A Case of Tricuspid Valve Repair with Artificial Chordae after Resection of Tricuspid Valve Myxoma / 日本心臓血管外科学会雑誌

A 76-year-old-woman, who had undergone endoscopic resection of a gastric polyp 2 years previously, had a cardiac tumor incidentaly pointed out on an abdominal ultrasonographic image. Echocardiography showed a solid round mass (34×25 mm in diameter), attached by a short stalk and which was floating on the right ventricular outflow tract and prolapsing over the pulmonary valve during systole. We suspected right ventricular myxoma. Urgent surgery was performed under cardiopulmonary bypass. After aortic clamping, the trunk of the pulmonary artery was opened near the right ventricule. The tumor was found under the pulmonary valve, attached to the anterior papillary muscle and chordae of the tricuspid valve. The tumor was completely excised with a piece of the papillary muscle and chordae. After right atriotomy, mild tricuspid regurgitation was seen on a water test. After we performed tricuspid annuloplasty and chordplasty with artificial chordae, a second water test did not show any tricuspid regurgitation. The postoperative course was uneventful, and she was discharged on the 13th postoperative day.

Surgical Treatment of a Case of Primary Angiosarcoma of the Right Atrium Associated with Cardiac Tamponade / 日本心臓血管外科学会雑誌

We report a case of angiosarcoma of the right atrium, which manifested as cardiac tamponade. A 50-year-old man was admitted to our hospital complaining of dyspnea on effort. Echocardiography and chest CT revealed massive pericardial effusion and a right atrial tumor mass. An emergency pericardiocentesis was performed to remove massive hemorrhagic fluids. Further examinations revealed primary cardiac neoplasm. Because there was no distant metastasis, the tumor in the right atrium was resected with the right atrial free wall under cardiopulmonary bypass support. The sinus node involved in the tumor was resected, necessitating pacemaker implantation. Microscopic examination of the resected tumor revealed angiosarcoma. As the resection border showed tumor tissue, postoperative radiotherapy was added. There was no evidence of recurrence or metastasis 14 months after surgery. The prognosis for angiosarcoma is very poor, and mean survival is less than 6 months. In cases with no metastases, early resection is the treatment of choice. In spite of incomplete resection, long-term survival may be possible with postoperative radiotherapy.

Two Cases of Combined Operation of Abdominal Aortic Aneurysm and Urinary Malignant Tumor / 日本心臓血管外科学会雑誌

We experienced 2 cases of abdominal aortic aneurysm (AAA) with malignant tumor of urinary organs. Case 1 was a 70-year-old man who was admitted for aortic dissection (De Bakey IIIb) with coexistence of AAA and left renal cancer. After the pseudolumen of the aortic dissection became thrombotic, the abdominal aortic aneurysmectomy and left nephrectomy were performed simultaneously. Case 2 was a 75-year-old man with AAA and prostatic cancer. He was treated by a one-stage operation consisting of aneurysmectomy, prostatectomy and castration. The postoperative courses were uneventful without prosthetic graft infection. Chemohormonal therapy could be induced one month after the operations. Concomitant resection of urinary malignant tumor and abdominal aortic aneurysmectomy may be feasible even in older patients.