Nonspecific Inflammatory Aortic Regurgitation Diagnosed after Aortic Valve Replacement / 日本心臓血管外科学会雑誌

A case of clinical1y unsuspected nonspecific inflammatory aortic regurgitation is reported. A 69-year-old female patient underwent aortic valve replacement for aortic regurgitation. Pathological examination of resected aortic valve showed abscess formation and inflammatory granulation tissue in the non-coronary cusp. Therefore, we diagnosed nonspecific inflammatory aortic regurgitation. It is generally considered that the use of prednisolone for vasculitis syndrome is effective ; however, for nonspecific inflammatory aortic regurgitation its use has not been established. Prednisolone treatment could be an option for nonspecific inflammatory aortic regurgitation.

Successful Pericardiectomy for Acute Constrictive Bacterial Pericarditis in the Active Phase of Infection / 日本心臓血管外科学会雑誌

Constrictive pericarditis is usually a chronic inflammatory process. We encountered a case of acute constrictive pericarditis caused by infectious pericarditis in a patient receiving pericardial drainage for pericardial effusion. We performed emergency pericardiectomy and primary closure in the active phase of infection. An 82-year-old man was referred to our hospital for investigation and management of pericardial effusion. The patient was admitted, and continuous pericardial drainage was performed. After 2 days of drainage, he had fever, and after 7 days, there was purulent exudate in the drain tube. Methicillin-sensitive <i>Staphylococcus aureus </i>was identified by culture of the purulent exudate. Despite administration of antibiotics, he developed malaise, anorexia, and generalized edema, and he also began to suffer from dyspnea. Computed tomography demonstrated infected pericardial effusion, while a right ventricular pressure study showed a “dip and plateau” pattern. Pericardial drainage and irrigation were done via a small subxyphoid skin insicion. However, his hemodynamics did not improve and oliguria was noted. Because more extensive drainage was necessary, we performed emergency on-pump beating pericardiectomy via median sternotomy. Along with administration of antibiotics, continuous mediastinal irrigation with saline was done via mediastinal, pericardial, and chest drain tubes for 7 days after the operation. His postoperative course was relatively uneventful, and he was discharged after recovery.

A Recovery Case of Severe Heart Failure after Emergency Coronary Artery Bypass Grafting Supported by a Left Ventricular Assist System / 日本心臓血管外科学会雑誌

In general strategy for postcardiotomy heart failure includes inotropic support followed by the use of an intra-aortic balloon pump and percutaneous cardiopulmonary bypass support (POPS). The insertion of a ventricular assist system (VAS) may become necessary when these procedures fail to restore hemodynamic stability. The ABIOMED BVS 5000 left ventricular assist support system (LVAS) has been approved for clinical use in Japan since 1998. Here we describe our experience with the recovery of a 52-year-old man from postcardiotomy heart failure after using an ABIOMED BVS 5000 LVAS. The patient was admitted to our institution with dyspnea. Heart failure with severe left ventricular dysfunction was diagnosed, and recent myocardial infarction was suspected from his history and electrocardiogram. Two days after admission, ventricular fibrillation occured and the arrythmia was hard to control. PCPS was connected and emergency coronary angiography showed triple vessel disease. We performed emergency coronary artery bypass grafting with the heart beating under PCPS and immediately implanted an ABIOMED BVS 5000 device to achieve myocardial recovery after stopping PCPS. He was weaned from the LVAS at 6 days after surgery. His postoperative course was relatively uneventful and he was discharged after recovery.

Surgical Treatment of Aortic Valve Regurgitation due to Infective Endocarditis Associated with Congenital Quadricuspid Aortic Valve / 日本心臓血管外科学会雑誌

An isolated quadricuspid aortic valve is an extremely rare congenital anomaly and there have been few surgical case reports published. A 47-year-old man with untreated diabetes mellitus was admitted to our institution because of fever and dyspnea. Transesophageal echocardiography showed severe aortic valve regurgitation and a quadricuspid valve with vegetations. Blood culture revealed <i>Streptococcus agalactiae</i>. Despite administration of antibiotics and treatment of his heart failure, the infection and heart failure were not controlled. Therefore, we performed aortic valve replacement in the presence of active infective endocarditis. The aortic valve had 2 equal-sized larger cusps and 2 equal-sized smaller cusps. There were vegetations on each cusp and an annular abscess was detected. The resection site of the abscess was reinforced with an autologous pericardial patch, and the aortic valve was replaced using a 21-mm SJM valve. His postoperative course was uneventful and he was discharged after recovery.

Clinical Experiences of Dissecting Aortic Aneurysm with Organ Ischemia / 日本心臓血管外科学会雑誌

We studied 6 surgical cases of dissecting aortic aneurysm with organ ischemia, consisting of 4 cases of DeBakey type I dissection and 2 cases of DeBakey type III b dissection and the average age was 62 years old. The ischemic organs were, the brain and upper extremities, intestine and kidney, kidney, kidney and lower extremity, and bilateral lower extremities, respectively. We performed the graft replacements of the ascending aorta or ascending aorta and arch for DeBakey type I dissection, and bypass or Y-graft replacement for DeBakey type III b dissection. In one case of DeBakey type I dissection we performed a second Y-graft replacement two days after the first operation. MNMS (myonephropathic metabolic syndrome) developed in two cases of 3 lower extremity ischemia. The results were unsatisfactory because 3 patients died. To improve of the outcome of surgical treatment in case of dissecting aortic aneurysm with organ ischemia, preoperative appropriate diagnosis and appropriate surgical planning are necessary.

Three Operations Following Conservative Therapy in Patients with Stanford A Type Acute Thrombosed Aortic Dissection / 日本心臓血管外科学会雑誌

We performed 3 operations for Stanford A type aortic dissections which were confirmed as acute thrombosed type by contrast chest CT. Initially conservative therapy was chosen in all patients. In case 1, a 64-year-old woman received ascending aortic replacement with a Hemashield^® vascular prosthesis 3 days after admission, because of increasing diameter of the ascending aorta and sustained back pain. In case 2, a 54-year-old woman, we replaced the total aortic arch with Hemashield^® graft, on an emergency basis since recanalization of the false lumen was revealed by contrast CT and D.S.A. 3 days after admission. In case 3, a 52-year-old woman, cardiac tamponade occured on the 30th admission day even though anti-hypertensive treatment had been effectively performed immediately after onset. Emergency D.S.A. revealed an“ulcer like projection” in the ascending aorta, so following pericardiocentesis, we resected and directly anastomosed the ascending aorta at the entry site 34 days after onset. Generally, acute thrombosed aortic dissections should be treated conservatively. Here we reported 3 operations for acute thrombosed Stanford A type aortic dissections even under good B.P. control, suggesting the importance of careful and long term observation for acute thrombosed aortic dissections.