Reoperation for Rupture of the Porcine Aortic Wall of a Stentless Bioprosthesis / 日本心臓血管外科学会雑誌

A 63-year-old woman presented with pseudoaneurysm formation due to rupture of the porcine aortic wall of the stentless bioprosthesis. She had undergone aortic root replacement using the full root technique with the 25-mm Prima Plus bioprosthesis for annuloaortic ectasia. Congestive heart failure, appearing 65 months after the first surgery, progressed rapidly. Multidetector computed tomography (CT) showed a pseudoaneurysm of the aortic root, and echocardiography revealed severe mitral regurgitation. At reoperation, a large pseudoaneurysm with a 20-mm horizontal tear was seen in the non-coronary sinus of the Prima Plus valve. A repeat aortic root replacement and mitral valve replacement with two mechanical valves were performed. The patient had an uneventful recovery. Histologic examination of the explanted porcine aortic root showed host mononuclear cells and macrophages between the well-stained and poorly stained areas, suggesting that the torn tissue had undergone host-mediated degeneration to some extent. Porcine aortic roots have excellent hemodynamic features, but ruptures in the aortic sinuses of the porcine aortic root have been reported in some cases. Careful follow up with CT or echocardiography is therefore needed after aortic root replacement with stentless bioprostheses.

A Case of Coronary Artery Bypass Grafting for Anomalous Aortic Origin of a Coronary Artery / 日本心臓血管外科学会雑誌

Anomalous aortic origin of a coronary artery (AAOCA) can cause sudden death, especially in young athletes. AAOCA does not have any clinical cardiovascular manifestations and sudden death is often the first manifestation ; hence, it is difficult to diagnose AAOCA before a major episode occurs. We report the case of a 58-year old woman with a right coronary artery arising from the left sinus and passing between the aorta and the pulmonary artery. Although the results of the exercise treadmill test and various other tests were normal, this patient underwent coronary artery bypass, surgery using the right internal thoracic artery to preventing sudden death. Two years after the operation, she is asymptomatic and has normal results on the exercise treadmill test.

Aortic Valve Replacement in Octogenarians: Are Concomitant Coronary Artery Bypass Grafting Operations Predictive Factors? / 日本心臓血管外科学会雑誌

Because of increasing life expectancy and the high incidence of aortic stenosis (AS) in high-age groups, aortic valve replacement (AVR) for severe AS has become more frequent in recent years. The purpose of this study is to analyze operative outcome in octogenarians and evaluate the effect of concomitant coronary artery bypass grafting (CABG) for coronary artery disease. Between 2003 and 2010, 77 patients (18 men) aged over 80 years (80∼88 years ; mean age, 82.7 years) underwent AVR (bioprosthesis in 75 cases). Of these patients, 43.4% were categorized in New York Heart Association (NYHA) class III∼IV and 41% had a history of congestive heart failure. In addition, 26 patients (33.8%) underwent associated CABG operations (1-4 grafts ; mean, 1.8 grafts) with AVR. Operative mortality was 5.2% (4 patients). The operation time, cardiopulmonary bypass time, and aortic clamp time were significantly longer and amount of blood transfusion needed was greater in the concomitant CABG group than in the AVR-alone group. However, there were no differences between the groups with regard to intensive care unit (ICU) stay, postoperative hospital stay, operative mortality, and long-term survival. The outcome of AVR in octogenarians was good even in concomitant CABG patients. Aggressive surgical treatment of both aortic valve disease and concomitant coronary artery disease is warranted for most patients, despite advanced age.

Aortic Valve Replacement in Octogenarians : Are Concomitant Coronary Artery Bypass Grafting Operations Predictive Factors ? / 日本心臓血管外科学会雑誌

Because of increasing life expectancy and the high incidence of aortic stenosis (AS) in high-age groups, aortic valve replacement (AVR) for severe AS has become more frequent in recent years. The purpose of this study is to analyze operative outcome in octogenarians and evaluate the effect of concomitant coronary artery bypass grafting (CABG) for coronary artery disease. Between 2003 and 2010, 77 patients (18 men) aged over 80 years (80∼88 years ; mean age, 82.7 years) underwent AVR (bioprosthesis in 75 cases). Of these patients, 43.4% were categorized in New York Heart Association (NYHA) class III∼IV and 41% had a history of congestive heart failure. In addition, 26 patients (33.8%) underwent associated CABG operations (1-4 grafts ; mean, 1.8 grafts) with AVR. Operative mortality was 5.2% (4 patients). The operation time, cardiopulmonary bypass time, and aortic clamp time were significantly longer and amount of blood transfusion needed was greater in the concomitant CABG group than in the AVR-alone group. However, there were no differences between the groups with regard to intensive care unit (ICU) stay, postoperative hospital stay, operative mortality, and long-term survival. The outcome of AVR in octogenarians was good even in concomitant CABG patients. Aggressive surgical treatment of both aortic valve disease and concomitant coronary artery disease is warranted for most patients, despite advanced age.

A Recurrent Case of Infectious Endocarditis after Mitral Valve Repair / 日本心臓血管外科学会雑誌

A 36-year-old man was admitted to our hospital due to infectious endocarditis and severe mitral regurgitation caused by a prolapsed anterior leaflet. Mitral valve repair with chordal replacement using expanded polytetrafluoroethylene was performed and the post operative course was uneventful. One year after the first operation, he was readmitted with a high fever and lumbargo. Echocardiography revealed vegetation on the anterior mitral leaflet and computed tomography of the brain showed cerebral infarction. Blood culture was positive for <i>Staphylococcus aureus</i>. Inflammatory symptoms improved following multiple antibiotic medication and the blood culture became negative. Echocardiography demonstrated the disappearance of the vegetation, but moderate grade mitral regurgitation remained. We performed mitral valve replacement instead of repair because the infectious lesion extensively destroyed the anterior mitral leaflet. In order to determine the appropriate time for surgical treatment of infectious endocarditis, we must consider several factors, such as the effectiveness of antibiotic treatment, potential cerebral complications, and the degree of damage to the valve and surrounding structures.