Acute Anterolateral Papillary Muscle Rupture Following Successful Percutaneous Coronary Intervention and Emergent Mitral Valve Replacement / 日本心臓血管外科学会雑誌

A 72-year-old woman complaining of orthopnea was admitted with cardiogenic shock. Her systolic blood pressure was only 66mmHg and electrocardiogram showed high lateral myocardial infarction. Transthoracic echocardiogram showed severe mitral regurgitation and disruption of the anterolateral papillary muscle. After orotracheal intubation and intraaortic balloon pumping (IABP), coronary angiogram was performed and an occlusion of the entrance of circumflex artery (#11) was diagnosed. Percutaneous coronary intervention was done successfully and emergency mitral valve replacement was performed using a St. Jude Medical prosthetic valve preserving the posterior mitral valve leaflet and mitral apparatus. Her postoperative recovery was entirely uneventful and she was followed up as an outpatient. Acute anterolateral papillary muscle rupture is a rare complication of acute myocardial infarction (AMI), although left coronary artery disease is associated with it and immediate recanalization is an important issue to rescue the patient.

Anuria Resulting from the Non-Inflammatory (Atherosclerotic) Large Abdominal Aortic Aneurysm. A Successful Surgical Case with Recovery of Renal Function / 日本心臓血管外科学会雑誌

The sudden onset of anuria in a 71-year-old man was found to be caused by the non-inflammatory (atherosclerotic) large abdominal aortic aneurysm compressing the bilateral ureters. A computed tomography scan demonstrated the bilateral extrinsic ureteral obstructions due to the large aneurysm of 13cm in diameter, left hydronephrosis and no thick layer of perianeurysmal fibrotic tissue. On the 9th day from the onset of anuria, an emergency operation was performed. There was no fibrotic adhesions around the aneurysm and mobilization of the aorta was easy. A straight Dacron prosthesis was inserted between the infrarenal aorta and the bifurcation of the abdominal aorta following resection of the aneurysm of the atherosclerotic origin. Soon after the operation, the patient had very good urinary output with adequate recovery of renal function. This case seems to be very uncommon, but very important in the surgical management of abdominal aortic aneurysm complicated by oliguria or anuria.

Report of a Case Surgically Treated for Intravenous Leiomyomatosis with Extension into the Right Atrium / 日本心臓血管外科学会雑誌

We report a case with successful surgical resection for a leiomyoma with an extension into the right atrium from the pelvic vein. The patient was a 54-year-old woman who presented with syncope in 1989. She had had a history of resection of a uterine leiomyoma 10 years previously. Preoperative angiograms showed a long tumor with an extension into the right atrium through the inferior vena cava originating from the right internal iliac vein. The diagnosis of intravenous leiomyomatosis was made. The operation was performed through a median sterno-laparotomy using cardiopulmonary bypass with successful results. Histologic sections showed a benign leiomyoma. To our knowledge, 20 cases of resection of intravenous leiomyomatosis with the use of extracorporeal circulation have been reported in the literature. This rare condition was discussed with the review of the literature.