Coronary sinus atrial septal defects in adults over the past 20 years at new Tokyo hospital: case series.

BACKGROUND: An isolated coronary sinus (CS) atrial septal defect (ASD) is defined as a CS unroofed in the terminal portion without a persistent left superior vena cava or other anomalies. This defect is rare and part of the wide spectrum of unroofed CS syndrome (URCS). Recently, several reports have described this finding. The database of New Tokyo Hospital was searched to determine the incidence of this defect. Additionally, to raise awareness of this condition, the findings from five patients with CS ASD who underwent surgical repair at New Tokyo Hospital are discussed. CASE PRESENTATION: The patients were three women and two men with an age range of 63-77 years. All patients underwent transthoracic echocardiography and computed tomography, and one underwent magnetic resonance imaging. In two patients, the defect was found unexpectedly intraoperatively; left-to-right shunting was apparent in the other three patients preoperatively. The pulmonary-to-systemic blood flow ratio ranged from 1.42 to 3.1 following cardiac catheterization, and oxygen saturation step-up was seen on the right side of the heart. Valvular regurgitation was seen in 4/5 patients with different combinations and degrees of mitral, tricuspid, and aortic valve involvement. Right atrial and ventricular dilation were seen in 4/5 patients; three patients had left atrial dilation. Three patients experienced atrial fibrillation, and one of these also experienced paroxysmal ventricular contractions. All patients underwent surgical repair, and some underwent multiple procedures. One patient who had previously undergone kidney transplantation died approximately 1 year postoperatively; the remaining four patients are currently experiencing good activities of daily living without symptoms. CONCLUSIONS: CS ASD (Kirklin and Barratt-Boyes type IV URCS) comprised 1.3% of adult congenital heart surgeries and 0.07% of adult open-heart surgeries at New Tokyo Hospital from 1999 to 2019. At New Tokyo Hospital, cardiac surgery is performed mainly for patients with acquired cardiac disease, and CS ASD is rare. Early diagnosis is important, as well as early surgical repair in symptomatic patients, especially those with blood access shunts, which may overload the heart. The case of a poor prognosis in this series is noteworthy, as similar cases have not been reported previously.

[The Role of Corrugated Bioresorbable Sheet for Bone Fixation after Median Sternoto].

OBJECTIVES: Performing sternal reconstruction after a median sternotomy using a corrugated bioresorbable sheet composed of poly-L-lactide acid and hydroxyapatite can improve the safety and efficacy of the treatment outcome and promote bone healing. METHODS: We compared treatment outcomes of 53 patients who underwent sternal closure using a corrugated sheet (group P) from October 2018 with retrospectively evaluated outcomes of 57 patients who underwent sternal closure using a sternal pin-type device( group C). RESULTS: Sternal wound infection was not observed in either group. Significant sternal dehiscence was not observed in group P, but it was seen in three cases in group C( p=0.0449). Incomplete approximation by wire cutting was observed in 3% of patients in group P and 15% of patients in group C( p=0.0645). Displacement in the antero-posterior direction was 1.35 mm in group P and 1.67 mm in group C (p=0.0707). The drain discharge volume during 12 hours after operation was 175 ml for group P and 220 ml for group C (p=0.1958), while the total drain discharge volume was 380 ml for group P and 622 ml for group C( p=0.0068). The mean hospital stay was 23.9 days for group P and 26.3 days for group C( p=0.3637). CONCLUSIONS: The total volume of drain discharge significantly decreased when a bioresorbable corrugated sheet was used for sternal closure. We also consider that the bioresorbable corrugated sheet may improve repair of the split sternum and could result in decreased sternal dehiscence.