[Aortic Valve Endocarditis complicated by Aorto-cavitary Fistula to the Left Atriam Report of a Case].

Aorto-cavitary fistula( ACF) is a rare and serious complication of aortic valve endocarditis, which frequently requires high risk surgical repair. A 78-year-old man under cardioventilatory support was referred to our hospital. Aortic valve regurgitation with ACF to the left atrium, caused by endocarditis, was demonstrated by transthoracic echocardiography. Under ongoing support, surgery was suspended for two weeks after referral, because subacute cerebral infarction was detected. Then we performed aortic valve replacement, mitral valve annuloplasty and closure of the aorto-left atrial communication. The perforation was sutured directly, with glutalaldehyde-treated autologous-pericardium support, on both the aorta and left atrium side. His hemodynamic condition improved dramatically after operation. The patient was discharged from our institute on the 45th-postoperative-day.

[Ascending Aortic Mural Thrombus Caused by Plaque Destruction:Report of a Case].

A 52-year-old male with complaints of pain and cold sensation on left upper-extremity was admitted to a hospital. He was diagnosed with acute left brachial artery occlusion and accordingly underwent emergency thrombectomy. Contrast-enhanced computed tomography (CT) revealed an ascending aortic mural thrombus (AMT). After his transferring to our institution, the AMT was removed, and the ascending aorta was replaced under cardiac arrest. Based on histopathological findings, the thrombus was caused by the destruction of an atheromatous plaque. The patient's postoperative course was uneventful, and no recurrence of AMT was presented for 12 months after operation.

Dilated right internal thoracic artery as a systemic pulmonary shunt.

We report the use of a dilated right internal thoracic artery as a systemic-pulmonary shunt in a patient with a single ventricle who developed a systemic-pulmonary shunt stenosis following a modified Norwood's procedure. The systemic-to-pulmonary artery shunt was performed at 13 months of age, and the patient has stable oxygen saturations five years after the surgery.

[Adult congenital aortic coarctaion;report of a case].

A 63-year-old man with a history of hypertension from 20-year-old complained of dyspnea on effort. He was diagnosed as an adult congenital aortic coarctaion by computed tomography (CT). The CT showed the many collaterals from the subclavian artery, the internal thoracic artery and the intercostal artery to the descending aorta. The coarctation was totally replaced with prosthetic graft through 3rd left thoracotomy under partial cardiopulmonary bypass. The operation was successful and the postoperative course was uneventful. To avoid postoperative paradoxical hypertension, total prosthetic replacement is preferable.

Reasonable and effective volume reduction of a giant left atrium associated with mitral valve disease.

Severe left atrial enlargement associated with mitral valve disease has been known to carry a poor prognosis in patients undergoing mitral valve repair or replacement. There are several reasons why left atrial size can have a significantly negative impact on prognosis. A giant left atrium (LA) can cause postoperative respiratory dysfunction by bronchial and pulmonary compression and hemodynamic disturbance subsequent to compression of the posterobasal portion of the left ventricle (LV). Moreover, the presence of a giant LA can increase thromboembolic risk despite anticoagulant therapy after operation. We report a case of a 62-year-old female who had a markedly enlarged LA associated with mitral valve stenosis and regurgitation. The patient, who had severely restrictive and obstructive respiratory dysfunction, underwent mitral valve replacement and left atrial volume reduction with postoperative improvement in hemodynamic and respiratory function. We believe that volume reduction of an enlarged LA, in addition to mitral valve surgery, is important not only because it leads to improvement in heart failure but also because it will relieve compression of the adjacent organs.

Novel three-sinus enlargement technique for supravalvular aortic stenosis without aortic transection.

BACKGROUND: Although repair of a supravalvular aortic stenosis (SVAS) can be performed with low mortality rates, surgery for the complex form of SVAS continues to be associated with a high incidence of residual stenosis. CASE PRESENTATION: The patient was referred to our hospital at 1 month of age and was diagnosed with aortic valve stenosis (AS) by using echocardiography. Cardiac catheterization revealed moderate AS, and subsequent left ventriculography revealed discrete stenosis of the sino-tubular junction and a narrowed proximal ascending aorta. We performed a reconstructive operation for such heart defects involving novel three-sinus and ascending aorta enlargement without aortic root transection in a 6-month-old boy. CONCLUSION: Our novel three-sinus enlargement technique is suitable for treating each type of SVAS and is a useful method for a baby particularly less than 10 kg without disturbing the growth of the ascending aorta.

A case of right superior vena cava draining into the left atrial roof.

We report the multidisciplinary consideration in a case of right superior vena cava draining into the left atrial roof. A 12-year-old boy was diagnosed with a sinus venosus-type atrial septal defect associated with anomalous right upper pulmonary venous return. However, intraoperative inspection showed the right superior vena cava draining into the left atrial roof, associated with anomalous right upper pulmonary venous return. An anatomical radical operation was performed using a modified conventional technique.

Tricuspid Atresia IIc With a Vascular Ring: Novel Approach for Fontan Completion.

We report a successful Fontan completion in a 22-month-old boy with tricuspid atresia (TA) IIc with a vascular ring. The patient was referred at 1 month of age and was diagnosed with TA IIc using echocardiography. Subsequent 3-dimensional computed tomography revealed a vascular ring. We describe a reconstructive approach for such a heart defect, involving a Damus-Kaye-Stansel (DKS) anastomosis reduction plasty combined with a bidirectional cavopulmonary shunt (BCPS) created by end-to-end suturing of the right superior vena cava (SVC) to the left central pulmonary artery (PA), called the SVC translocation technique.

In vivo study of the effects of cryopreservation on heart valve xenotransplantation.

BACKGROUND: Recent reports have suggested that cryopreservation reduces the immunogenicity of donor tissue. The immunomodulation by cryopreservation might influence on the tissue durability after xenotransplantation. We investigated the in vivo morphologic changes in cryopreserved xenograft (CXG) heart valves. MATERIAL AND METHOD: We transplanted a fresh (fresh xenograft; FXG) and a cryopreserved (CXG) porcine aortic root and a cryopreserved canine (cryopreserved allograft; CAG) aortic root into the abdominal aorta of a dog without any immunosuppressive agents. Explanted grafts on the 21st to 49th days after implantation were analyzed morphologically with light microscopy using some special stains, immunohistochemical analysis, and scanning electron microscopy (SEM). RESULT: Light microscopy showed the absence of smooth muscle cells in the media of the aorta in any group after transplantation. FXG valves did not maintain any cellularity after transplantation. CXG valves contained cellular infiltration in themselves. CAG valves contained numerous fibroblasts, which showed the maintenance of tissue integrity without allowing cellular infiltration. The structure of elastic fibers was well maintained, even in the part of CXG valve with cellular infiltration. Immunohistochemical studies documented the infiltration of T lymphocytes in CXG valves that were labeled by anti-CD3 antibodies. SEM demonstrated that no endothelia were seen on the surface of the valves in any group after transplantation. CONCLUSION: We concluded that the cryopreservation method might provide an immunomodulation of xenogeneic heart valves for transplantation.

A rare case of biventricular outflow obstruction with intact ventricular septum.

We report a case of pulmonary atresia with intact ventricular septum and aortic valve stenosis in a neonate. This combination is extremely rare. Cardiac catheterization was performed at 2 days of age, which confirmed the prenatal echocardiographic diagnosis and identified associated moderate aortic valve stenosis. Soon after the examination, an urgent surgical intervention was required due to uncontrollable circulatory instability. The baby underwent a successful Fontan-type repair achieved by surgical management only.

Off-pump quintuple coronary artery bypass grafting for situs inversus totalis.

Dextrocardia associated with situs inversus totalis is a rare condition. A 49-year-old man with dextrocardia and situs inversus totalis underwent off-pump quintuple coronary artery bypass grafting using bilateral internal thoracic arteries and bilateral radial arteries. The operative technique was similar to that of off-pump coronary artery bypass grafting for situs solitus. His postoperative recovery was uneventful.

Surgery for cardiomyopathy with mitral regurgitation and dyssynchrony.

We present a case of dilated cardiomyopathy with medically intractable congestive heart failure, which was improved by surgical intervention including mitral valve repair and biventricular pacing. This strategy is effective against dilated cardiomyopathy with interventricular dyssynchrony and mitral regurgitation.

Truncus arteriosus communis with interrupted aortic arch: successful repair using a novel technique.

We report a successful one-stage biventricular repair of truncus arteriosus communis with interrupted aortic arch in a neonate. This newborn girl was diagnosed with truncus arteriosus communis type III-B (Congenital Heart Surgeons Society classification) by the echocardiography and three-dimensional computed tomography. We present a new reconstructive approach for such heart defects, involving a modified Lecompte maneuver combined with arch reconstruction, by suturing the ascending aorta to the descending aorta in end-to-end fashion called the swing-back technique.

Successful surgical treatment of intravascular ultrasonography catheter entrapment.

Coronary angiography (CAG) was performed in a 77-year-old woman who presented with chest discomfort. The CAG showed two diseased vessels. For treatment, the patient underwent angioplasty and stenting. During intravascular ultrasonography (IVUS) following stent deployment, the IVUS catheter became entrapped in the left anterior descending coronary artery, causing ischemic changes in the anterolateral wall, which were apparent on the electrocardiogram. The patient underwent emergency coronary artery bypass grafting and removal of the entrapped IVUS catheter.

A technique of snaring method for fitting a prosthetic valve into the annulus.

BACKGROUND: Tourniquetting technique to fit a prosthetic valve (PV) into the annulus in valve replacement surgery has been previously reported. We modified the previously reported method and designed a simpler tying technique. PATIENTS: We performed 11 aortic (AVR: including four cases for calcified aortic stenosis (AS) with a small annulus and one cases for infective endocarditis with intramuscular abscess cavity), eight mitral valve replacements (MVR), and one tricuspid valve replacement (TVR: for corrected transposition of the great arteries). TECHNIQUES AND RESULTS: A PV was implanted using 2-0 polyester mattress sutures with a pledget. Each of the two tourniquets held a suture at the bottom of the annulus and at the opposite position to fit a PV. The sutures between each snare were tied down from the bottom to the top. In MVR, after seating of a PV with two tourniquets, we could make sure that no native tissue of any preserved mitral apparatus disturbed PV leaflet motion. In calcific AS, a PV had a good fitting into the annulus because of tourniquets applied to unseated part during tying sutures. In AVR for infective endocarditis, mattress sutures supported by a Teflon pledget were placed to close the abscess cavity. After snaring on one of these sutures, we tied down the sutures, ensuring that they did not cut through the friable tissues. In TVR, we found that native leaflets interfered with PV motion after seating down the prosthesis and those leaflets were resected before tying down the sutures. Postoperative transesophageal echocardiography showed no paravalvular leakage in any patients and excellent PV functions.

Enhancement of cell viability in cryopreserved rat vascular grafts by administration of regenerating gene (REG) inducers.

The regenerative capacity of viable cells remaining in cryopreserved vascular allografts is still unclear. Recently, the regenerating gene (REG) has been documented to play an important role in various regenerating tissues. Here we show the possibility of REG induction for the enhancement of cryopreserved vascular allograft viability. Cryopreserved rat aortae were isografted or allografted heterotopically. Fresh isografts were also tested. The transplants were retrieved 3, 6, 9, and 12 days after implantation and the intragraft REG mRNA was measured by a real-time quantitative reverse transcriptional polymerase chain reaction method. REG expression was not detected before implantation. REG expression in cryopreserved isografts gradually increased after transplantation, whereas in fresh isografts or cryopreserved allografts it decreased over time after initial expression. Daily administration of 0.5 g/kg nicotinamide (an agent known to be a potent inducer of REG) induced intragraft REG mRNA in cryopreserved allografts (p < 0.05) accompanied by augmentation of the intragraft cell population. Daily administration of 0.5 mg/kg FK506 (an immunosuppressant) induced intragraft REG mRNA both in cryopreserved isografts and allografts (p < 0.01). We conclude that REG-inductive therapy shows promise as a novel strategy for enhancing the viability of vascular allografts. Moreover, FK506 may be involved in tissue regeneration as well as immunosuppression.