A Case of Thrombectomy under Cardiopulmonary Bypass for a Left Atrial Appendage Thrombus in an Elderly Patient without Valvular Disease / 日本心臓血管外科学会雑誌

An 80-year-old woman who had been suffering from atrial fibrillation and recurrent cerebral infarction was admitted to our hospital. Transesophageal echocardiography revealed a giant mobile thrombus in the left atrial appendage. The patient underwent thrombectomy and left atrial appendage obliteration under cardiopulmonary bypass. Her postoperative course was uneventful. The patient showed no recurrence of the left atrial thrombus nor thromboenbolism postoperatively. Based on the present results, we recommend cardiac thrombus be investigated by transesophageal echocardiography in cases of atrial fibrillation accompanied by recurrent thromboembolism. This should be followed by thrombectomy under cardiopulmonary bypass, even in the elderly.

Supra-annular Flangeless Mitral Valve Replacement for Mitral Regurgitation Caused by Mitral Annular Calcification / 日本心臓血管外科学会雑誌

A 51-year-old woman with a 12-year history of chronic hemodialysis and secondary hyperparathyroidism suffered dyspnea induced by massive mitral regurgitation due to severe circular mitral annular calcification. Her anterior mitral leaflet was resected and successfully replaced with a 25mm SJM valve in the supra-annular position. The posterior leaflet was heavily calcified and adhered to the left ventricle. The flangeless prosthesis was directly implanted into the left atrial wall on the calcified annulus. Postoperative cine fluoroscopy and echocardiography showed good hemodynamic performance of the prosthesis without perivalvular leakage. In cases of mitral annular calcification due to chronic renal failure, the SJM valve is a more suitable valve prosthesis for replacement of the mitral valve in the supra-annular position. Supra-annular mitral valve replacement without a flange may give superior valve-performance compared to valves with a flange considering thrombogenicity and left ventricular function. However, we may still have to consider the indication of a supra-annular mitral valve replacement with a flange in cases with wide mitral annular calcification in the giant left atrium.

A Case of Ruptured Aortic Aneurysm Presenting as a Closing Aortic Dissection on Chest CT / 日本心臓血管外科学会雑誌

A 68-year-old male was admitted as an emergency case because of two severe back pain episodes in one week. Chest X-ray showed a marked prominence of the aortic knob. A remarkable bulging of the distal aortic arch and a crescentic low density area along the descending aorta on enhanced chest CT suggested a closing aortic dissection. Operation revealed extensive collapse of the very fragile intima of the aneurysmal wall and extraluminal hematoma along the descending aorta due to bleeding from the ruptured site. The ruptured aneurysm of this type should be accurately differentiated from the DeBakey type III closing aortic dissection which can be followed up medically.

Coronary Artery Bypass Grafting in a Patient with Severe Left Ventricular Dysfunction and Enlargement, Showing Clinical Features of Ischemic Cardiomyopathy / 日本心臓血管外科学会雑誌

Ischemic cardiomyopathy with a severe left ventricular dysfunction and enlargement, is a dismal prognosis, but can be a surgical candidate. So, differential diagnosis of ischemic cardiomyopathy from other cardiomyopathies and evaluation of myocardial viability are important. We successfully performed coronary artery bypass in a 68-year-old patient with ischemic cardiomyopathy. His preoperative left ventricular function showed an end-diastolic volume of 281.8cc/M/m², pressure of 30mmHg, and ejection fraction of 13.1%. We conclude that coronary artery revascularization provides significant benefits for ischemic cardiomyopathy with reversible myocardial ischemia.