Surgical Management of a Residual Shunt after Extended Sandwich Repair via a Right Ventricular Incision for Posterior Ventricular Septal Perforation / 日本心臓血管外科学会雑誌

Posterior ventricular septal perforation (VSP) is a severe complication of acute myocardial infarction (AMI). In some cases, it is difficult to manage residual shunts after VSP repair. We report a patient who required reoperation early after surgery due to a residual shunt and underwent successful repair through a newly devised maneuver. A 55-year-old man developed VSP after catheter intervention for AMI. He underwent VSP closure with extended sandwich repair via a right ventricular (RV) incision. A residual shunt was observed on the 4th day after surgery. Follow-up echocardiography showed progress of the residual shunt, and he developed cardiac failure ; therefore, reoperation was performed 16 days after the initial surgery. The residual shunt was successfully repaired with only a reinforcing left ventricular (LV) side patch via an LV incision to extend between the LV side patch and septal myocardium without removing the RV side patch. The patient's clinical course after reoperation was uneventful, and no residual shunt was observed on postoperative echocardiography.

A Pediatric Case of Infective Endocarditis with Pseudoaneurysm of the Sinus of Valsalva and Annular Abscess / 日本心臓血管外科学会雑誌

Although aortic annular abscess and rupture of the sinus of Valsalva are known as complications of infective endocarditis, few cases in children have been reported. We report a surgical case of a 6-year-old girl with active infective endocarditis complicated with an annular abscess and pseudoaneurysm of the sinus of Valsalva. The patient presented progressive symptoms of heart failure and a subsequent echocardiogram demonstrated severe aortic regurgitation. A computed tomography indicated pseudoaneurysm of sinus of Valsalva and an emergency operation was performed. At operation, a bicuspid aortic valve with vegetation was noted. The annular abscess caused a large tissue defect of the left coronary sinus of Valsalva and formed a pseudoaneurysm. The infected lesion was resected completely. The defective aortic annulus and sinus of Valsalva were repaired with a bovine pericardial patch and aortic valve was replaced with a mechanical valve. The postoperative course was uneventful and the patient was discharged after adequate antibiotic treatment.