An Autopsy Case of Transthyretin-Related Cardiac Amyloidosis (TTR-CA), Which Fell into Low-Output Syndrome after Cardiac Surgery / 日本心臓血管外科学会雑誌

We present the case of 83-year-old male patient. He was under observation as an outpatient with mild to moderate aortic stenosis and regurgitation since 75 years old. He underwent surgery because of repeated hospitalization by heart failure due to progressive aortic valve stenosis and regurgitation, mitral valve stenosis and regurgitation, and tricuspid regurgitation. Elective aortic valve replacement, mitral valve replacement and tricuspid valve repair was performed. Even though his condition after surgery was stable, suddenly feature like low output syndrome appeared on day 6, and led to a mortality on day 8 after operation. Ejection fraction was kept above 50 percent before and after surgery, which indicated to Heart Failure with preserved Ejection Fraction (HFpEF). After autopsy examination, by immunohistochemical staining identified transthyretin, we demonstrated previously undiagnosed transthyretin-related cardiac amyloidosis (TTR-CA).

A Case of Heparin-Induced Thrombocytopenia (HIT) with Postoperative Cerebral Infarction Following Surgical Repair of Acute Type A Aortic Dissection / 日本心臓血管外科学会雑誌

A 61-year-old man with consciousness disorder was transferred to our hospital. Computed tomography found acute type A aortic dissection and cardiac tamponade, and an emergency operation was performed. Operation findings indicated dissection above the commissure between the left coronary cusp and the right coronary cusp, to the ostium of the right coronary. An ascending aorta replacement and coronary aorta bypass grafting were performed. The postoperative course was good, but he did not regain clear consciousness. Results of magnetic resonance imaging showed multiple cerebral infarctions. At the same time, the platelet count had decreased and we suspected heparin-induced thrombocytopenia (HIT). Following detection of an heparin-dependent antibody, administration of an heparin was discontinued. However, the platelet count still tended to decrease. Therefore, we started continuous administration of argatroban, which resulted in the gradual increase in platelet count to within normal limits on postoperative day 26. The results indicate that in patients continuously and repeatedly treated with heparin, there is a possibility of the development of HIT and thrombosis with HIT.

Redo CABG Using Lateral Minimally Invasive Direct Coronary Artery Bypass Technique-Selection of Grafts, Bypass Inflow and Bypass Routes- / 日本心臓血管外科学会雑誌

We performed redo coronary artery bypass grafting (CABG) using lateral MIDCAB for 3 patients with severe symptomatic ischemia in the left circumflex system alone. When the descending thoracic aorta had no atherosclerotic lesions on chest CT, it was selected as the inflow of the bypass. According to the location of the target artery, we undertook sequential or T-composite off-pump bypass using the radial artery through a left lateral thoracotomy. On the other hand, when the descending aorta was diseased, the left axillary artery was chosen as the inflow of the bypass. We selected the saphenous vein as a conduit to obtain sufficient graft length. A proximal anastomosis was made through a left infraclavicular incision, and then a distal anastomosis was done through a left lateral thoracotomy without cardiopulmonary bypass. Moreover, care was taken not to kink the grafts. The postoperative course was uneventful in all patients. Lateral MIDCAB technique was useful for redo revascularization to the circumflex system. We believe that selection of bypass conduits, routes, and bypass inflow according to the individual patient is essential for the procedure.

Revascularization after Removal of Aneurysm of the Superficialized Brachial Artery. Successful Treatment with Brachial-Ulnar Artery Bypass through the Ulnar Side Roots in the Elbow / 日本心臓血管外科学会雑誌

We performed 6 revascularization procedures in 5 patients after removing aneurysms of the superficialized brachial artery. The patients were 2 men and 3 women with an age range of 52 to 73 years. Their periods of hemodialysis ranged from 1 to 10 years. The aneurysms included 3 unruptured aneurysms, 1 ruptured aneurysm at the anastomosis site of an arteriovenous fistula and 1 ruptured infected aneurysm. Three procedures with interposed techniques for aneurysms and 3 brachial-urnal bypasses through the ulnar side roots of the elbow were performed with saphenous vein grafts (SVG) for revascularization. Two interposed SVGs closed after operation angiographically. In contrast, all brachial-ulnar bypass SVGs remained patent. One patient of the 2 graft occlusion patients had a ruptured infected aneurysm, and the other patient had exercised his elbow joint actively after operation. In conclusion, brachial-ulnar bypass through the ulnar side roots in the elbow is an effective revascularization technique for patients who exercise the elbow joint after operation or who have infected aneurysms.

A Case of Double Valve Annuloplasty for Combined Valvular Disease with Protein-Losing Gastroenteropathy after Closure of VSD / 日本心臓血管外科学会雑誌

A 37-year-old man with protein-losing gastroenteropathy underwent surgery for mitral and tricuspid regurgitation. Serum protein level and serum albumin level were normalized after surgery. Gastrointestinal scintigraphy images using ^99mTc-labeled albumin also showed no collection of tracer in gastrointestinal tract.