Aortic valve replacement for dextrocardia with situs inversus totalis.

Dextrocardia is a rare congenital cardiac positional anomaly. A 74-year-old woman was referred for aortic regurgitation (AR). Chest X-ray revealed a mildly enlarged heart that directed to the right side. Transthoracic echocardiography showed AR due to cusp prolapse with a dilated left ventricle and reduced wall motion. Computed tomography demonstrated the heart and great vessels in a mirror image of their normal positions. A median sternotomy performed by the surgeon standing on the right side of the patient. After establishing a cardiopulmonary bypass, the surgeon moved to the left side of the patient, and then performed aortic valve replacement.

Acute Mitral Regurgitation After Blunt Chest Trauma: A Case Report.

Myocardial contusion is the most common cardiac injury from blunt chest trauma (BCT), whereas isolated valve injury is uncommon. We report a case of acute mitral regurgitation (MR) due to isolated valve injury after BCT. A 60-year-old man received an impact on his left chest by a car wheel three weeks prior to visiting our hospital. At the time a diagnosis of contusion of the chest wall without rib and sternal fractures was made. Thereafter, the patient had progressive worsening of heart failure symptoms. Eventually he developed dyspnea on slight exertion but echocardiographic evaluation was not performed at the time of diagnosis or during the three weeks prior to admission. At admission a holosystolic murmur was heard. Transthoracic echocardiography revealed prolapse of the posterior mitral leaflet due to torn chordae tendineae with severe MR and normal left ventricular wall motion. At surgery, torn chordae tendineae and a leaflet tear of the posterior leaflet were detected, and mitral valve repair was achieved without residual MR. Pathological examination of the torn chordae showed no findings of endocarditis or myxomatous degeneration. Echocardiography may play an important role for accurate and prompt diagnosis of cardiac lesions in patients with recent or a history of high-energy BCT.

Streptococcus Mitis Endocarditis Associated with Early Gastric Carcinoma.

We report a case of Streptococcus mitis endocarditis associated with early gastric carcinoma. A 71-year-old man who had been diagnosed with aortic regurgitation (AR) two years previously was referred for valve surgery and evaluation of elevated inflammatory markers. Four months previously, atrophic gastritis, early gastric adenocarcinoma, and colon polyp had been identified in the patient during endoscopy. However, Helicobacter pylori testing was negative. On admission, he had no dental diseases or recent oral procedures. Echocardiography demonstrated severe AR and mobile vegetation on the aortic valve. Magnetic resonance imaging revealed cerebral embolism and spondylodiscitis. Blood cultures grew Streptococcus mitis. At surgery, destruction of the left cusp with vegetation and a perforation of the non-coronary cusp were found; in addition, aortic valve replacement was performed. Although the association between Streptococcus bovis bacteremia and colon neoplasm is well recognized, the association between Streptococcus mitis endocarditis and gastrointestinal carcinoma should also be kept in mind.

Rothia Aeria Endocarditis Complicated with Multiple Systemic Embolisms.

Rothia aeria is part of the normal flora in the human oral cavity and rarely causes serious systemic infection in healthy hosts. We report a case of infective endocarditis of the mitral valve due to Rothia aeria. A 53-year-old man suffered a cut on his left thumb. At the time, the patient licked the wound as a conventional way to accelerate its cure. Thereafter, he developed a recurrent fever, which was temporarily lysed with treatment using an intravenous antibiotic, over a period of 2 months after the injury. On admission, the patient had no dental caries and denied any dental procedures before onset of the fever. Auscultation revealed a systolic cardiac murmur. Echocardiography showed torn chordae of the posterior mitral leaflet with a small vegetation and severe mitral regurgitation. Two sets of blood cultures were positive for Rothia aeria. Computed tomography revealed splenic and left renal infarctions but no cerebral infarction. After resolution of the inflammation by 6 weeks of penicillin treatment, mitral valve repair was successfully performed.

Anomalous Aortic Origin of the Right Coronary Artery Incidentally Detected In a Patient with Degenerative Mitral Valve Disease.

Anomalous aortic origin of a coronary artery from the opposite sinus of Valsalva is known as a cause of sudden cardiac death. However, it is often asymptomatic and incidentally diagnosed during evaluation for other cardiac diseases. We report a case of anomalous aortic origin of the right coronary artery (RCA) from the left sinus of Valsalva (ARCA) detected incidentally in a patient with degenerative mitral regurgitation (MR). A 47-year-old man, who had no history of myocardial ischemic symptoms on exertion, was admitted for sudden orthopnea. ECG revealed no ischemic changes and arrhythmias. Echocardiography demonstrated MR due to torn chordae of the posterior mitral leaflet. Computed tomography (CT) revealed the RCA arising from the left sinus of Valsalva at an acute angle and taking an interarterial course between the great arteries. The proximal RCA showed a circular shaped cross-section on CT, suggesting no presence of an intramural segment. Considering refractory heart failure and no history of myocardial ischemic symptoms on exertion as well as the findings of the CT angiography, urgent mitral valve repair was undertaken without surgical intervention for the anomalous RCA, and without evaluating myocardial ischemia. The patient recovered uneventfully. Postoperatively, myocardial perfusion scintigraphy demonstrated no exercise-induced myocardial ischemia. Patients with ARCA who are asymptomatic and whose coronary course is not intramural can be managed without surgical intervention for an anomalous coronary artery.

A case of angioleiomyoma presenting as a pulsatile tumor in the left ring finger.

Angioleiomyomas in the finger are rare and their preoperative diagnosis is difficult. Most of them are not associated with arteries and their chief complaint does not reveal pulsation tumor. We report a case of the angioleiomyoma in the finger which was misdiagnosed as arteriovenous fistula of tumor, based on the presence of pulsating tumor and angiography finding.

[Long-term outcomes of thoracic endovascular aortic repair with homemade stent-grafts].

We reviewed our experience with homemade stent-grafts in the repair of thoracic aortic lesions. The objective of this study was to assess the long-term outcomes of this therapy. From 1999 to 2008, homemade stent-grafts were inserted in 94 patients with various thoracic diseases. The endoprostheses were stainless steel Z-stents covered with polyester graft and were custom designed for each patient. Placement of the stent-grafts was technically successful in 85 of the 94 patients (90%). Within 30 days after the treatment, 4 patients died, 3 had cerebral infarction, and 3 had the onset of paraplegia or paraparesis. Primary endoleaks were observed in 10 patients (11%). During the mean follow-up period of 43 +/- 29 months, 10 patients had endoleaks and 8 had stent-graft migration. The aneurysm-related mortality rate was 12%. Our early outcomes of elective and emergency thoracic endovascular aortic repair with homemade stent-grafts demonstrated their therapeutic effectiveness in high-risk patients with various thoracic diseases. Endoleaks and migration were, however, the factors most responsible for secondary intervention in the mid-term period. Careful follow-up of the treated patients is needed to avoid the major complication in the long-term period.

Pregnancy-unrelated spontaneous rupture of a right ovarian artery aneurysm.

Spontaneous rupture of an ovarian artery aneurysm is extremely rare. It can lead to retroperitoneal hemorrhage that is often life-threatening. We report a case of pregnancy-unrelated spontaneous rupture of a right ovarian artery aneurysm in a multiparous woman. A 29-year-old woman, gravida 3, para 3, whose latest pregnancy involved uneventful gestation and delivery 2 years previously, was admitted for right flank pain. The urine test result for pregnancy was negative. Computed tomography revealed a large retroperitoneal hematoma and right ovarian artery aneurysm with contrast extravasation. After selective angiography, embolization of the right ovarian artery was successfully achieved using microcoils. Diagnostic angiography with subsequent transcatheter arterial embolization is an effective and less invasive technique for the management of ovarian artery aneurysm.

Spontaneous dissection of the iliac artery in a patient with fibromuscular dysplasia.

A 49-year-old man was referred to our hospital at 10 days after the onset of sudden intermittent claudication of the right lower limb and with right lower abdominal pain. Diagnosis by computed tomography scan and pelvic angiography was dissection from the common iliac artery to peripheral external iliac artery with thrombosed false lumen. Replacement of the common and external iliac artery was performed using a 10-mm Dacron prosthesis. A pathological examination of the right common iliac artery revealed an arterial disorder caused by fibromuscular dysplasia.

Pericardial injury from chest compression: a case report of incidental release of cardiac tamponade.

BACKGROUND: Although chest compression is a standard technique in cardiopulmonary resuscitation, it is well recognized that manual chest compression causes various internal injuries, of which major injuries are often fatal. Similarly, when cardiac tamponade occurs in patients with type A acute aortic dissection, many patients die before reaching the hospital. We report a rare case in which chest compressions caused pericardial laceration that may have inadvertently played a life-saving role in releasing cardiac tamponade induced by acute aortic dissection. CASE PRESENTATION: A 67-year-old woman developed cardiac arrest soon after complaining of epigastric pain, and after successful resuscitation by manual chest compression, she was transferred to our hospital. On arrival, the patient was 14 on the Glasgow Coma Scale. An ECG showed a normal sinus rhythm, and no arrhythmias or signs of myocardial ischemia were observed. A chest X-ray revealed left pleural effusion, while cardiomegaly and pneumothorax were not identified. Computed tomography revealed type A aortic dissection, mild pericardial effusion, and massive left pleural effusion. No pulmonary embolus was found on the CT. After drainage of bloody effusion from the left pleural space, an emergency operation was begun. During surgery, a pericardial laceration with communication to the left pleural space and a hemothorax were found; however, no cardiac injury was identified. No other intra-thoracic injuries or rupture of the aortic dissection causing the hemothorax were detected. Hemiarch replacement was performed without difficulty, but the patient died of multi-organ failure 30 days after surgery. CONCLUSIONS: We report a case of pericardial injury without skeletal fracture caused by chest compression. The pericardial laceration may have inadvertently served to release the cardiac tamponade induced by the acute aortic dissection, resulting in the hemothorax, and provided time to receive surgery.

Abdominal Aortic Aneurysm Caused by Aortic Fibromuscular Dysplasia: A Case Report.

Fibromuscular dysplasia (FMD) mainly develops in medium-sized arteries, including renal, extracranial, and extremity arteries, but it rarely causes abdominal aortic aneurysm (AAA). A 69-year-old woman with AAA diagnosed on ultrasonography by a home doctor visited our hospital. Contrast-enhanced computed tomography revealed a saccular aneurysm of terminal abdominal aorta. We performed abdominal aortic replacement and resected the section with aneurysm. Pathological examination of the wall tissue of the resected aneurysm revealed findings that are consistent with FMD. We report this case of AAA caused by aortic FMD because of its rarity.

D-dimer value more than 3.6 µg/ml is highly possible existence deep vein thrombosis.

OBJECTIVE: The present study aimed to establish whether a more optimal cutoff value for D-dimer testing could definitively rule out acute deep vein thrombosis (DVT). METHODS: Between April 2009 and March 2010, 190 referral patients suspected to have DVT were assessed by the D-dimer assay. Additionally, ultrasonography (US) and computed tomography (CT) imaging were performed to detect thrombosis. RESULTS: DVT was identified in 47 patients (24%). The average D-dimer level in patients with DVT was 17.6±22.4 µg/ml, and was significantly lower (p=0.035),] at 2.7±4.2 µg/ml, in those without DVT. On the basis of receiver operating curve analysis, the specificity of the D-dimer for diagnosing DVT increased from 40% to 78.3%, and its sensitivity reached 93.8%, when the cutoff value for the assay was set at 3.6 µg/ml. CONCLUSIONS: D-dimer value over 3.6 µg/ml was highly prognostic for DVT.

Non-permanent inferior vena cava filters for prophylaxis and treatment of lower limb venous thromboembolism.

OBJECTIVES: The purpose of this study was to evaluate and compare our recent clinical experience with temporary inferior vena cava (IVC) filters (TF) and retrievable IVC filters (RF). MATERIALS AND METHODS: Patients who received TF or RF implantation between October 2002 and May 2009 were studied. The early clinical outcomes between the 2 groups were compared. RESULTS: Nonpermanent IVC filters were placed in 119 patients (34 in TF and 85 in RF). Retrieval of RF and removal of TF were successful in 98.7% and 100%, respectively. The incidence of filter-related complications for TF was significantly higher than for RF (26.5% vs 3.5%; P = .0004). However, no symptomatic pulmonary embolism (PE) was observed during filter placement. CONCLUSION: TF and RF provided similar protection from PE. We prefer RF because they can be left in permanently if it is impossible to remove or retrieve the filter for some reason.