A Juvenile Case of Folding Plasty for Mitral Active Infectious Endocarditis / 日本心臓血管外科学会雑誌

We report a case of mitral active infectious endocarditis in a 15-year-old boy successfully managed by folding plasty without any prosthetic devices. He was admitted to our hospital because of high fever and general fatigue. Echocardiography revealed a vegetation of 15×18 mm attached to the anterior commissure area of the mitral valve with severe mitral regurgitation. Brain MRI showed acute brain infarction without symptoms, and enhanced computed tomography also showed multiple infarctions of the spleen and the left kidney. <i>Staphylococcus aureus </i>was identified in the venous blood culture. We diagnosed active mitral infectious endocarditis with multiple systemic embolization and disseminated intravascular coagulation. After antibiotic therapy for 9 days, mitral valve surgery was performed with cardiopulmonary bypass and cold blood cardioplegia through a median sternotomy and a left atriotomy. A giant vegetation was attached to the damaged mitral leaflet of the AC to A1 and P1. The vegetation and damaged leaflet were removed by an ultrasonic aspirator and resected. Removal of the superficial vegetation with the aspiration method enabled preservation of more than half of the A1 and half of the P1 for valve repair. The anterior commissure annulus without a leaflet was reconstructed by compression suture. Furthermore, in a procedure similar to folding plasty, leaflet A1 was folded down and sutured to annulus P1, and a simple suture technique was involved to the left cut edges of leaflet A1 and P1. The postoperative course was uneventful. Two years after surgery, the patient was well with no recurrence of infection and trivial mitral regurgitation on echocardiography.

Left Thoracotomy, Deep Hypothermia and Total Body Retrograde Perfusion for Descending Thoracic Aortic Disease / 日本心臓血管外科学会雑誌

Since 1998, as a method of operating on descending thoracic aortic disease, especially distal aortic disease, a simple circulatory support technique, which uses the axillary artery or the ascending aorta as the aortic inflow, and the inferior vena cava for total body retrograde perfusion of cold oxygenated blood during circulatory arrest for open proximal anastomosis has been applied. This technique has been used in 25 consecutive cases over 10 years. In this report, we evaluate the efficacy of this support technique. From our experience, an atherosclerotic lesion in the ascending aorta required selection of the femoral artery as an aortic inflow site in 7 patients. Prolonged ventilatory support was unnecessary postoperatively unless neurological sequelae supervened, and no heart or visceral organ complications were occurred recognized. The hospital mortality rate was 16%. These results suggest our technique will continue to play an important role in operations on descending thoracic aortic diseases.

Successful Surgical Treatment of Traumatic Rupture of the Descending Aorta in a Child / 日本心臓血管外科学会雑誌

Traumatic rupture of the thoracic aorta is extremely rare in pediatric patients. We present a case of blunt traumatic aortic disruption in a 13-year-old boy who was successfully managed by patch aortoplasty using cardiopulmonary bypass. He was involved in a motor vehicle accident. He had a transient loss of consciousness. Initial vital signs were stable. Upon arrival at our hospital he was awake, alert, and oriented. Chest roentgenogram showed a subtly widened upper mediastinum with left pleural effusion. Chest computed tomography revealed a hematoma around the transverse and proximal descending thoracic aorta, and a 25-mm pseudoaneurysm with the intimal flap in the proximal descending thoracic aorta. Aortography verified a partial transection of the proximal descending aorta. Within 4h after injury, aortic repair was initiated through a left anterolateral thoracotomy. Following heparinization, partial cardiopulmonary bypass was established via the right femoral artery and vein. Sequential occlusion of the left subclavian artery, aortic arch between the left carotid and subclavian arteries, and descending aorta was performed. The periaortic hematoma was incised longitudinally to show a transverse tear involving the anterolateral aortic wall 3cm distal to the origin of the left subclavian artery. The disruption involved approximately 90% of the circumference of the aortic wall and there was retraction of the torn edges. A half of the impaired aorta was sutured, primarily to accommodate future aortic growth, and the other half of the defect was closed with a prosthetic patch. Bypass time was 173min. The postoperative course was complicated by persistent low-grade fever and hoarseness. Four years following discharge, he was well with only slight hoarseness, and magnetic resonance angiography two years later demonstrated a normal aorta without clinical evidence of coarctation.