ABSTRACT
A 65-year-old man who had been taking warfarin for a mitral mechanical valve, was transported to our hospital for acute heart failure 3 months after switching to edoxaban. The fluoroscopy revealed restriction of the mechanical valve opening, and the catheterization showed an increased pressure gradient of the mechanical valve. The patient was diagnosed with valve thrombosis, and emergency redo mitral valve replacement was performed. The patient recovered well without complication. In cases with mechanical heart valves, sufficient explanation and education about warfarin administration is mandatory for patients' home doctors as well as patients and their families.
ABSTRACT
A diagnosis of active aortic valve endocarditis was made in a 52-year-old man who presented with fever and edema. Blood cultures were positive for Streptococcus gallolyticus subsp. pasteurianus. The infection was treated successfully using antibiotics and dental care, but a mobile vegetation-like structure on the aortic valve and severe aortic regurgitation, mainly due to aortic annulus dilatation, remained and required surgery. During the surgical procedure, the aortic valve leaflets were seen to be almost normal, and the regurgitation was found to be mainly due to aortic annulus dilation. Regurgitation could be managed with external suture annuloplasty alone, although a second session was necessary to reduce the annular size by one size. The annular size has been stable for over 1 year after surgery without re-operation of the aortic valve. This procedure not only reduces the operation time but also decreases the surgical stress and avoids the need for prosthetic valve replacement.
ABSTRACT
Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare congenital coronary anomaly. Although asymptomatic in most cases, with the anomaly only being detected incidentally, surgical correction should be considered before onset of severe myocardial ischemia in such cases. Here, we present a 70-year-old man who was referred to our department due to chest pain on effort and was given a diagnosis of ARCAPA concomitant with mild aortic stenosis. As the symptoms and the degree of aortic stenosis deteriorated during follow-up, the patient underwent direct re-implantation of the right coronary artery into the ascending aorta and aortic valve replacement. The patient's postoperative course was uneventful, and the symptoms disappeared. Postoperative myocardial perfusion scintigraphy revealed improvement of the myocardial ischemic area.
ABSTRACT
In this study, we report early and mid-term outcomes of endoscopic saphenous vein (SV) harvesting (EVH) for coronary artery bypass grafting. EVH is expected to have superior cosmetic results and fewer wound complications than conventional open techniques. EVH was performed in 262 patients from April 2008 to December 2010. From September 2010, we have administered heparin before EVH to prevent intraluminal SV clot formation. The mean age of the patients was 70±7.3 years, and 178 (67.9%) patients were men. The success rate of EVH was 97.3%. Hospital mortality was 1.2%. Postoperative wound complications occurred in only 7 (2.8%) patients. The early and mid-term patency was 95.8% (276/288) and 74.2% (187/252), respectively, as evaluated by postoperative angiography or computed tomography. Comparing the mid-term patency rate between the groups with or without systemic heparinization before EVH, statistical significance was not observed, but the mid-term patency was good in the group with systemic heparinization (82.5% vs. 73.6%, <i>p</i>=0.16). Actuarial 1-year and 3-year survival were 93.9% and 79%. Actuarial 1-year and 3-year major adverse cardiac event-free rates were 92.2% and 77.5%. In 10 patients who had SV graft occlusion during the observation period, percutaneous coronary intervention was required for the native coronary artery. EVH has great cosmetic advantages and has a good early patency. However, the mid-term patency is not satisfactory. Thus, systemic heparinization before EVH, improvement of the device and further clinical experience and techniques are required to improve the mid-term and late patency.
ABSTRACT
A 47-year-old man was referred to our hospital with acute congestive heart failure. Echocardiography and computed tomography revealed a left atrial tumor obstructing blood flow. An emergency operation was performed to relieve the obstruction. The tumor deeply invaded the posterior wall of the left atrium. We did not completely resect the tumor. The patient was discharged 10 days after surgery without complications. The tumor was diagnosed as pleomorphic rhabdomyosarcoma histopathologically. Adjuvant chemotherapy (cyclophosphamide, vincristine, adriamycin and dacarbazine) was started 23 days after surgery. Although partial remission was achieved, the tumor started to grow after chemotherapy was discontinued because of severe adverse effects. The patient died 11 months after surgery. In this patient, even though complete resection was not done, emergency palliative surgery was effective to treat acute heart failure and to establish a pathologic diagnosis of the tumor. We report this rare case and discuss the therapeutic strategy for primary cardiac sarcomas.