Successful Repair of Tricuspid Valve Endocarditis in a Drug Abuser / 日本心臓血管外科学会雑誌

This case report describes a 20-year-old man, who was a drug abuser, and was treated surgically for tricuspid valve endocarditis. He presented with fever, caused by tricuspid valve endocarditis with a lung abscess. Blood culture detected <i>Staphylococcus aureus </i>and cardiac ultrasonography showed tricuspid insufficiency and tricuspid valve vegetation. He was treated with intravenous antibacterial agents, but the inflammation signs did not improve. He had a large number of puncture scars, as a consequence of self-injection of drugs in his lower arm. He underwent tricuspid valve plasty, and recovered successfully. He was discharged 2 weeks after surgery, and we instructed him to return for follow-up examination in our hospital. However, he did not return to our hospital because he was arrested for drug possession. In such cases, it is necessary to consider the operative method relative to reuse of drugs in the postoperative management of medication.

Surgical Treatment for Kommerell Diverticulm / 日本心臓血管外科学会雑誌

We report 3 surgical cases of aortic graft replacement with reconstruction of an aberrant subclavian artery (ASA) for Kommerell diverticulum (KD) and ASA. Cases 1 and 2 both had a right aortic arch, KD and a left ASA. In these 2 cases, we performed distal aortic arch replacement and <i>in-situ </i>reconstruction of the left ASA via a right thoracotomy. Case 3 had an aortic arch aneurysm, KD and a right ASA. In this patient, we chose median sternotomy and total aortic arch replacement, using 2 pieces of artificial grafts with 1 and 4 branches, respectively. The right ASA was reconstructed by end-to-side anastomosis between the right axillary artery and the side branch of the graft with 1 branch. In all 3 cases, cardiopulmonary bypass and deep hypothermia with a rectal temperature under 18°C were used in aortic graft replacement. In addition to deep hypothermia, either antegrade or retrograde cerebral perfusion was introduced, depending on the surgical situation, to provide additional brain protection. Selective ASA perfusion was performed in all patients during aortic graft replacement. In Case 1, aortic anastomosis was achieved while clamping, and cerebral perfusion was maintained via a cannula for aortic return at the ascending aorta. In Cases 2 and 3, aortic anastomosis was performed under deep hypothermic circulatory arrest, using retrograde and antegrade cerebral perfusion respectively in Cases 2 and 3. The postoperative course was uneventful in all 3 patients.

Successful Operation for Multiple Giant Aneurysms with Congenital Coronary Artery Fistula in an Adult / 日本心臓血管外科学会雑誌

We report a case of successful operation for multiple giant aneurysms with a right coronary artery fistula from the right coronary artery to the left atrium. A 35-years-old woman was found to have a right coronary artery aneurysm with a maximum diameter of 85mm, and two other coronary artery aneurysms with maximum diameters of 40 mm along the coronary fistula, which arose from the proximal right coronary artery, traversed the root of the left atrium, and drained into the left atrium. Surgical treatment was indicated to relieve symptoms and to prevent possible rupture of the aneurysms. She underwent resection of coronary artery aneurysms, closure of orifices of the fistula and coronary bypass grafting to the right coronary artery with cardiopulmonary bypass. Her postoperative course was uneventful, and she was discharged in good condition.

Two Cases of True Left Ventricular Aneurysm Resembling Its False Type / 日本心臓血管外科学会雑誌

Differential diagnosis of a so-called false aneurysm of the left ventricle from the true type after a myocardial infarction is important because the risk of rupture of the false aneurysm is high. Two cases of ventricular aneurysms with false type-like shape underwent surgical repair. Preoperative left ventriculography in Case 1 (male, 77) showed an aneurysm of 40×40×35mm in size with a narrow neck at the postero-inferior wall. The aneurysm of Case 2 (male, 61) was 20×20×10mm in size with a narrow neck at the inferior wall. These ventriculographic findings suggested a false type of aneurysm, but operative findings and pathological examination revealed that these were“true”aneurysms in which wall myocardial cells were observed. Left ventriculography and echocardiography were not sufficient to differentiate false left ventricular aneurysm from true aneurysm, particularly at the posterior and inferior wall.