ABSTRACT
We report a case of extracardiac rupture of the left Valsalva sinus aneurysm, which is an extremely rare and fatal lesion. The three drugs, clindamycin, ethambutol and rifampicin, had been administered for eleven years because of lung mycobacterium infection. An emergency surgery was performed because of cardiac tamponade. The left Valsalva sinus was entirely enlarged without an aneurysmal neck. The other Valsalva sinuses seemed to be almost normal. The aneurysmal wall adhered the pulmonary artery and the left atrium. The left descending and circumflex arteries independently originated from the aneurysmal wall. The left main trunk seemed to become a part of the aneurysmal wall. Additionally the intraoperative transesophageal echocardiography showed severe aortic regurgitation. The Bio-Bentall procedure was performed. The right coronary artery was reconstructed with the Carrel patch method and the saphenous vein grafts were anastomosed to the proximal portions of the left anterior descending and circumflex arteries, individually. On the thirty-third postoperative day, the patient was discharged uneventfully expect for the delayed sternal closure on the second postoperative day. Five and half years after surgy, the patient is living a normal life and rifampicin has been administered without any anticoagulation drugs.
ABSTRACT
Primary cardiac malignant tumors are relatively rare, and their prognosis is poor. We report a patient with sarcoma causing severe mitral regurgitation and stenosis due to rapid and specific infiltration into the mitral valve.
ABSTRACT
A 64-year-old man who underwent aortic valve replacement with a 25mm Bjork-Shiley valve in 1993 began to have severe anemia and required repeated transfusions by November 2003. Doppler echocardiography showed only mild aortic regurgitation, but revealed turbulent flow around the mechanical valve. Autoimmune hemolytic anemia (AIHA) was diagnosed and he was treated with prednisolone (PSL) starting May 2004. Because of unremitting hemolysis requiring multiple transfusions and the occurrence of renal dysfunction, he underwent rereplacement of the aortic valve with a 25-mm Freestyle valve. His hemolysis and general condition immediately improved. This case suggests the possibility that mild regurgitant jet and turbulent jet stress can cause severe hemolysis when AIHA develops.
ABSTRACT
Left ventricular reconstruction methods (LVR) consisting of the Dor procedure or septal anterior ventricular exclusion (SAVE) have been advocated for left ventricular dysfunction due to ischemic cardiomyopathy (ICM). This study reports early results achieved with LVR in patients with ICM. Between April 2001 and August 2004, 9 patients with ICM underwent LVR and coronary artery bypass grafting (CABG). Their age was 62±11 years, and 7 were men. The Dor procedure was performed in 8 patients and 1 patient underwent SAVE. CABG was performed in all patients. Two patients with grade 3 mitral regurgitation (MR) preoperatively had mitral valve annuloplasty (MAP). The mean left ventricular ejection fraction (LVEF) improved from 31.6±7.2% to 47.8±9.4%. The mean left ventricular end diastolic volume index (LVEDVI) decreased from 166.7±50.4ml/m<sup>2</sup> to 102.6±23.0ml/m<sup>2</sup>. The mean left ventricular end systolic volume index (LVESVI) decreased from 114.4±34.7ml/m<sup>2</sup> to 52.4±16.6ml/m<sup>2</sup>. The mean coaptation depth decreased from 9.3±3.1mm to 4.5±1.4mm. The mean MR, with or without MAP, improved from grade 1.7±1.1 to grade 0.2±0.4. There were no hospital deaths. Seven of 9 patients were categorized as New York Heart Association functional class I at discharge. We conclude that LVR is an effective treatment for ICM with severe left ventricular dysfunction.
ABSTRACT
The patient was a 75-year-old man who was referred due to hematuria. CT revealed bladder carcinoma 8cm in length, a 5-cm aneurysm of the abdominal aorta and a 3-cm aneurysm of the left common iliac artery. He was referred to our hospital for the treatment of bladder carcinoma and aneurysms. We simultaneously performed Y graft replacement, radical cystectomy and bilateral cutaneous ureterostomy. His postoperative course was uneventful, without any prosthetic infection.
ABSTRACT
A 53-year-old woman underwent mitral valve replacement for congestive heart failure due to mitral stenosis and regurgitation. She had been receiving hemodialysis because of diabetic nephropathy since 1993, and had had congestive heart failure since 1999. Echocardiography demonstrated mitral stenosis (MVA; 1.10cm<sup>2</sup>) and regurgitation with a severely calcified mitral annulus. Annular calcification extended to the posterior wall of the left ventricle and the base of bilateral papillary muscles. After removing all calcium from the mitral annulus to the base of the papillary muscle, the left ventricular posterior wall and mitral annulus were reconstructed by glutaraldehyde-preserved autologous pericardium. Then, a Carbo-Medics mechanical valve was placed at the mitral annulus using everting mattress sutures. Although her hemodynamics were stable, bacteremia and multi-organ failure developed 3 months after surgery and she died. Autopsy showed that the reconstructed left ventricular posterior wall and mitral annulus using glutaraldehyde preserved autologous pericardium were in excellent condition without any thrombus. No dehiscence was found at the suture line of the mechanical valve. Mitral annulus reconstruction with glutaraldehyde preserved autologous pericardium is thought to be effective for patients with calcified mitral annulus who require mitral valve surgery.