Recurrent Paravalvular Leakage after Mitral Valve Replacement with Annular Reconstruction for Paravalvular Leakage Due to a Paravalvular Abscess: A case report / 대한흉부외과학회지

Paravalvular abscess is defined as infective necrosis of the mitral annulus and surrounding tissue that requires debridement of the necrotic tissue and patch reconstruction before valve implantation. Paravalvular abscess is associated with high operative mortality, postoperative complications, and recurrence. We report here a case of a 59-year old woman that had undergone mitral valvular replacement with a mechanical valve 13 years ago. The patient was determined to have paravalvular leakage due to paravalvular abscess as seen during follow-up. The patient underwent repeat mitral valvular replacement with annular reconstruction. However, the patient with mitral annular reconstruction and valvular replacement on the fifteenth postoperative day due to recurrence of paravalvular leakage. The patient is now receiving follow-up eight months after surgery.

A Case of Recurrent Bioprosthetic Valve Endocarditis by Candida Parapsilosis

Candida prosthetic valve endocarditis (PVE) is a rare entity. However, its incidence is expected to increase along with increasing incidence of nosocomial candida infection. A valve replacement combined with antifungal chemotherapy has been the standard treatment. However, successful treatment with the long-term administration of oral fluconazole has been reported. Herein, a case of bioprosthetic valve endocarditis due to candida parapsilosis, which recurred after a re-do operation, and treated with long-term antifungal chemotherapy, is reported.

Diagnostic Value of Dipyridamole Tc-99m Tetrofosmin SPECT for Detection of Coronary Artery Disease

Background and Objects: Tc-99m tetrofomsin is a recently developed myocardial perfusion agent. We examined the diagnostic accuracy of dipyridamole Tc-99m tetrofosmin SPECT. MATERIALS AND METHOD: 61 patients underwent one-day rest/dipyridamole Tc-99m tetrofosmin SPECT. 26 patients had history of myocardial infarction. Coronary angiography, performed within 1 week after SPECT study, revealed normal coronary arteries or insignificant coronary artery stenosis in 19 and 22 patients (when considering > or = 50% or > or = 70% reduction of luminal diameter as significant stenosis). RESULTS: Number of male was 39 (63.9%) and mean age was 59 (range 32 - 84). The diagnostic accuracy of dipyridamole Tc-99m tetrofosmin SPECT for detection of coronary artery disease (> or = 50% and > or = 70% coronary artery stenosis, respectively) was as follows: sensitivity 90.5%, 90.0%, specificity 73.7%, 66.7%, positive predictive value 88.4%, 83.7%, negative predictive value 77.8%, 77.8% and predictive accuracy was 85.2%, 81.9% respectively. The overall sensitivity and specificity of dipyridamole Tc-99m tetrofosmin SPECT for detection of individual coronary stenosis (> or = 50% and > or = 70% coronary stenosis by coronary angiography) were 64.6%, 64.1% and 86.4%, 85.7% respectively. In patients without myocardial infarction, sensitivity 76.5%, specificity 76.5%, positive predictive value 83.3%, negative predictive value 76.5% and predictive accuracy was 80.0%. CONCLUSION: One-day rest/stress dipyridamole Tc-99m tetrofosmin myocardial SPECT is a useful noninvasive method for detection of coronary artery disease.