Decalcification of Anterior Mitral Valve Leaflet to Repair Moderate Nonrheumatic Mitral Valve Stenosis with Severe Aortic Valve Stenosis / 日本心臓血管外科学会雑誌

A 78-year-old woman was referred to our hospital because of progressive exertional dyspnea due to nonrheumatic severe aortic valve stenosis and moderate mitral valve stenosis with mitral annular calcification. We subsequently performed aortic valve replacement and mitral anterior leaflet decalcification. During surgery, we found that the cause of mitral valve stenosis was calcification of A2 aortic curtain-medial trigon through aortic valve annulus and resected calcification with SONOPET. The postoperative echocardiography revealed good mitral valve motion with mild mitral valve stenosis.

Cardiac Tamponade due to Detachment of the Aortic Valve Commissure / 日本心臓血管外科学会雑誌

A 68-year-old man was taken to our hospital by ambulance due to syncope. He was in shock with cardiac tamponade. Pericardial drainage was performed. Aortic valve regurgitation gradually increased and surgery was performed at 25 days after onset. Surgical finding showed that there was a detachment of the commissure between the right and non coronary cusps of the aortic valve. An intimal tear was detected in the same place and aortic root replacement was required. The patient had a good recovery and he was discharged 14 days after surgery.

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.

Ruptured Coronary Artery Aneurysm with a Fistulous Communication / 日本心臓血管外科学会雑誌

A 68-year-old woman was referred to our hospital with arrhythmia and cardiomegaly. She lost consciousness in the waiting room. After urgent hospitalization, cardiac ultrasonography showed cardiac tamponade, and urgent pericardial drainage was performed. A ruptured coronary aneurysm with a fistulous communication was diagnosed by CT scan and coronary angiography. Under extracorporeal circulation, ligation of the unusual coronary vessels and resection of the aneurysm were performed. The postoperative course was uneventful and she was discharged on the 25th postoperative day. No ischemic signs were observed on treadmill test at one year after surgery. Most congenital coronary aneurysms are asymptomatic; however, once rupture occurs, it is important to diagnose this condition rapidly and treat surgically.

A Case Report of Double Valve Replacement for Mucopolysaccharosis with Chest Pain Attack and Severe Heart Failure / 日本心臓血管外科学会雑誌

We report a successfully treated case of double valve replacement for mucopolysaccharosis in a 27-year-old woman. Mucopolysaccharosis had been suspected since she was aged 11. Symptoms of heart failure and chest pain suggested valvular disease and she was referred to us. Echocardiography, aortography and cardioangiography showed aortic regurgitation (grade IV/IV) and mitral regurgitation (grade III/IV). She received double valve replacement and was discharged on the 38th postoperative day with symptom improvement. Although urinalysis was positive for heparan-sulfate, this case could not be diagnosed definitively as mucopolysaccharosis due to normal lymphocytic enzyme-activity. However, large amounts of mucopolysaccharoid deposits were present in her removed aortic and mitral valve leaflets, and her clinical picture corresponded with mucopolysaccharosis. Thus, it was considered that her ultimate diagnosis was combined cardiac valvular disease due to mucopolysaccharosis.

Successful Surgical Repair of Left Main Coronary Artery Total Occlusion with Aortitis Syndrome / 日本心臓血管外科学会雑誌

We report the successful repair of left main coronary artery obstruction with aortitis syndrome. She was a 39-year-old woman and was admitted to Saiseikai Kumamoto Hospital because of angina pectoris. Her bilateral radial artery pulsation was not palpable. Total occlusion of the left main coronary artery (LMT) and bilateral subclavian artery was detected by angiography. Patch enlargement of the LMT was performed using a Distaflo (Impra Carbon PTFE) graft. Postoperative coronary angiography showed an adequate LMT diameter and sufficient blood flow.

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).

Effects of Modified Ultrafiltration in Pediatric Cardiac Surgery / 日本心臓血管外科学会雑誌

Modified ultrafiltration (MUF) for cardiopulmonary bypass (CPB) in children decreases total body water and improves left heart function. We investigated the effects of MUF in pediatric open-heart surgery. Eighty-six patients less than 15kg who underwent radical cardiac operation were divided into four groups according to whether they received transfusion during the operation or not, and whether MUF was performed after completion of CPB or not. MUF group showed significantly higher hematocrit levels 20min after the end of CPB compared with non-MUF group in both transfused group and non-transfused group. Then, MUF group showed a significantly higher serum protein level than non-MUF group. In MUF groups, the systolic blood pressure elevated without the elevation of the left atrial pressure. We calculated PaO₂/FiO₂ as an index of postoperative lung function. The postoperative PaO₂/FiO₂ of MUF group was significantly higher than that of non-MUF group in transfused group. MUF significantly decreased homologous blood transfusion during the operation. MUF after CPB elevated hematocrit level and serum protein level, and improved cardiac function without volume load. Since MUF reduced the need for homologous blood transfusion. MUF is a useful means for pediatric cardiac surgery.