"Leafletization" of Atrialized Ventricular Septum Endocardium in Ebstein Anomaly.

This case presentation of a 73-year-old man introduces a unique tricuspid valve repair with "endocardium leafletization" for Ebstein anomaly. In this procedure, an atrialized portion of the right ventricular endocardium was delaminated, starting from the level of the true tricuspid annulus, to create a neoleaflet in continuity with the displaced true leaflet. The obtained neoleaflet was then anchored to the true tricuspid annulus. Preoperative severe tricuspid regurgitation was effectively controlled with preserving sufficient leaflet mobility. This procedure can be one of the useful options for a certain lesion of Ebstein anomaly that aims to avoid excessive leaflet rotation and restore functional valve apparatus.

Left circumflex artery aneurysm with fistula to the coronary sinus.

A giant coronary artery aneurysm with arteriovenous fistula is a unique pathology having few surgical reports. An 82-year-old woman presented with a symptomatic giant left circumflex artery aneurysm with a fistula to the coronary sinus. The left coronary artery was dilated, and an aneurysmal change was visible from the left main trunk to the fistula. Surgery was performed to close the fistula and seclude all parts of the aneurysmal coronary artery. All coronary branches emerging from the aneurysm required bypass grafting. Herein, we present the history of this unusual case and our successful surgical strategy.

[Ascending-to-abdominal Aorta Bypass under Percutaneous Cardiopulmonary Support for Lower Body Organ Malperfusion Secondary to Acute Type B Aortic Dissection; Report of a Case].

A 66-year-old man was admitted to our hospital because of uncomplicated Stanford B acute aortic dissection. Antihypertensive therapy was initially started; however, he suddenly experienced vomiting, diarrhea, anuria, and paraparesis on the fourteenth hospital day. Contrast-enhanced computed tomography (CECT) revealed expansion of the false lumen and severe stenosis of the true lumen at the distal aortic arch, which caused malperfusion syndrome of the lower body. Percutaneous cardiopulmonary support (PCPS) was immediately initiated to restore lower body organ perfusion, and an extra-anatomic ascending-to-abdominal aorta bypass was performed with a 16-mm Dacron graft. Postoperative CECT revealed expansion and good patency of both of the true lumen and the bypass graft. His symptoms improved except for the paraparesis; he was eventually able to ambulate using a crutch after postoperative rehabilitation.

Superior vena cava syndrome caused by a swollen absorbable haemostat after repair of ischaemic mitral regurgitation.

Surgicel, an absorbable haemostat, is widely used in cardiovascular surgery. An 81-year-old woman, who was diagnosed with ischaemic mitral regurgitation, underwent mitral valve plasty and coronary artery bypass grafting. On postoperative day two, her superior vena cava (SVC) pressure gradually rose to 38 mmHg and she developed low output syndrome. Emergent surgery revealed that the cause of SVC syndrome was external compression from a haematoma at the posterior surface of the SVC, which formed around the Surgicel.

[Surgical treatment of traumatic aortic rupture].

This report focuses on 3 cases of traumatic aortic dissection or rupture at the isthmus. We selected 3 different methods of treatment. In the 1st case, we performed an emergency operation with graft replacement of the proximal descending aorta. In the 2nd case, we performed elective graft replacement 5 months after the rupture under careful blood pressure control. Thirdly, we performed emergency stent grafting at the isthmus, the rupture site. All cases were successfully treated, but it remains difficult to select the method of treatment for multisystem disorder. Our current strategy for traumatic rupture at the isthmus is immediate stent grafting. It will also be a very useful procedure for multisystem trauma.

[Aortic valve-sparing operation for chronic dissecting aneurysm of the sinus of valsalva associated with redissection in a young woman who experienced out-of-hospital cardiac arrest].

A 38-year-old woman was admitted to our hospital because she experienced cardiopulmonary arrest at her wedding;her cardiac beats were resumed 20 min after cardiopulmonary resuscitation performed by her relatives and hotel staffs. Enhanced computed tomography revealed acute aortic redissection in chronic dissecting aneurysm in the right sinus of Valsalva, which was believed to have occurred in the 4th month of pregnancy 2 years before. Echocardiography showed moderate aortic regurgitation. We performed aortic valve-sparing operation and ascending aortic replacement with partial remodeling of the right sinus of Valsalva. She returned to work 2 months later without high-order dysfunction.

Hypogastric and lumbar artery bypasses to restore gluteal perfusion after open aortoiliac aneurysm repair.

Gluteal ischemia is a rare but often fatal complication after open abdominal aortic aneurysm repair. A 67-year-old man with an aortoiliac aneurysm presented with a patent right internal iliac artery (IIA) and an occluded left IIA. A bifurcated graft replacement was performed with both limbs of the graft anastomosed to the external iliac arteries. The right IIA was ligated and the inferior mesenteric artery was reimplanted. Postoperatively, the patient developed right gluteal ischemia. Hypogastric and lumbar artery bypasses were immediately performed and the patient recovered without gait disturbance. This treatment prevented potentially fatal necrosis of the buttock.