ABSTRACT
We present a case of successful mitral valve repair in a 38-year-old woman with Marfan's syndrome. Prolapse in a redundant billowing posterior mitral leaflet caused severe mitral valve regurgitation. Only slight dilatation of the sinus Valsalva and grade I aortic regurgitation were recognized. At operation, prolapsed portions seen on both sides of the middle scallop were quadrangularly resected. The sliding leaflet technique reduced the height of the posterior mitral leaflet to prevent systolic anterior motion of the mitral valve, which could be expected to occur after the operation. The anterior extremities of the Carpentier-Edwards annuloplasty ring were bent upward to accommodate the shape of the anterior mitral leaflet. Mitral valve regurgitation disappeared postoperatively, and she is now doing well 3 years after the operation. In general, isolated mitral valve regurgitation appears in relatively young patients with Marfan's syndrome, and these patients are at high risk of developing aortic dissection and aortic regurgitation. Therefore, mitral valve repair should be performed to improve the quality of life after the operation, and to reduce the risk of bleeding, which may be a lethal complication in aortic surgery.
ABSTRACT
A 70-year-old woman was admitted to our hospital complaining of upper abdominal pain. Computed tomography revealed a 6-cm tumor next to the inferior vena cava (IVC). Venography revealed obstruction of the IVC, and venous return was via collateral circulations. Right nephrectomy and tumor resection of the middle part of the IVC was performed. The left renal vein, which was invaded by tumor, was divided without venous reconstruction. Pathological diagnosis was leiomyosarcoma. Postoperatively hemodialysis was needed for a month, but maintenance hemodialysis was avoided. Leiomyosarcoma of the middle part of the IVC sometimes invades bilateral kidneys, and sometimes it is not possible to reconstruct the renal vein. It is important to recognize collateral circulation by preoperative angiography, and to protect such circulation during operation.
ABSTRACT
A 76-year-old man was admitted with a diagnosis of mitral valve regurgitation and angina pectoris. Cardiac catheterization demonstrated grade III mitral valve regurgitation with elevated pulmonary pressure and stenosis in the LAD. Severe stenosis in the left internal carotid artery and multiple cerebral infarctions were also recognized. Mitral valve repair with coronary artery bypass was performed at one month after the left carotid endarterectomy. The ascending aorta contained fragile atheroma, so an arterial cannula was inserted into the graft anastomosed to the right axillary artery. Mitral valve repair with coronary artery bypass was performed under moderately hypothermic ventricular fibrillation. Air embolism in the right coronary artery was recognized during systemic rewarming. Mitral valve repair with coronary artery bypass was performed safely under moderately hypothermic ventricular fibrillation in this case of an atherosclerotic ascending aorta. Axillary artery cannulation is useful to avoid cerebral complications in such cases. The de-airing procedure should be completed before the initiation of the heart beating.