Simple Excision for Cardiac Fibroelastomas Arising from Three Leaflets of the Aortic Valve / 日本心臓血管外科学会雑誌

Cardiac papillary fibroelastomas are rare but are still the second most common benign cardiac tumor ; after myxoma. While cardiac papillary fibroelastomas are benign, there is the potential for severe complications related to embolism. Consequently, a surgical treatment approach is generally recommended. Nevertheless, from the risk of the recurrence of tumor and the valve insufficiency, the excision range is still controversial, particularly with tumors arising from the valve. We report the case of a 66-year-old woman who underwent resection of cardiac papillary fibroelastomas arising from three leaflets of the aortic valves. We performed simple excision without valve surgery and obtained an uneventful prognosis. At 18 months after surgery, no recurrence of tumors was recognized. We consider that it is possible to resect cardiac papillary fibroelastomas without performing valve repair or replacement if they are removed carefully even if the tumors arise from three leaflets of an aortic valve.

A Case of Acute Retrograde Aortic Dissection during TALENT Endovascular Repair of a Thoracic Aortic Aneurysm / 日本心臓血管外科学会雑誌

An 83-year-old woman underwent stent graft endovascular repair using a Medtronic TALENT device for a saccular aortic aneurysm in the distal arch. The landing zone which targeted the proximal side was directly distal to the orifice of the left common carotid artery (Z2), and the stent graft was placed at the targeted position. However, a decline in the right radial arterial pressure was observed immediately following this, and a retrograde dissected ascending aorta was observed on a transesophageal echocardiogram. The endovascular surgery was immediately converted to open surgery, and an intimal tear to the lesser curvature of the arch, caused by a bare spring (bare stent) of the proximal stent graft, was observed. Total arch replacement was performed by means of the concomitant use of the placed stent graft. Sometimes a TALENT stent graft exhibits specific movements (e.g. a misaligned opening) on its initial deployment. It is therefore believed that special attention is necessary when placing it in the aortic arch.

Neuropsychologic Outcome after Aortic Arch Surgery: Effects of a Selective Cerebral Perfusion Technique under Deep Hypothermic Circulatory Arrest / 日本心臓血管外科学会雑誌

To determine the effects of a selective cerebral perfusion (SCP) technique under deep hypothermic circulatory arrest (DHCA) for aortic arch surgery, the neuropsychological outcomes of 38 patients with cardiovascular disease were examined before and after the operation. Thirteen patients undergoing aortic arch repair with SCP under DHCA (SCP group) were evaluated with 2 batteries of neuropsychological tests (Benton Visual Retention Test and Miyake's Verbal Memory Test) resulting in 4 subscores, and the results were compared with those of 15 heart surgery patients who underwent a normal cardiopulmonary bypass (CPB group) and 10 patients who underwent abdominal aortic aneurysm repair without CPB (Y group). There were no significant differences in age, incidence of preoperative cerebrovascular complications, or mean score on the preoperative neuropsychological tests among the groups. In the postoperative period, the patients in all 3 groups performed less well than they did preoperatively on 3 of 4 subscores, however, there were no differences among the 3 groups. On 1 of 3 subscores, the postoperative mean score in the SCP group was significantly lower than the preoperative and postoperative mean scores in the Y group, whereas there were no differences between the SCP and CPB groups. In the SCP group, the patients whose postoperative mean score was lower than the preoperative score had longer SCP times than the patients without a lower postoperative mean score. In conclusion, CPB, including SCP, may be a risk factor for the deterioration of postoperative neuropsychological function, although each group had deteriorated test scores in the early postoperative phase and the severity of the deterioration was not exceedingly high using our SCP methods. Various factors, such as drugs, anesthesia, surgical technique, and physical and psychological damage are believed to potentially have an effect on deteriorated postoperative neuropsychological function.

Early and Long-term Results of Type B Aortic Dissection / 日本心臓血管外科学会雑誌

Between 1961 and 1994, 121 patients our hospital were treated by conservative and surgical therapy for acute (67 patients) and chronic (54 patients) type B aortic dissection. Among the acute type B aortic dissections, two patients died before operation and 4 patients underwent surgical treatment in the acute phase. The false channel was occluded due to thrombosis in 30 patients. 9 in 31 patients with patent false channels required surgical therapy in the chronic phase. 46 of 54 patients with chronic type B aortic dissection underwent surgical treatment and 9 other patients were not operated on because of the false channel was not enlarged, nearly thrombosed type and refusal to operate. The long-term survival rate appeared to be better in cases acute closing aortic dissection than in cases of aortic dissection with patent false channels. Among the 54 patients who required surgical treatment in the chronic phase, there were eight early deaths (13.3%). Among chronic phase surgical cases, the long term survival rate appeared to be similar to that in type B aortic dissections treated by conservative therapy. Therefore, we consider that type B aortic dissections with acutely thrombotic false channels should be treated by medical therapy, while type B aortic dissection with patent false channel should be treated surgical treatment in the subacute phase or early chronic phase.