Cor triatriatum in adulthood with mitral valve regurgitation and atrial fibrillation.

Cor triatriatum is a rare congenital heart disease. A 57-year-old woman had cor triatriatum with severe mitral valve regurgitation (MR) and atrial fibrillation (AF). We performed mitral valve repair, left atrial appendage resection, and maze procedure by resection of the anomalous septum in the left atrium. As a result, MR was controllable and AF disappeared after the operation. Although there is no established maze procedure with cor triatriatum, removing the septum was effective to complete it.

"Millefeuille Technique" by Using Excised Intimal Layers in Repair of Type A Aortic Dissection.

Surgical outcomes for acute Type A aortic dissection (AAD) have dramatically improved in recent years due to prompt diagnosis, improved surgical technique and perioperative management. A single needle hole can become a new entry point in AAD cases with such a fragile wall, so a mixed technique using minimal surgical stitches and glue is required for a good outcome. The 'Millefeuille' technique involves multiple layers with a prosthetic graft, intimal layer, additionally inserted surplus intimal layer with BioGlue, adventitial layer, and felt. This technique may help to prevent needle hole re-entry.

Spinal cord injury following aortic arch replacement.

PURPOSE: Postoperative spinal cord injury is a devastating complication after aortic arch replacement. The purpose of this study was to determine the predictors of this complication. METHODS: A group of 254 consecutive patients undergoing aortic arch replacement via median sternotomy, with (n = 78) or without (n = 176) extended replacement of the upper descending aorta, were included in a risk analysis. The frozen elephant trunk technique was used in 46 patients. The patients' atherothrombotic lesions (extensive intimal thickening of > 4 mm) were identified from computed tomography images. RESULTS: Complete paraplegia (n = 7) and incomplete paraparesis (n = 4) occurred immediately after the operation (permanent spinal cord injury rate, 1.97%; transient spinal cord injury rate, 2.36%). A multivariable logistic regression analysis identified the use of the frozen elephant trunk technique (odds ratio 36.3), previous repair of thoracoabdominal aorta or descending aorta (odds ratio 29.4), proximal atherothrombotic aorta (odds ratio 9.6), chronic obstructive lung disease (odds ratio 7.1) and old age (odds ratio 1.1) as predictors of spinal cord injury (p < 0.0001, area under curve 0.93). CONCLUSIONS: Spinal cord injury occurs with a non-negligible incidence following aortic arch replacement. The full objective assessment of the morphology of the whole aorta and the recognition of the risk factors are mandatory.

[Covering Suture Line Using Bovine Pericardium during Mitral Valve Replacement for Third Time Infectious Endocarditis;Report of a Case].

A 33-year-old man presenting with fever, fatigue, and delirium was diagnosed with infectious endocarditis(IE). He had already undergone surgery for IE twice;initial valve repair 4 years ago and mitral valve replacement(MVR) 1 year later. He has refractory atopic dermatitis, which was considered to be the cause of his repeated IE. Initially, antibiotics were administered but the infection was not controlled. Therefore, we decided to perform the 3rd surgery. MVR was performed, and using bovine pericardium, we covered valve cuff and suture felts to separete these parts from blood stream. Postoperative echocardiography showed good prosthetic valve motion without transvalvular regurgitation or paravalvular leak. He was discharged on the 39th postoperative day and has been doing well for 2 years since.

Giant coronary artery aneurysm occluded completely by a thrombus.

A coronary artery aneurysm is an uncommon vascular disorder, and it can be a life-threatening disease when associated with rupture or an embolism. A 52-year-old man was found to have a 50-mm coronary artery aneurysm at the right coronary artery, and the aneurysm was completely occluded by a thrombus. He had no symptoms after arriving at our hospital, and his hemodynamics was stable. Therefore, initially, we administered anticoagulation therapy involving heparin. After therapy, the distal coronary artery was detected when the thrombus dissolved, and elective surgery was planned. Coronary artery bypass grafting, ligation of the inflow and outflow vessels, and resection of the aneurysm were performed. Early anticoagulation therapy and surgical aneurysm resection were effective for treating the completely occluded coronary artery aneurysm. We herein report this rare case of a giant coronary artery aneurysm occluded completely by a thrombus and treated successfully by anticoagulation therapy and surgical aneurysm resection.

Abdominal aortic aneurysm mimicking the cause of gastric obstruction.

A case of abdominal aortic aneurysm appeared to be compression of the antrum of the stomach and was suspected of causing a gastric obstruction. However, an upper gastrointestinal endoscopy to rule out an obstruction by a tumor revealed a gastric tumor, thus avoiding unnecessary intervention, such as open surgery.

Plaster technique for filling up a future entry at the suture hole in type A aortic dissection.

Although the surgical technique for acute type A aortic dissection dramatically improved in recent years, the postoperative mortality and morbidity rates remain high. After the emergency surgery for acute type A aortic dissection, a small tear in the aorta may result in dilation of the false lumen in the future. Some tears originate from the suture line on the anastomosis. This report introduces the novel "plaster technique" that involves using a single interrupted suture with felt and plastering a minimum dose of BioGlue into the suture hole. Similar to patients with acute aortic dissection, we found that the plaster technique using a felt pledget and minimum dose of BioGlue is effective for fragile aortic walls. Moreover, it is a simple, safe, and durable technique to strengthen the suture line. Supplementary Information: The online version contains supplementary material available at 10.1007/s12055-022-01351-0.

Surgical techniques for infectious endocarditis of the mitral valve with hypertrophic cardiomyopathy in Costello syndrome.

Costello syndrome is a rare congenital disease caused by activating germline mutations, and it is often associated with cardiac abnormalities. A 17-year-old male with a history of Costello syndrome presented with persistent fever. Vegetation attached to anterior mitral leaflet was detected, and antibiotic therapy was administered as treatment for infectious endocarditis. However, it was difficult to manage his heart failure owing to the worsening of mitral valve regurgitation. Therefore, mitral valve repair with vegetation resection was performed. His hypertrophic cardiomyopathy and systolic anterior motion of mitral anterior leaflet caused left ventricle outflow tract obstruction. A floating stitch on the anterior mitral leaflet from the posterior ring annulus was effective. Herein, we report a successfully repaired case of infectious endocarditis on the mitral valve with hypertrophic cardiomyopathy complicated by Costello syndrome. .

Late-phase left ventricular pseudoaneurysm after three-time mitral valve surgery.

Rupture of the left ventricular posterior wall is a fatal complication during mitral valve replacement (MVR), and rupture mainly occurs intraoperatively and up to several days after MVR, but it rarely occurs in the late phase, such as several years postoperatively. Late rupture occasionally presents as left ventricular pseudoaneurysms (LVPAs). A 40-year-old man who had a three-time history of mitral valve surgery for infectious endocarditis was incidentally found to have a left ventricular aneurysm with no symptoms. He underwent closure of a LVPA with MVR. Although there are various surgical techniques to close LVPAs after mitral valve repair, it is still a challenging problem. Here, we report the case of a patient who successfully underwent LVPA repair with MVR and describe the technique.

Late detection of communication between juxtaposed atrial appendages.

A 40-year-old woman underwent an atrial septal defect closure 4 years before presentation. During the operation, juxtaposition of the atrial appendages was found simultaneously but no obvious communication was found between the appendages. She recently experienced desaturation on exercise, and the residual communication was found between the juxtaposed atrial appendages. The residual communication was closed from the right to the left atrium. Herein, we report the rare case of juxtaposition of the atrial appendages with residual communication between them after an atrial septal defect closure.

Beating pulmonary vein sign during catheter ablation.

The beating of a pulmonary vein during cardiac catheterization is a rare phenomenon caused by the heart beating through the pericardial effusion when a cardiac tamponade occurs. This "beating pulmonary vein" sign is useful for early detection of a tamponade before circulatory collapse occurs.

Pericardioperitoneal and pericardiopleural windows: A drainage technique for the treatment of recurrent cardiac tamponade. A case report.

INTRODUCTION: Given that pericardial effusion may sometimes lead to cardiac tamponade and chronic heart failure, its management seems absolutely essential. In case of a poor response to medical therapy, surgical drainage of the effusion is required. Although some drainage procedures for pericardial effusion (e.g., temporary puncture, pericardiopleural drainage, and pericardioperitoneal drainage) are currently used in clinical practice, their long-term efficacy remains unclear. PRESENTATION OF CASE: We present a case of a 58-year old female with recurrent pericardial effusion secondary to systemic lupus erythematosus. Since she was relatively young and on steroids, long-term patency of pericardial fenestration needed to be insured without any device. Hence, we created 2 pericardial windows, pericardioperitoneal and pericardiopleural, via a single-incision subxiphoid approach to allow the effusion to drain into the abdominal and thoracic cavities. DISCUSSION: It is important to efficiently manage pericardial effusion because it can lead to more serious conditions such as cardiac tamponade and chronic heart failure. Our technique, which involves making a small incision, can reduce the risk of recurrence. CONCLUSION: Simultaneous creation of pericardioperitoneal and pericardiopleural windows is simple and can be feasibly performed to prevent the recurrence of pericardial effusion.

Coronary artery aneurysm complicated by pneumothorax with a history of Kawasaki disease.

Kawasaki disease (KD) is a common vasculitis disorder of childhood. It can sometimes complicate coronary artery aneurysms, and treatment is required depending on the condition of stenosis. A 20-year-old man was referred for surgery with a coronary artery aneurysm and stenosis in the left coronary artery as sequelae of KD. He had a surgical history of left pneumothorax and bullae remaining on the right lung. We simultaneously performed off-pump coronary artery bypass for coronary artery stenosis and bullectomy. Coronary artery aneurysms with KD complicated by pneumothorax are rare, and we treated them using one-stage surgery.

Total resection of an infected aortic arch aneurysm caused by Mycobacterium avium: a case report.

BACKGROUND: Infected aortic arch aneurysms caused by Mycobacterium avium are rare in immunocompetent individuals. Promptly recognizing these aneurysms is important because delays in treatment result in aneurysm rupture and a high fatality rate. Although Salmonella species, Streptococcus species, Staphylococcus aureus, and S. epidermis are commonly found in immunocompetent individuals, to our knowledge, infected aortic arch aneurysms caused by M. avium have not yet been reported. CASE PRESENTATION: We report the case of a 63-year old immunocompetent man who underwent total arch replacement following infection by the nontuberculous mycobacteria M. avium. The procedure involved total aneurysmal resection and arch replacement with a rifampicin-bonded gelatin-sealed woven Dacron graft. He was discharged without complications and remained asymptomatic after 30 months. CONCLUSION: In this brief report, we outline and discuss the rare successful case of total arch replacement using total aneurysmal resection and rifampicin-bonded gelatin-sealed woven Dacron graft for an infected aortic arch aneurysm resulting from M. avium in an immunocompetent patient.

[Rotavirus vaccine].

Rotavirus gastroenteritis is one of the most important diseases in young children. There are 400,000 to 600,000 deaths annually among children under 5 years old in the world, especially in developing countries. Rotavirus vaccine has been developed since 1980s. However vaccine development and trial took a long time before the commercial available. One reason is the genetic variability of rotavirus, there are more than 10 serotypes (G types) in group A rotavirus. Another reason is side reaction such as intussusception which was recognized at the time of development of RotaShield. At present, RotaTeq (5 valent recombinant vaccine) and Rotarix (monovalent human strain vaccine) are evaluated for vaccine efficacy in several countries. These two vaccines are in field study, licensed or soled in different countries. Thus for, these vaccines have not licensed in Japan but it will be used in near future.

Detection and genetic characterization of rotavirus infections in non-hospitalized children with acute gastroenteritis in Japan, 2007-2009.

The molecular epidemiology of rotavirus infections in non-hospitalized children in five different regions (Sapporo, Saga, Tokyo, Osaka, and Maizuru) of Japan during 2007-2009 was investigated. Overall, rotavirus was detected in 156 out of 1008 (15.5%) specimens. The rotavirus infection in 2007-2008 (19.3%) was higher than those in 2008-2009 (12.1%). G1P[8] was the most prevalent (62.8%), followed by G3P[8] (21.8%), G9P[8] (14.7%), and G2P[4] (0.7%). Interestingly, the number of G3P[8] strains increased threefold from the former season (2006-2007) from 7.3% to 21.8%, whereas G2P[4] and G9P[8] decreased from 11.4% to 0.7% and 20.3% to 14.7%, respectively. In the phylogenetic analysis, G3 rotaviruses were closely related to "the new variant G3" 5091 strain, which previously emerged in Japan and China. G9 viruses isolated in 2007-2008 were genetically close to the Thai strain, while those isolated in 2008-2009 had a close relationship with Chinese strains. G1 viruses appeared to be more similar to the recently reported G1 strain in China. Nucleotide sequence analysis of 33 P[8]-nontypeable strains revealed 5 nucleotide mismatches at the primer binding site. Based on previously reported (2003-2007) and current (2007-2009) data of rotavirus surveillance in the five areas of Japan, it was revealed that in Sapporo, Osaka, and Maizuru, G1P[8] and G3P[8] were detected at high frequencies, ranging from 47.2 to 57.7% and 31.7 to 47.4%, respectively. In Tokyo, G1P[8] (47.4%) was the predominant strain, followed by G9P[8] (20.6%), whereas in Saga, G3P[8] (38.9%) and G9P[8] (36.1%) were identified as the most dominant types. None of G9P[8] was detected in Sapporo. This study highlights the genetic diversity and the significance of rotavirus diarrhea in Japan.

In vivo temporal EPR study using a region-selected intensity determination method to estimate cerebral reducing ability in rats treated with olanzapine.

Region-selected intensity determination (RSID) is a method for obtaining the temporal changes in electron paramagnetic resonance (EPR) signal intensity from a target region, without the use of complicated procedures employed in the conventional imaging methods. An in vivo 700-MHz radio frequency EPR spectrometer equipped with a bridged loop-gap resonator was used with the RSID method to estimate intracerebral reducing ability in the rat following acute administration of olanzapine (OZP) or haloperidol (HPD). To this end, temporal changes in EPR signal intensity of target regions (the striatum and the prefrontal cortex) of rats which had received a blood-brain-barrier-permeable nitroxide radical (3-hydroxymethyl-2,2,5,5-tetramethylpyrrolidine-1-oxyl) via an intravenous route were observed. The half-lives of EPR signal intensity in both regions of OZP- or HPD-treated rats were significantly longer than in control animals. This indicated that reducing abilities of the striatum and cerebral cortex decreased in the rats to which either OZP or HPD had been acutely administered.

Genotypic linkages of VP4, VP6, VP7, NSP4, NSP5 genes of rotaviruses circulating among children with acute gastroenteritis in Thailand.

Rotavirus is the main cause of acute viral gastroenteritis in infants and young children worldwide. Surveillance of group A rotavirus has been conducted in Chiang Mai, Thailand since 1987 up to 2004 and those studies revealed that group A rotavirus was responsible for about 20-61% of diarrheal diseases in hospitalized cases. In this study, we reported the continuing surveillance of group A rotavirus in 2005 and found that group A rotavirus was detected in 43 out of 147 (29.3%) stool samples. Five different G and P genotype combinations were detected, G1P[8] (27 strains), G2P[4] (12 strains), G9P[8] (2 strains), G3P[8] (1 strain), and G3P[10] (1 strain). In addition, analysis of their genotypic linkages of G (VP7), P (VP4), I (VP6), E (NSP4), and H (NSP5) genotypes demonstrated that the rotaviruses circulating in Chiang Mai, Thailand carried 3 unique linkage patterns. The G1P[8], G3P[8], and G9P[8] strains carried their VP6, NSP4, NSP5 genotypes of I1, E1, H1, respectively. The G2P[4] strains were linked with I2, E2, H2 genotypes, while an uncommon G3P[10] genotype carried unique genotypes of I8, E3 and H6. These findings provide the overall picture of genotypic linkage data of rotavirus strains circulating in Chiang Mai, Thailand.