection with the following frequencies: Staphylococcus aureus, 18 cases; Coagulase-negative Staphylococcus, 7 cases; other organisms, 10 cases. Eleven patients presented repeat bacteremia on at least 2 different occasions. Twenty patients (17.8%) presented sternal wound infections. There was no difference in operative mortality between the patients with and without sternal wound infection. Univariate and multivariate analyses demonstrated that bilateral mammary artery use (OR, 13.68, 95% CI, 1.09-167.36, p = 0.043), positive blood culture for Staphylococcus aureus (OR, 19.51, 95% CI, 4.46-104.33, p < 0.0001), repeat bacteremia (OR, 17.98, 95% CI, 2.51-161.77, p = 0.004) were risk factors that were associated for sternal wound infection. CONCLUSION: Repeat blood cultures in febrile patients appear to be useful for the early detection of Staphylococcus aureus and repeat bacteremia, and these were associated with sternal wound infection. Bilateral internal mammary artery use was another risk factor of sternal wound infection in febrile patients. These factors may identify patients suitable for expeditious radiological examination and aggressive treatments.

Aortic valve replacement for quadricuspid valve: a lesson learnt from a negative experience.

Quadricuspid aortic valve is a rare congenital abnormality often associated with valve incompetence and requires surgical correction in adulthood. However, using a standard suture technique of aortic valve replacement, postoperative complete atrioventricular block is not uncommon because of the downward displacement of the supranumerary leaflet towards the membranous septum. We describe a suture technique where the sutures on the supranumerary leaflet were passed through the aortic sinusal wall above the valvar hinge. This technique can preclude injury to the conduction system, thereby avoiding atrioventricular block.

Preoperative Coil Embolization to Aortic Branched Vessels for Prevention of Aneurysmal Sac Enlargement Following EVAR: Early Clinical Result.

OBJECTIVE: Persistent Type 2 endoleaks (PT2) after endovascular aortic aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) are associated with increased adverse outcomes, including aneurysmal sac enlargement and rupture. The aim of this study was to report early clinical outcomes of coil embolization (CE) to aortic branched vessels prior to EVAR and assess the effectiveness of this strategy in terms of prevention of sac growth due to PT2. MATERIALS AND METHODS: Between May 2007 and April 2012, EVAR was performed for 215 cases, divided into two groups (150 cases in Group A, before introduction of CE; 21 in Group B, receiving CE before EVAR). Early clinical outcomes were compared between groups. RESULTS: Fifty percent of cases in Group B had a marked reduction of aneurysmal sac diameter based on multi-detector row computed tomographic angiography (MDCTA) findings at the 6-month follow-up after EVAR, whereas, only 25% of cases in Group A had shrinkage of the aneurysmal sac during the same time period after EVAR. CONCLUSION: This strategy has the possibility of improving late outcomes of EVAR by reducing endoleak volumes beforehand.