A Case of Cardiac Angiosarcoma Successfully Treated with Postoperative Conformal Dynamic Arc Radiotherapy / 日本心臓血管外科学会雑誌

Cardiac angiosarcoma is a rare heart malignancy. The prognosis is reported to be very poor. Here, we report a case of cardiac angiosarcoma which was treated by postoperative conformal dynamic arc radiotherapy. The patient has been in good health with no recurrence for 18 months after surgery. The patient was a 71-year-old woman, who presented edema and general malaise. Echocardiography and computed tomography revealed a right atrial mass and massive pericardial effusion, which was thought to be the cause of tamponade. Intraoperatively, we found a large tumor arising from right atrial wall spreading and invading to the inferior vena cava, diaphragm, and right pericardium. We abandoned complete resection of the tumor. We only resected the part of the tumor under cardiopulmonary bypass. The subsequent defect of the right atrial wall was reconstructed with bovine pericardial patch. The pathological diagnosis was consistent with angiosarcoma, and the margin was positive for the tumor. In addition to reduction surgery, we adopted radiotherapy (conformal dynamic arc radiotherapy, 10MV-X-ray, 54 Gy/18 Fr/4.5 week, fractionated radiotherapy). The CT, one month after the radiation, showed a significant reduction in tumor size. Moreover, no tumor could be pointed out by echocardiography 18 months after surgery. Advances in technology and methodology has made tumor control possible without significant side effects. We conclude that reduction surgery accompanied with postoperative radiotherapy is promising in maintaining quality of life and in improving life expectancy.

Successful Surgical Repair for Rupture of Penetrating Atherosclerotic Ulcer with MRSA Infection of a Porcelain Descending Aorta / 日本心臓血管外科学会雑誌

A 41-year-old man with focal glomerulosclerosis had been treated by hemodialysis for 22 years. Kidney transplantation from a living donor was performed once, but the transplanted kidney was removed out because it had been infected by methicillin-resistant <i>Staphylococcus aureus </i>about 3 months previously. He was admitted to our hospital with over 38°C fever 2 months after the removal. He had hemoptysis and marked back pain. Computed tomography scan revealed ruptured descending aorta. The descending aorta was circumferentially calcified but not enlarged. We thought that a penetrating atherosclerotic ulcer had formed in a crack of the porcelain aorta and ruptured with infection. First we tried endovascular treatment with stent-graft implantation. It was useful to control hemoptysis, but a small amount of type I leakage remained. Finally, after controlling the infection, we performed prosthesis replacement with extra-corporeal circulation and surrounded the artificial aorta with the omentum. The postoperative course was uneventful and he recovered completely.

Perioperative Acute Aortic Dissection Complicating Open Heart Surgery: Report of Three Cases / 日本心臓血管外科学会雑誌

Aortic dissection is a rare but potentially fatal complication of cardiac surgery. We report 3 cases of acute aortic dissection complicating open heart surgery. The incidence of complications was 0.18% of cardiac operation during 10 years at our institute (3/1, 647). The dissection is most frequently observed to originate in the ascending aorta, and can occur during operation. In our series, however, two of the three had their dissection entry in the descending aorta and another in the left subclavian artery. Their dissection mainly extended to the distal site of the aorta. Two of the cases were found by postoperative examinations (CT, US) and had had no symptoms or complications, and they were treated conservatively with antihypertensive therapy. One case died due to intrathoracic bleeding and a cerebrovascular event just after the onset of the complication on the 10 postoperative-day. We have to pay attention to this as one of the possible complications after open heart surgery, and intraoperative transesophageal echocardiography or postoperative examinations such as CT were useful for detecting them. We should also take care of hypertension after cardiac surgery in cases in which this is a potential factor such as Marfan's syndrome.

A Case of Mitral Valve Replacemernt in a Patient with Severe Mechanical Hemolytic Anemia after Mitral Valve Repair / 日本心臓血管外科学会雑誌

A 60-year-old man, who had undergone mitral valve repair with quadrangular resection of the posterior mitral leaflet and ring annuloplasty with a Cosgrove-Edwards ring, developed severe mechanical hemolytic anemia. Doppler echocardiography showed only mild residual mitral regurgitation, but turbulent jet was directed toward the annuloplasty ring. Because of unremitting hemolysis requiring multiple transfusions and the occurrence of renal dysfunction, he underwent replacement of the mitral valve with a St. Jude Medical valve. Inspection of the annuloplasty ring at operation showed no evidence of dehiscence, but the area of the annuloplasty ring adjacent to the posteromedial commissure showed no endothelization. After the reoperation, the hemolysis and general condition immediately improved. This experience made us realize the possibility that a high-velocity regurgitant jet toward the cloth-covered annuloplasty ring, even if it mild, can cause severe hemolysis.