ABSTRACT
A 77-year-old-woman was hospitalized at our institution following the diagnosis of severe aortic and mitral stenoses. Although she had thrombocytopenia before surgery, bone marrow examination revealed no abnormality. Thrombocytopenia was thought to be caused by shear stress accompanying valvular diseases. She underwent surgery for the replacement of aortic and mitral valves and the resection of left ventricular outflow tract myocardium. Because the mitral valve involved the calcification of the annulus the valve replacement was performed after decalcification using CUSA. After surgery, she experienced a transient sick sinus syndrome ; however, the overall course was good, and the platelet counts spontaneously recovered. More than 12 months have passed since surgery, but the platelet counts remains around 110,000.
ABSTRACT
<p>A 64-year-old man originally underwent Bentall procedure for annulo-aortic ectasia for the first time at the age of 38 years. The surgery was to repair a pseudoaneurysm at the anastomotic site of the left coronary artery by direct closure 11 years after the first Bentall procedure. The anastomosis of the right coronary artery was normal at the time of the first reoperation. However, he had surgery to repair a pseudoaneurysm at the anastomotic site of the right coronary artery 26 years after the first operation ; this was accomplished using the button technique. However, seven months after the second reoperation, he again manifested a pseudoaneurysm at the anastomotic site of the left coronary artery and died of rupture of the pseudoaneurysm. We report the case of pseudoaneurysms at the right and left coronary artery anastomoses that occurred three times after the first Bentall procedure.</p>
ABSTRACT
We describe a case of ruptured coronary artery aneurysm with a coronary artery to a pulmonary artery fistula. An 89-year-old woman with general fatigue and dyspnea was admitted. At the visit she went into shock and was restored by rehydration therapy. Enhanced computed tomography shows a coronary aneurysm (maximum diameter of 50 mm) at the left side of pulmonary artery and mild pericardial effusions. She was scheduled for an emergency operation due to the ruptured coronary artery aneurysm with a coronary artery to pulmonary artery fistula. We performed aneurysmectomy and ligation of the coronary artery to the pulmonary artery fistula under cardiopulmonary bypass. We also reviewed 23 cases of ruptured coronary artery aneurysm with coronary artery extending to a pulmonary artery fistula in Japan. The disease is a rare clinical state and regarded as an indication for emergency surgery.
ABSTRACT
We report a case of tricuspid infective endocarditis with peripheral pulmonary artery aneurysm. A 31-year-old man with a history of intravenous drug abuse was admitted to our institution. Echocardiography showed severe tricuspid valve insufficiency and large vegetation (10 mm) attached to the tricuspid valve. Computed tomography (CT) revealed a right peripheral pulmonary artery aneurysm. We operated because of the large amount of vegetation. Before the operation, we performed coil embolization for peripheral pulmonary aneurysm. During the operation, we removed the posterior leaflet with vegetation, and performed tricuspid valve repair. The postoperative course was uneventful. Postoperative echocardiography did not show any tricuspid valve insufficiency or vegetation.
ABSTRACT
Infectious endocarditis associated with <i>Streptococcus bovis</i>, which is rare in Japan, is a frequently reported complication of gastrointestinal tumors, especially in colon cancer. We report a patient who was successfully treated for the <i>S. bovis</i>-induced infectious endocarditis complication in colon cancer. A 60-year-old man was admitted to our hospital for detailed examination of high fever of unknown origin, that had lasted for 2 months. <i>S. bovis </i>was identified in the venous blood culture. An echocardiogram showed severe aortic valve regurgitation of the third degree and vegetation on the aortic valve. We therefore diagnosed infectious endocarditis. Colonoscopy revealed sigmoid colon cancer. After endoscopic mucosal resection of the lesion, the aortic valve was replaced. The postoperative course was uneventful and he was discharged from the hospital 36 days post operatively.
ABSTRACT
Infectious endocarditis associated with <i>Streptococcus bovis</i>, which is rare in Japan, is a frequently reported complication of gastrointestinal tumors, especially in colon cancer. We report a patient who was successfully treated for the <i>S. bovis</i>-induced infectious endocarditis complication in colon cancer. A 60-year-old man was admitted to our hospital for detailed examination of high fever of unknown origin, that had lasted for 2 months. <i>S. bovis </i>was identified in the venous blood culture. An echocardiogram showed severe aortic valve regurgitation of the third degree and vegetation on the aortic valve. We therefore diagnosed infectious endocarditis. Colonoscopy revealed sigmoid colon cancer. After endoscopic mucosal resection of the lesion, the aortic valve was replaced. The postoperative course was uneventful and he was discharged from the hospital 36 days post operatively.
ABSTRACT
Although the pressure gradient (PG) and the effective orifice area (EOA) have been used as indices of prosthetic valve function, these values show correctly neither energy loss, nor increased workload. This study aimed to evaluate the prosthetic valve function using echocardiography and PG, EOA and energy loss index, a new index advocated by Garcia et al. These were calculated for 40 patients with aortic prosthetic valve replacement by SJM valve (19HP, 6 cases; 21mm, 16 cases; 23mm, 14 cases; 25mm, 4 cases). Preoperative and postoperative echocardiographic measurements and their variations were analyzed and compared according to the size of implanted valve. In the comparison before and after aortic valve replacement, left ventricular mass (383±151g vs 288±113g, <i>p</i><0.01), SV1+RV5 on ECG (5.07±1.73mV vs 3.83±1.5mV, <i>p</i><0.01), and diastolic left ventricular posterior wall thickness (14.4±3.7mm vs 12.9±2.8mm, <i>p</i><0.05) decreased significantly after the operation. However, there was no significant difference according to the size of the prosthetic valve in these reduction rates caluculated by (preoperative value-postoperative value)/preoperative value. Small size prosthetic valves were used for patients with small diameter of left ventricular outflow tract (LVOT) (19HP, 18±2mm; 21mm, 21±2mm; 23mm, 23±4mm; 25mm, 27±3mm; <i>p</i><0.01) and small body surface area (19HP, 1.5±0.2m<sup>2</sup>; 21mm, 1.5±0.2m<sup>2</sup>; 23mm, 1.7±0.1m<sup>2</sup>; 25mm, 1.8±0.1m<sup>2</sup>; <i>p</i><0.01) in our study. There was a signifcant difference in EOA (19HP, 1.2±0.4cm<sup>2</sup>; 21mm, 1.9±0.7cm<sup>2</sup>; 23mm, 2.2±0.9cm<sup>2</sup>; 25mm, 3.5±1.1cm<sup>2</sup>; <i>p</i><0.01), but not in ELI (19HP, 1.01±0.41cm<sup>2</sup>/m<sup>2</sup>; 21mm, 1.87±1.03cm<sup>2</sup>/m<sup>2</sup>; 23mm, 1.83±1.09cm<sup>2</sup>/m<sup>2</sup>; 25mm, 3.08±1.21cm<sup>2</sup>/m<sup>2</sup>; <i>p</i>=0.055) according to the size of the prosthetic valve. Small size prosthetic valves had small EOA, but showed satisfactory valve function in decreasing left ventricular hypertrophy and reducing LVM and ELI of small size was similar to that of large size.