ABSTRACT
The patient was a 48-year-old woman who had been taking oral steroids for dermatomyositis since age 39. The patient experienced an episode of sudden chest tightness at age 48, and acute myocardial infarction was suspected. Coronary angiography revealed a right coronary artery occlusion ; emboli (thrombi) were collected from the same site. Left cardiac ventriculography revealed the presence of a mobile thrombotic mass in the ascending aorta. Although heparin therapy was initiated considering the possibility of thrombosis, no shrinkage of the mass was observed, and surgery was planned as per treatment guidelines. The mass was a rod-shaped thrombus measuring 20 mm×7 mm×7 mm attached to the aortic wall, approximately 2.5 cm distal from the entrance to the right coronary artery. Since the aortic wall at the site of the tumor attachment was normal, surgery involved only removal of the mass. A histopathological assessment revealed that the mass was a mixed thrombus containing both white and red thrombotic components. The patient was started on postoperative oral antiplatelet and anticoagulant drug therapy to prevent additional thrombosis, and no recurrence has been noted at 1 year postoperative.
ABSTRACT
Here, we report a patient who underwent surgery for acute aortic regurgitation (AR) due to rupture of an aortic valve commissure. The patient was a 51-year-old man who had undergone ascending aorta replacement for acute type A aortic dissection 6 years previously. He presented with a 2-day-history of headache and insomnia. Echocardiography showed only AR initially. However, 2 days later, a vegetation-like mass was noted at the aortic valve commissure on transesophageal echocardiography. We diagnosed AR associated with infective endocarditis, and decided to perform aortic valve replacement immediately. During surgery, we found that the cause of AR was rupture of the aortic valve commissure without infection. The cause of rupture in this case was suspected to be traumatic or myxomatous degeneration.
ABSTRACT
<p>We report a case of reoperation for proximal and distal pseudoaneurysmal formations of the ascending aorta with aortic regurgitation (AR) after an ascending aorta replacement for acute type A aortic dissection. The patient was a 69-year-old woman who had undergone ascending aorta replacement for acute type A aortic dissection six years previously. Subsequent development of pseudoaneurysms of the ascending aorta and aortic regurgitation were revealed by computed tomography and echocardiography respectively. We chose debranch Thoracic Endovascular Aortic Repair (TEVAR) with a staged approach. First, aortic valve replacement, patch closure of proximal pseudoaneurysmal formation, coronary artery bypass, and ascending aorta-axillary artery bypass were performed. Two weeks later, debranching and TEVAR were performed. Cardiac reoperation for proximal and distal pseudoaneurysmal formations of the ascending aorta with aortic regurgitation after an ascending aorta replacement is known to be high risk. Nevertheless we performed the operation safely in two-stage surgery.</p>
ABSTRACT
A 62-year-old woman was admitted to our hospital because of dextrocardia on her chest X-ray film. She had been in good health though the X-ray abnormality had been pointed out from her childhood. Echocardiogram, magnetic resonance imaging, and cardiac catheterization revealed situs inversus, congenitally corrected transposition of the great arteries, and severe tricuspid valve (systemic atrioventricular valve) regurgitation with mild systemic ventricular dysfunction. The surgeon stood on the patient's left side during the operation. On cardiopulmonary bypass, the tricuspid valve, facing almost dorsally, was exposed through a superior transseptal approach. Tricuspid valve replacement with a mechanical valve was performed with leaflet preservation. Systemic ventricular function is preserved at one year after operation.
ABSTRACT
Emergency coronary artery bypass grafting (CABG) in patients with acute coronary syndrome (ACS) is still associated with high mortality and morbidity, and early outcome is poor compared with outcome in patients with stable angina. The purpose of this study was to examine the clinical results of on-pump beating heart CABG vs. off-pump coronary artery bypass (OPCAB) for ACS patients. From a total of 432 CABG patients, we retrospectively analyzed 72 (16.7%) patients who underwent emergency CABG between 2004 and 2008. Emergency CABG cases were divided into 2 operative groups : an on-pump beating-heart CABG group (on, <i>n</i>=31) and an OPCAB group (off, <i>n</i>=41). A preoperative history of acute myocardial infarction (AMI), detection of troponin T, preoperative creatine phosphokinase (CPK) value, low ejection fraction, presence of mitral regurgitation (MR) (>II) and cardiomegaly were markedly higher in the on group. There were no statistically significant differences in intraoperative factors. In-hospital mortality was 3.2% (1 patient) in the on group and 7.3% (3 patients) in the off group. Furthermore, statistically significant differences were found between the 2 groups in incidence of all-cause morbidity (on=71.0% : off=41.5%, <i>p</i>=0.01), respiratory failure (on=58.1% : off=29.3%, <i>p</i>=0.01), ICU stay (on=6.5±4.6 days : off=4.1±3.2 days, <i>p</i>=0.01), and necessary inotropic support (on=51.6% : off=17.1%, <i>p</i>=0.02). Multivariate regression analysis of preoperative and intraoperative factors was performed to identify independent factors for in-hospital mortality and morbidity. On multivariate analysis of preoperative factors, only the pre-CPK value reached statistical significance as an independent factor for in-hospital mortality and morbidity.
ABSTRACT
A 56-year-old man had aneurysms of the right subclavian artery and cerebral artery in association with congenital absence of the right internal carotid artery. The aneurysm of the subclavian artery was successfully surgically repaired through a partial sternotomy. Congenital absence of the internal carotid artery is rare vascular anomaly. This anomaly contributes to the occurrence of intracranial aneurysms. However, aneurysm of subclavian artery associated with congenital absence of the internal artery is very rare. This is the 3rd case reported in the literature.
ABSTRACT
Five autopsy cases of poisoning by the weed killer paraquat (Gramoxone) are presented.<BR>Case 1. A 33-year-old female swallowed about 150 ml of Gramoxone. She died after 11 hours of intoxication.<BR>Abnormal post-mortem findings were confined to the lungs, the kidneys and the adrenals. Histologically, the lungs showed congestion and edema; the kidneys showed tubular' degeneration and necrosis; and the adrenals showed cortical degeneration and necrosis.<BR>Case 2. A 74-year-old male swallowed about 20 ml of Gramoxone. He died on the 4th day of ingestion of Gramoxone.<BR>Histologically, the lungs were congestive and there were a moderate degree of hyperplasia of alveolar septa.<BR>Alveolar spaces contained edematous fluid containing fibrin. Some skeletal muscle fibers were variable in size, and showed degenerative changes including vacuolization. The adrenal cortex was atrophic.<BR>Case 3. A 44-year-old female swallowed about 20 ml of Gramoxone. She died on the 8th day of ingestion. The lungs were both congestive and edematous. Alveolar spaces contained edematous fluid with a trace amount of fibrin. The kidneys showed tubular degeneration. The liver showed a moderate degree of fatty changes in the central zones.<BR>Acute oesophagitis and acute ulcerative change in the stomach were noticed.<BR>Case 4. A 45-year-old male swallowed about 90 ml of Gramoxone. He died after 12 hours of intoxication. Histologically, the lungs were remarkably congestive and edematous. There were fatty changes in the central areas of the liver. Acute gastritis were noticed.<BR>Case 5. A 32-year-old female swallowed about 15 ml of Gramoxone. She died on the 28th day of ingestion. At post-mortem examination, the lungs were solid and atelectatic. Histologically, the lungs showed generalized, severe degree of fibrosis together with desquamative changes of alveolar epithelium and PAS-positive hyaline menbrane formations. The liver showed a moderate degree of fatty changes in the central areas. The skeletal muscle fibers were variable in size showing a moderate degree of vacuolar and targetoid changes.<BR>Various amounts of Paraquat were detected in the lungs, the livers, the kidneys and the muscles of case 1 and 4, in the fatty tissues and the brain of case 1 using formalin-fixed specimens.<BR>Degenerative changes of skeletal muscle fibers presented in this report may be ascribed to the effect of Praquat in the light of the literature.