ABSTRACT
We report a surgical case of severe tricuspid regurgitation with hemodynamic features mimicking constrictive pericarditis. A catheterization study showed a dip and plateau pattern of right and left ventricular pressure. Intraoperative finding : the pericardium was not adherent to the epicardial wall. The tricuspid regurgitation was successfully repaired by cleft suture and tricuspid annuloplasty. After surgery, the echocardiographic features mimicking constrictive pericarditis were normalized.
ABSTRACT
A 65-year-old woman presented to a local hospital with chest, back and right leg pain. She was transferred to our hospital because her abdominal pain gradually increased. CT scan demonstrated an acute type A aortic dissection from the proximal ascending aorta to the right common iliac artery, with a 48 mm diameter in the ascending aorta. The proximal superior mesenteric artery (SMA) was completely occluded by the thrombosed false lumen. Echocardiography showed minor aortic regurgitation, and no pericardial effusion. Her hemodynamics were stable, but abdominal pain persisted. Emergency laparotomy, performed because of mesenteric infarction with intestinal necrosis, provided no evidence of any intestinal necrosis. She underwent left external iliac artery to distal SMA bypass with a saphenous vein graft, because the intestine looked pale. Then the total arch replacement was performed two days later. The patient's postoperative course was uneventful, and her abdominal symptom completely disappeared.
ABSTRACT
An 80-year-old man complained of bilateral leg edema. Doppler echocardiography showed a mobile tumor (33mm) in the right atrium and severe tricuspid regurgitation with an atrial fibrillation. An operation was performed urgently. Excision of the tumor including the right atrial wall and tricuspid annuloplasty were done. Histologic study demonstrated lipoma and no malignancy. Bilateral leg edema disappeared, and the sinus rhythm was restored after the operation.
ABSTRACT
A 69-year-old woman underwent aortic valve replacement (AVR) for prosthetic valve (Freestyle<sup>TM</sup> stentless valve) endocarditis (PVE) in April 2001. The patient was admitted to our hospital with diarrhea and tarry stools in January 2002 and was treated with intravenous hyperalimentation. She had fever and inflammatory findings at 1 week after admission, and was given intravenous antibiotics. Symptoms and laboratory findings improved gradually, but transesophageal echocardiography revealed a mobile mass in the ascending aorta near the noncoronary sinus of Valsalva. The serum β<sub>-D</sub> glucan level was elevated and blood culture was positive for <i>Candida parapsilosis</i>. These findings suggested fungal endocarditis of the ascending aorta, so the patient underwent surgery. Vegetation was attached to the aortic wall near the noncoronary sinus of Valsalva. It was removed with part of the ascending aorta, followed by reconstruction with a gusset xenograft. In addition, aortic valve replacement was performed with a mechanical valve. The resected tissue grew <i>C. parapsilosis</i>, so parenteral anti-fungal drugs were administered intravenously for 8 weeks after surgery. Although cerebral infarction occurred, she was discharged on the 133rd postoperative day. There was no recurrence of infection and she remained on oral anti-fungal medication for 24 months postoperatively.
ABSTRACT
A 68-year-old woman received aortic valve replacement (AVR) with a Freestyle stentless valve using a subcoronary technique for aortic stenosis and regurgitation in September 2000. She complained of chest pain, had low grade fever and findings of inflammation and was admitted to our hospital with a diagnosis of acute myocardial infarction in December 2000. She suffered from repetitive or recurrent myocardial infarction. Transesophageal echocardiogram revealed no abnormal findings of the Freestyle stentless valve, but her blood culture was positive for methicillin-resistant coagulase negative <i>Staphylococcus aureus</i> (MRCNS) and she underwent an emergency operation. The Freestyle stentless valve was removed and replaced with a mechanical valve. The patient's intraoperative tissue grew MRCNS and parenteral antibiotics were administered for 8 weeks after surgery. Her condition was complicated with multiple cerebral infarction, however she was discharged on the 113th postoperative day and is doing well without recurrence of infection 12 months after the operation.
ABSTRACT
We report a case of successful surgical treatment for an aortic anastomotic false aneurysm associated with a graft-duodenal fistula after abdominal aortic aneurysm repair. A 63-year-old man was admitted with melena and an aortic anastomotic false aneurysm after prosthetic graft replacement 8 years previously. CT scan demonstrated an aneurysm with a maximum diameter of 70mm at the proximal anastomotis of the prosthetic graft. Gastroduodenoscopy revealed no bleeding site in the stomach or the first and second portions of the duodenum. Therefore, we performed an emergency operation under a diagnosis of an aortic anastomotic false aneurysm associated with a graft-duodenal fistula. The aneurysm was replaced with interposition of a new prosthetic graft via a thoracoabdominal approach. The fistula was repaired by covering the duodenum with the jejunum through a left pararectal laparotomy. The postoperative course was uneventful, and there was no evidence of graft infection at 14 months after the operation.