Effective Management with IMPELLA CP® and Hypothermia Therapy for a Case of Severe Ischemic Coronary Disease after Cardiopulmonary Arrest / 日本心臓血管外科学会雑誌

A 67-year-old man was admitted to our hospital following cardiopulmonary arrest (CPA) during work. After resuscitation, coronary angiography revealed left main coronary artery stenosis and three-vessel disease. We considered that coronary artery revascularization was required, but the neurological prognosis was unknown. Thus, an IMPELLA CP® device was inserted and systemic management, including hypothermic therapy, was initiated. Circulatory conditions were stable during hypothermia therapy. Rewarming was initiated 24 h later, and we confirmed no abnormal neurological findings. Emergency off-pump coronary artery bypass was then performed. During the procedure, hemodynamic status was maintained using the IMPELLA CP® device. After surgery, the patient was discharged without neurological complications. We report the management of a patient with severe three-vessel disease after resuscitation for CPA using an IMPELLA CP® device and hypothermic therapy.

A Suspected Case of Heyde Syndrome with Bleeding of the Small Intestine before Aortic Valve Replacement for Severe Aortic Valve Stenosis / 日本心臓血管外科学会雑誌

The patient was a 74-year-old woman who had undergone mitral valve replacement with a mechanical valve for rheumatic mitral valve stenosis at age 60. She was scheduled for aortic valve replacement for severe aortic stenosis. However, she had significantly worsening anemia before the operation. Capsule endoscopy showed angiodysplasia with bleeding in her small intestine, which was considered the cause of the anemia. Because of progressive anemia, we tried embolization under angiography. However, there was no evidence of extravasation. Neither melena nor exacerbation of anemia was observed, and she underwent aortic valve replacement. She was discharged on postoperative day 22 without gastrointestinal bleeding. Heyde syndrome is aortic valve stenosis associated with gastrointestinal bleeding induced by von Willebrand disease and angiodysplasia in small intestine. Molecular multimeric analysis of von Willebrand factor and the existence of angiodysplasia with hemorrhage of the digestive tract are important for definitive diagnosis. Capsule endoscopy, which is a general examination, is more useful for diagnosis than molecular multimeric analysis of von Willebrand factor. Aortic valve replacement is the only therapeutic option for Heyde syndrome. It is important to decide the appropriate timing of AVR with cardiopulmonary bypass.

Aortic Valve-Sparing Operation in a 8 Years Old Boy with Loeys-Dietz Syndrome with Annuloaortic Ectasia / 日本心臓血管外科学会雑誌

An 8 year-old boy had a cardiac murmur pointed out on day three after birth and was given a diagnosis of ventricular septal defect (VSD). He underwent VSD patch closure at two months after birth. He was also found the having Loeys-Dietz syndrome on the basis of mutation of <i>TGFBR2 </i>and physical examination at the age of 2 years. He had been followed up at pediatrics clinic of our hospital since then, and was hospitalized for a 46.5-mm extension of valsalva sinus diameter and moderate aortic insufficiency. The aortic valve was three-cusped and had no abnormality. We performed valve-sparing aortic root replacement. He was discharged on day 18 after the operation without any problems in the postoperative course. Use of an artificial heart valve for the surgery of the aortic root lesion in childhood will probably cause reoperation in the future and difficulty in Warfarin anticoagulation control. A careful decision is needed in the choice of an operation method. Valve-sparing aortic root replacement is a useful operation for patients without aortic valve abnormality.