[Mitral Valve Repair under Ventricular Fibrillation for Acute Mitral Valve Regurgitation in a Patient with Aortitis Syndrome].

A 73-year-old woman with a history of aortitis syndrome was referred to our hospital presenting with congestive heart failure caused by acute severe mitral regurgitation due to posterior leaflet prolapse. Upon admission, the patient fell into shock state while undergoing an examination. Medical treatment including mechanical ventilation could not alleviate circulatory collapse, so emergency surgery was performed on the day of admission. Severe calcification of the ascending aorta and severe stenosis or occlusion of the aortic arch vessels resulted from the patient's aortitis syndrome precluded aortic cannulation and aortic clamp. Therefore, mitral valve repair was performed under ventricular fibrillation at moderate hypothermia. Surgery was successful, and the patient recovered well without any cerebral complications after the surgery.

[Rupture of Left Ventricular Pseudo-false Aneurysm after Myocardial Infarction].

We herein present a case of ruptured left ventriclular pseudo-false aneurysm. A 73-year-old female had acute myocardial infarction due to occlusion of the left circumflex artery, and subsequently underwent percutaneous coronary intervention. Three weeks later, however, the patient suddenly fell into a state of shock. Contrast-enhanced computed tomography (CT) revealed rupture of left ventricular aneurysm, and emergency surgery was performed. A ruptured aneurysm was observed in the posterior wall, and as the wall of the aneurysm was fragile, it was repaired using double-patch technique. Histopathological examination revealed myocardial cells in the aneurysm wall, confirming diagnosis of pseudo-false aneurysm. Pseudo-false aneurysm is a rare type of left ventricular aneurysm. In cases of rupture in acute or subacute phase of myocardial infarction, when the aneurysm wall is fragile, double-patch repair technique effectively ensures hemostasis and prevents future aneurysm formation.

[Anastomotic Pseudoaneurysms after Graft Replacement for IgG4-related Thoracic Aortic Aneurysm].

We report a case of pseudoaneurysms at the anastomotic sites after prosthetic graft replacement for Immunogloblin G4 (IgG4)-related thoracic aortic aneurysm. A 69-year-old male patient underwent ascending and aortic arch replacement and open stent graft insertion. Five months after the surgery, pseudoaneurysms at the anastomosis to the brachiocephalic artery and to the left common carotid artery developed, and urgency surgery was performed. The right common carotid artery, the right subclavian artery, and the left common carotid artery were individually reconstructed with grafts, and the anastomoses were wrapped with grafts. In IgG4-related aneurysms, complete resection of the diseased tissue and reinforcement of the anastomosis, such as anastomotic wrapping, are important to prevent anastomotic site failure. While serum IgG4 had normalized after the first surgery, C-reactive protein (CRP) remained elevated until the reoperation. Thus, CRP is considered one of the biomarkers for disease activity in IgG4-related vascular disease.

[Total Arch Replacement due to Tracheal Compression by Brachiocephalic Artery with Bovine Aortic Arch:Report of a Case].

A 78-year-old female presented to our institution with a dry cough and dyspnea. Chest computed tomography( CT) revealed tracheal stenosis caused by compression from a brachiocephalic artery with a bovine aortic arch. Subsequently, surgery was performed in which the brachiocephalic artery was resected, and a total arch replacement using a four-branched graft was completed. We paid particular attention to the graft branches, making sure to avoid contact with the trachea. Both the patient's cough and dyspnea dissipated after the surgery, and a CT revealed the tracheal stenosis had been completely relieved. The patient has remained in good condition for the past three years since the surgery showing no respiratory symptoms or thoracic aortic disease. Because the bovine aortic arch is a known risk factor for thoracic aortic disease, rather than simply reconstructing the brachiocephalic artery, we chose a more aggressive surgical treatment to prevent any possible future thoracic aortic disease.

[Successful Use of Left Ventricular Support Device (Impella 5.0) for Ischemic Heart Disease with Cardiogenic Shock:Report of a Case].

Postoperative hemodynamic support with an Impella 5.0 was effective in an obese man who underwent coronary artery bypass grafting (CABG) for ischemic heart disease and cardiogenic shock. A 43-year-old obese man presented to our hospital complaining severe chest pain. Coronary angiography revealed acute coronary syndrome due to severe triple-vessel disease, and the patient fell into a state of shock, which required veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support. The patient subsequently underwent CABG, but he was unable to be separated from VA-ECMO. Impella 5.0 was introduced through right axillary artery on the next day. VA-ECMO was converted to veno-venous (VV)-ECMO on the 3rd postoperative day to enable respiratory rehabilitation in a sitting posi-tion;his respiratory status gradually improved. VV-ECMO and the Impella 5.0 were discontinued on the 6th and 7th postoperative days, respectively. He was eventually transferred to nearby facility for further rehabilitation three months later. As of two years, his cardiac function has improved and he is doing well at home.

[Fatal Cerebral Hemorrhage after Mitral Valve Repair for Active Infective Endocarditis:Report of a Case].

Cerebral hemorrhage is a known complication of infective endocarditis (IE) and is associated with a high mortality rate. We herein present a case of fatal cerebral hemorrhage occurring after successful mitral valve repair in a patient in active phase of IE. A 58-year-old male with active IE underwent an urgent mitral valve repair due to systemic embolisms and a massive mobile vegetation on the mitral valve. During the surgery, a rolled autologous pericardium was fixed onto the annulus, therefore we initiated anticoagulation therapy with warfarin. A follow-up brain MRI on the 18th postoperative day showed several cerebral micro bleedings, and on the next day, the patient suffered massive and fatal cerebral hemorrhage. As cerebral hemorrhage can be fatal especially in patients taking anticoagulants, we believe that anticoagulation therapy should be avoided after mitral valve repair in patients who have cerebral micro bleeding in active phase of IE.

Acute Dissection of the Middle Colic Artery Immediately after Endovascular Abdominal Aortic Aneurysm Repair: A Case Report.

A 78-year-old man underwent endovascular abdominal aortic aneurysm repair (EVAR) for a true aortic aneurysm. He developed sudden abdominal pain 4 hr after EVAR. Angiography revealed a dissected aneurysm of the middle colic artery (MCA). Despite conservative treatment, follow-up computed tomography revealed an expanded aneurysm of the MCA. We therefore performed coil embolization of the dissected MCA to prevent a rupture of the aneurysm. There has never been a reported case of acute dissection of the MCA immediately after EVAR that was not caused by catheters. In this report, we discuss the possible underlying mechanisms and the optimal therapeutic strategy for this rare complication.

Papillary fibroelastoma causing severe aortic stenosis.

Herein, we present a rare case of papillary fibroelastoma of the aortic valve, which caused severe aortic stenosis. The papillary fibroelastoma developed on the left ventricular side of the non-coronary cusp, immobilizing the cusp motion and obstructing the left ventricular outflow tract, resulting in severe aortic stenosis that brought on acute heart failure. The patient underwent an urgent surgical treatment, which resulted in a successful outcome. To the best of our knowledge, this is the first case of papillary fibroelastoma in which aortic stenosis was so severe as to cause congestive heart failure. Learning objective: Papillary fibroelastoma (PFE) is the most commonly observed primary cardiac tumor in adults that commonly involves left heart chambers. While PFEs often cause embolisms, they rarely cause valvular dysfunction. In a case presented herein, a PFE developed on the left ventricular side of the non-coronary cusp, immobilizing the cusp motion and obstructing the left ventricular outflow tract, resulting in severe aortic stenosis that brought on acute heart failure.