ABSTRACT
We present a case of ruptured aneurysm of the sinus of Valsalva with congenitally bicuspid aortic valve and aortic regurgitation. A 50-year-old woman was admitted with congestive heart failure. Transesophageal echocardiography demonstrated that an aneurysm originating from the anterior sinus of Valsalva had ruptured into right ventricular outflow tract. With the aid of cardiopulmonary bypass, the aneurysm was repaired with direct closure through an aortotomy and aortic valve replacement with a Carbomedics 21mm was successfully performed. Because of the marked calcification of her cusps and shortening and thickening of the free-edge, valvuloplasty for the insufficient bicuspid valve was not applied in this case. However, valvuloplasty should be considered as the first surgical procedure of choice, even in cases of bicuspid aortic valve associated with ruptured aneurysm of the sinus of Valsalva and aortic regurgitation.
ABSTRACT
A patient developed perioperative coronary artery spasms (CAS) twice, in initial and redo open heart operations for mitral stenosis. CAS was shown by sudden ST segment elevation, hypotension, bradycardia, and decreased cardiac output. The patient, a female, had the first CAS attack in the ICU following open mitral commissurotomy at the age of 48. The Second CAS attack occurred during redo surgery for mitral valve replacement at age of 56. Preoperative coronary angiography before both operations did not indicate significant organic lesions. Intraaortic balloon pumping in conjunction with intravenous nitroglycerin and norepinephrine were effective to treat CAS in this case.