A Case of Decreased Swallowing Function Due to Cardiac Myxoma / 日本プライマリ・ケア連合学会誌

The case was a 77-year-old man. He had dizziness and dysphagia for 2 years, and underwent detailed screening at the internal medicine department for general malaise and bloody sputum. He was hospitalized for aspiration pneumonia due to dysphagia of unknown origin. This time, he visited a local doctor with palpitations and shortness of breath. Echocardiography indicated a left atrial tumor involving the mitral valve and arrhythmia. Emergency surgery was performed to remove the left atrial myxoma and close the patch at our hospital's cardiovascular surgery department. After the excision, swallowing function was restored, and the patient was diagnosed with postoperative Ortner's syndrome. We report a case where echocardiography was considered important as a detailed investigation of the cause of swallowing dysfunction and dizziness.

Emergency Surgical Treatment for Fungal Prosthetic Valve Endocarditis due to Giant Vegetation / 日本心臓血管外科学会雑誌

A 68-year-old man presented to the emergency department with a high fever of 39.0 degrees Celsius. His past surgical history was significant, including mitral valve replacement and, tricuspid valve annuloplasty in 2012. On echocardiography, multiple vegetation with a maximum diameter of 20 mm was identified on the leaflet of the prosthetic valve. The vegetations were large, multiple, and appeared floating. Moreover, advanced prosthesis valve regurgitation was observed. Candida grablata was detected in the blood culture, suggesting a high probability of PVE due to fungal infection. Emergency surgery was performed to prevent deterioration of his condition. Multiple large vegetations were noted attached to the prosthetic valve, resulting in damage to the valve leaflets and subsequent stenosis. The operation was concluded following removal of the last prosthetic valve and re-enforcement of the MVR. After surgery, antibiotic therapy with amphotericin B liposome was administered. Given that there were no signs of infection, the patient was discharged from the hospital on the 50th day after surgery. Although the vegetation was deemed large with a likelihood of patient deterioration, we believe that the degree of destruction to the leaflets prevented fatality. Existing literature reported cases whereby patients were discharged despite having such large vegetation on the valve. In cases of fungal infective endocarditis (Fungal IE), regardless of whether the valve was natural or prosthetic, the optimal treatment is to combine infected tissue debridement with thorough lesion removal, valve replacement surgery or valve annuloplasty, supplemented with a long-term antifungal agent. We believe this to be an effective treatment, especially if intervention is implemented early.

Simultaneous Off-pump Coronary Artery Bypass Grafting and Ascending Aorto-bifemoral Bypass in Leriche Syndrome / 日本心臓血管外科学会雑誌

In the presence of Leriche syndrome, the lower extremities are perfused by collateral flow from internal mammary arteries. If an internal mammary artery graft is used in coronary artery surgery, an acute ischemic limb will develop postoperatively. A 52-year-old man was admitted to our department with bilateral claudication. Multidetector row computed tomography with contrast showed total occlusion of the infrarenal abdominal aorta and rich collateral flow to the lower extremities from internal mammary arteries. Cardiac angiography revealed three-vessel disease. Simultaneous coronary artery bypass grafting and an ascending aorto-bifemoral bypass were performed without cardiopulmonary bypass. Postoperative computed tomography angiography showed that grafts to the coronary and bifemoral arteries were patent. This combined procedure is useful for patients with coronary artery disease and aortoiliac occlusive disease. This procedure without cardiopulmonary bypass has not previously been reported.

Clinical Evaluation of Atrioventricular Myocardial Pacing on Left or Biventricular Sites / 日本心臓血管外科学会雑誌

Multisite pacing has recently been available as a new treatment for patients with congestive heart failure. This study was intended to evaluate the effects of atrioventricular myocardial pacing on left or biventricular sites. Eleven patients (4 men, 7 women) who had undergone atrioventricular myocardial pacing between January 2000 and April 2002 were selected for this study. They ranged in age from 24 to 74 years (mean age 58.5 years). The diagnosis was dilated cardiomyopathy in 3 patients, ischemic cardiomyopathy in 4, complete atrioventricular heart block in 2, sick sinus syndrome in 1, and atrial fibrillation with bradycardia in 1. The method of pacemaker implantation was atrioventricular myocardial pacing on left or biventricular sites by means of mini-thoracotomy under general anesthesia. A DDD-R pacemaker was used. When biventricular pacing was employed, the ventricular pacing lead was cut, connected with a Y adapter, and implantation was made biventricularly. We analyzed pre- and postoperative hemodynamic states by means of a Swan-Ganz catheter, and clinical course (NYHA class). There was a significant difference between pre- and postoperative clinical course and hemodynamic state. The atrioventricular myocardial pacing on left or biventricular sites was a useful method of improving the clinical course and hemodynamic state. It is concluded that this method is available as a new therapeutic option in patients with congestive heart failure.

A Case of Double Valve Replacement 22 Years after the First Aortic Valve Replacement in a Patient with Swyer-James Syndrome / 日本心臓血管外科学会雑誌

A 53-year-old woman was admitted because of cardiac failure caused by mitral valve stenosis and regurgitation. She had been treated by an aortic valve replacement with a Björk-Shiley convexo-concave valve (21mm) 22 years previously in our institute. Her clinical symptoms and the histological findings of the lung specimen from the operation led to a diagnosis of Swyer-James syndrome. The diagnosis was confirmed by pulmonary blood flow scintigraphy on the present admission. With her informed consent, we treated her cardiac disease by mitral valve replacement and a second aortic valve replacement was carried out because of the structural brittleness of the Björk-Shiley convexo-concave valve. She was discharged from our institute after the operation without any complications.

Reactivity of the Internal Thoracic Artery Graft to Drugs in Coronary Artery Bypass Grafting / 日本心臓血管外科学会雑誌

The internal thoracic artery is a useful conduit for coronary artery bypass grafting (CABG). Recently we have developed a method for increasing blood flow by directly injecting a phosphodiesterase III (PDE III) inhibitor into the left internal thoracic artery (LITA) to inflate the artery and prevent its contraction. In the present study we compared the reactivity of the LITA to three drugs: PDE III inhibitor, papaverine hydrochloride and isosorbide dinitrate (ISDN). Forty-two patients with a mean age of 66.8±11.5 years old who were undergoing primary CABG were enrolled in this study and were randomly separated into one of three groups based on the vasodilating drug administered. Each drug was used in 14 cases. Graft free flow (GFF) and systemic blood pressure were measured before and one minute after drug administration to calculate blood vessel resistance (<i>R</i>). All the drugs significantly increased GFF, and reduced both <i>R</i> and blood pressure. A comparison of the change rate of blood pressure did not differ significantly among the three drug groups. The PDE III inhibitor significantly increased change rates of both GFF and <i>R</i>, compared with the other drugs. These results indicate that PDE III inhibitor is most effective for increasing the blood flow of LITA grafts for CABG.