[Open Stent Grafting for Aortic Arch Aneurysm in a Patient with Fuctional Coronary Bypass Grafts:Report of a Case].

Treating a thoracic aortic aneurysm (TAA) after coronary artery bypass (CABG) surgery requires an appropriate surgical procedure to preserve the bypass grafts. We present a case of open stent grafting. The patient was a 71-year-old man with a history of CABG. Chest computed tomography (CT) revealed a saccular-shaped aortic aneurysm in the aortic arch with diameter of 56 mm. Coronary angiography revealed the LIMA and SVG grafts were patent. The chest was opened via re-midsternotomy. After a circulatory arrest was induced at 30 ℃ with cerebral perfusion, the anterior surface of the arch was incised in a hemi-circumferencial mannar between the left common carotid and left subclavian arteries. The stent graft was inserted into the aortic arch and was deployed. The proximal side of the graft was then trimmed, and the posterior aortic wall and the graft were continuously anastomosed, the aortic incision was continuously closed involving anterior side of the graft. Finally, the left axillary artery was reconstructed. The patient's postoperative course was uneventful and he was discharged on postoperative day 10. A open stent grafting via an aortotomy was useful in the surgery for TAA after CABG.

[Concomitant Cardiac and Pulmonary Operation on an Elderly Patient:Report of a Case].

An 83-year-old woman was admitted because of dyspnea. Transthoracic echocardiography revealed severe aortic valve stenosis with a systolic gradient of 105 mmHg. Coronary angiography showed 75% stenosis at segment 1. Computed tomography( CT) of the chest revealed a mass, of 15 mm in diameter, in the right segment 1 of the lung. She was diagnosed with severe aortic valve stenosis, right coronary artery stenosis, and a lung tumor suspected to be lung cancer. We performed right lobe partial resection, aortic valve replacement and coronary artery bypass grafting through a median sternotomy. The tumor was diagnosed as adenocarcinoma by pathological examination. The postoperative course was uneventful, and she was discharged three weeks after the operation.

Combination therapy of midodrine and droxidopa for refractory hypotension in heart failure with preserved ejection fraction per a pharmacist's proposal: a case report.

BACKGROUND: Patients with chronic heart failure (CHF) are often treated using many diuretics for symptom relief; however, diuretic use may have to continue despite hypotension development in these patients. Here, we present a case of heart failure with preserved ejection fraction (HFpEF), which is defined as ejection fraction ≥50% in CHF, and refractory hypotension, which was treated with midodrine and droxidopa to normalize blood pressure. CASE PRESENTATION: The patient was a 62-year-old man with a history of HFpEF due to mitral regurgitation and complaints of dyspnea on exertion. He had been prescribed multiple medications at an outpatient clinic for CHF management, including azosemide 60 mg/day, bisoprolol 2.5 mg/day, enalapril 2.5 mg/day, spironolactone 50 mg/day, and tolvaptan 15 mg/day. The systolic blood pressure (SBP) of the patient remained at 70-80 mmHg because the use of the diuretic could not be reduced or discontinued owing to edema and weight gain. He was hospitalized for the exacerbation of CHF. Although midodrine 8 mg/day was administered to improve hypotension, the SBP of the patient increased only up to 90 mmHg. On the 35th day after hospitalization, the urine volume decreased significantly (< 100 mL/day) due to hypotension. When droxidopa 200 mg/day replaced intravenous noradrenaline on the 47th day, the SBP remained at 100-120 mmHg and the urine volume increased. CONCLUSIONS: Oral combination treatment with midodrine and droxidopa might contribute to the maintenance of blood pressure and diuretic activity in HFpEF patients with refractory hypotension. However, further long-term studies evaluating the safety and efficacy of this combination therapy for patients with HFpEF are needed.

[Infective Endocarditis with Pseudoaneurysms of the Sinus of Valsalva Ruptured into the Right Ventricle and the Left Atrium;Report of a Case].

A 65-year-old woman was admitted to our hospital with fever and left hemiplegia. She was diagnosed with infective endocarditis with multiple brain abscess. At first, heart failure was not present, and she was given medical treatment with antibiotics. But on day 12 after admission, she progressively developed heart failure. Transthoracic echocardiogram demonstrated pseudoaneurysm of the sinus of Valsalva, ruptured into the left atrium. At operation, another fistula to the right ventricular outflow tract was revealed. They were repaired with autologous pericardial patches, and the aortic valve was replaced with a bioprosthetic valve. The postoperative course was uneventful.

[Successful Primary Endovascular Repair for Aortoesophageal Fistula due to Ruptured Tuberculous Pseudoaneurysm of the Thoracoabdominal Aorta;Report of a Case].

We report a successful case of 50-year-old woman with aortoesophageal fistula due to tuberculous pseudoaneurysm of the thoracoabdominal aorta. We underwent endovascular repair with stent graft. Her clinical course improved without additional surgical repair or postoperative complications. The patient remains well at 3-year follow-up.

[Tricuspid valve plasty using autologous pericardium in a patient with infective endocarditis].

A 67-year-old woman was diagnosed with infective endocarditis. She had no history of any cardiac event or dental treatment. Echocardiography showed a large vegetation attached to the anterior leaflet of the tricuspid valve with severe tricuspid regurgitation. Surgery consisted of removal of the vegetation and tricuspid valve plasty with a glutaraldehyde-treated autologous pericardial patch and artificial chordae of the anterior leaflet. Her postoperative course was uneventful. Five years after surgery, neither recurrence of infection nor worsening of tricuspid regurgitation was noted.

[Hemothorax complicated with celiac artery compression syndrome (CACS); report of a case].

We report a case of hemothorax complicated with celiac artery compression syndrome (CACS). A 43-year-old man presented with a sudden onset left back pain. Computed tomography (CT) showed its hemothorax, esophageal artery aneurysm and severe stenosis of the celiac truncus with its anterior compression by median accurate ligament, and a diagnosis of CACS associated with rupture of the aneurysm was made. Emergent transcatheter arterial embolization of the aneurysm resulted in a technical failure, although the patient's condition was stable and performed esophageal artery ligation through video-assisted thoracoscopic surgery on day 5 after onset. After surgery, the patient recovered without significant incidents. A cause of this aneurysmal development was supposed to be a significantly increased esophageal arterial blood flow with its luminal dilation to compensate a decreased celiac blood flow. Segmental arterial mediolysis could not be excluded as another cause.

Report of takotsubo cardiomyopathy occurring during cardiopulmonary bypass.

On weaning from cardiopulmonary bypass, a 59-year-old Japanese woman with mitral valve plasty suddenly showed a greatly increased heart rate, and an electrocardiogram revealed elevated ST-segments. There was also abnormal wall motion in the inferior region and apical ballooning of the left ventricle. We diagnosed the condition as takotsubo cardiomyopathy (acute left ventricle apical ballooning syndrome), possibly caused by catecholamine release and regional stress-induced ischemia. We believe this to be the first case report of takotsubo cardiomyopathy observed during heart surgery. We hypothesize that the condition was mediated by regional myocardial stunning and that it could be prevented by administration of angiotensin converting enzyme inhibitors before surgery and by the use of superior biocompatible cardiopulmonary bypass components. Once takotsubo cardiomyopathy occurs, we recommend mechanical circulatory assistance during weaning from the bypass.

Effective cardiac resynchronization after Dor procedure and mitral annuloplasty.

Endoventricular circular patch plasty (Dor ventriculoplasty) is an effective strategy for severely impaired left ventricular function due to ischemic cardiomyopathy. Cardiac resynchronization therapy improves cardiac function in patients with severe congestive heart failure and an intraventricular conduction delay. The present case demonstrates the efficacy of adding cardiac resynchronization to Dor ventriculoplasty and mitral annuloplasty in a patient with severely impaired left ventricular function and an intraventricular conduction delay.

Clinical Experience with the Nikkiso Centrifugal Pump.

The Nikkiso HPM-15 is a minimally sized centrifugal pump. Preliminary results regarding clinical use of this pump for cardiopulmonary bypass (CPB) procedures have been reported previously. Recently, we have managed some additional cases using a newly developed controller. This article reports our clinical experiences with the use of this pump. We have managed 23 cases with a Nikkiso centrifugal pump. Twenty-two patients underwent CPB and 1 patient with fulminant viral myocarditis underwent percutaneous cardiopulmonary support (PCPS). With this pump, the circuit was extremely easy to prepare and deaeration was achieved readily. Hemodynamics during CPB and PCPS were stable in all cases. The increase in serum-free hemoglobin levels during CPB with this pump was as low as that seen in preliminary tests. A decrease in the platelet count was observed after the initiation of CPB with this pump; however, platelet counts returned to preoperative values 7 days after surgery. Moreover, urine output during CPB with this pump was as high as that seen in preliminary tests. No abnormalities in renal or liver function occurred during CPB. It appears that this new centrifugal pump is safe and easy to operate, and we conclude that it is useful for CPB and PCPS.