A Case of Re-replacement of the Mitral Valve in an Intravenous Drug User / 日本心臓血管外科学会雑誌

In Japan, infective endocarditis (IE) or prosthetic valve endocarditis (PVE) due to intravenous drug use (IDU) is rare. We report the case of a patient with PVE due to IDU who required mitral valve replacement (MVR) and tricuspid valvoplasty (TVP). A 21-year-old woman with an IDU history had earlier acquired IE, and had undergone MVR using a bioprosthetic valve and TVP in November, 2010. She was transferred to our institute because of fever and general fatigue in February, 2012. Echocardiography revealed vegetation on the mitral bioprosthetic valve, and antibiotic administration was started. Although the infectious condition improved, the vegetation became more mobile. A second MVR, using a bioprosthetic valve, and TVP were performed 18 days after admission. The patient's postoperative course was uneventful, and she was discharged on postoperative day 32. At one and a half years after the second surgery, the patient is currently followed-up regularly at our department, and PVE recurrence has not been observed.

A Case of Solitary Inferior Mesenteric Artery Aneurysm / 日本心臓血管外科学会雑誌

A 74 year-old man visited our hospital complaining of increasing sensory disorder of the left lower extremity. On physical findings, a pulsatile mass was detected in abdomen, but he had been aware of it for 5 years. Further examination revealed on inferior mesenteric artery aneurysm 8 cm in diameter. It had no communication with other visceral arteries or veins. Surgical treatment was performed to resect the aneurysm without revascularization. The postoperative course was uneventful. The pathological examination of the aneurysm showed atherosclerotic change. The chief complaint on admission was unchanged following surgery and was thought to have no relation to the aneurysm. It was thought that to derive from lumbar vertebral disease. After operation, regular follow-up is necessary to check for pseudoaneurysms formation at the surgical margin and development of other visceral artery diseases.

Surgical Treatment of a Caseous Calcification Lesion Which Originated from the Calcified Anterior Mitral Annulus in Patient on Chronic Hemodialysis / 日本心臓血管外科学会雑誌

We report a case of a caseous calcification lesion originating from a calcified anterior mitral annulus. A 59-year-old woman on chronic hemodialysis was referred to our hospital due to an elevated brain natriuretic peptide value. Transthoracic echocardiography demonstrated moderate aortic valve stenosis with regurgitation and a pendulous mass in the left ventricular outflow tract, and therefore we perfomed. The patient underwent resection of the mass with aortic valve replacement. Pathological examination of the mass revealed interstitial calcium deposits but without tumors or inflammatory cells. We speculated that the cardiac mass was caseous calcification which originated from a severely calcified mitral annulus based on its echocardiographic and pathological features.

A Case of Bentall's Operation at Ten Years after a Ross Operation / 日本心臓血管外科学会雑誌

A 22-year-old woman had been treated with a Ross operation for aortic root aneurysm and aortic regurgitation 10 years previously. In the initial Ross operation, a handmade tri-leaflet conduit was used for the right ventricle outflow tract (RVOT) reconstruction. The conduit was prepared preoperatively, by sewing a folded 0.1 mm expanded polytetrafluoroethylene (ePTFE) membrane onto the luminal cavity of the 24 mm woven double velour vascular graft, thereby creating a tri-leaflet valve. During ambulatory follow up after discharge, dilation of the pulmonary autograft had been observed, and its maximal diameter reached 60 mm. Furthermore, preoperative a pressure study revealed a 25 mmHg pressure gradient between the right ventricle and the pulmonary artery. At the time of reoperation, we performed an aortic root replacement combined with RVOT conduit replacement. A 24-mm woven double velour vascular graft integrating a 21-mm On-X mechanical prosthesis was used for aortic root replacement. A handmade ePTFE tri-leaflet conduit, 26 mm in size, was used to replace the previous RVOT conduit. The operation was successful, and the postoperative course was uneventful. The explanted conduit was sent for microscopic examination, which revealed that the graft was covered by a fibrocollagenous membrane. On the contrary, no surface membrane was found on the ePTFE valve. Moreover the microscopic examination showed cystic medionecrosis of the pulmonary autograft. Both dilatation of the pulmonary autograft and RVOT conduit failure were successfully treated at the second operation. However this young patient will require follow-up of the mechanical prosthesis and RVOT conduit for the rest of her life.

A Successful Case of Ascending Aorta-Abdominal Aorta Bypass in a Patient with Atypical Coarctation / 日本心臓血管外科学会雑誌

A 69-year-old woman was admitted with severe hypertension and intermittent claudication. The results of further examination, showed that the hypertension and intermittent claudication were due to stenosis of the descending aorta and we diagnosed atypical aortic coarctation. We performed median sternotomy and ventrotomy with side-to-end anastomosis a woven Dacron graft and the ascending aorta. The graft was passed through the lesser omentum, and mesocolon and to abdominal aorta. The postoperative state was stable, and the hypertension and intermittent claudication were remarkably ameliorated. Many cases of extra-anatomical bypass were reported, and the ascending aorta-abdominal aorta bypass was useful method and, very successful with no complications in this case.

A Case of Coronary Artery Bypass Grafting Using Arterial Grafts in a Patient with Systemic Lupus Erythematosus and Review of the Literature / 日本心臓血管外科学会雑誌

We report a case of coronary artery bypass grafting (CABG) in a patient with systemic lupus erythematosus (SLE). A 24-year-old woman with SLE had been treated with steroids and immunosuppressive agents for 7 years. The patient was admitted to Kumamoto University Hospital for the management of unstable angina. CABG was successfully performed using bilateral internal thoracic arteries and postoperative 3D-CT demonstrated good patency of both arterial grafts. The patient experienced no significant postoperative complications, and has remained well to date (8 months postdischarge).