Non-occlusive mesenteric ischemia after trans-catheter aortic valve implantation with thyroid storm: A case report.

Non-occlusive mesenteric ischemia (NOMI) is a rare but well-known life-threatening disease. However, reports on NOMI following trans-catheter aortic valve implantation (TAVI) are limited. This report presents a case of NOMI after trans-apical (TA) TAVI with thyroid storm. A 73-year-old man was admitted for a planned aortic valve surgery. Because he had severe aortic calcification and a right renal tumor that was suspected to be malignant, TA-TAVI was performed. At 61 h after TAVI, the patient complained of abdominal pain, and contrast-enhanced computed tomography showed ischemic necrosis of the cecum to the ascending colon. An ileocecal resection was performed emergently. He was extubated 61 h postoperatively, but severe delirium, high fever, and atrial fibrillation persisted. Due to a history of Basedow's disease, he was diagnosed with thyroid storm and treated with thiamazole and supportive care. The general status gradually improved, and he was transferred to the rehabilitation unit on the 17th postoperative day. We encountered a case of NOMI following TA-TAVI with a thyroid storm, which made it difficult to understand the patient's medical condition. Learning objective: The occurrence of non-occlusive mesenteric ischemia after trans-catheter aortic valve implantation is rare but possible, and a thyroid storm could occur even after a less invasive surgery. It is important to perform postoperative management while considering the possible occurrence of this condition.

The effects of hydroxyethyl starch 130/0.4 on perioperative renal function in patients undergoing cardiac surgery: A randomised controlled trial.

Background: Acute kidney injury (AKI) after cardiac surgery increases the risk of morbidity and mortality. Hydroxyethyl starch (HES) is often used during surgery due to its plasma-volume expanding effect, but the impact of HES 130/0.4 on renal function in patients undergoing cardiac surgery remains unclear. The aim of our study is to investigate the impact of HES 130/0.4 on postoperative renal function in patients undergoing cardiac surgery using cardiopulmonary bypass. Methods: Our study was a randomised, single-center, single-blind study conducted on 60 adult patients who underwent cardiac surgery using cardiopulmonary bypass: 30 patients were intraoperatively administered with HES 130/0.4; the other 30 with Ringer's bicarbonate. The primary endpoints were occurrence of AKI within 30 days of surgery and the disease stages. Results: The mean dose of 6% HES 130/0.4 was 28 ml/kg. AKI occurred within 30 days of the operation in 8 cases (28.6%) in the HES group and 6 cases (21.4%) in the crystalloid group (no significance: p = 0.5371). Disease stages were as follows: "no AKI", "stage 1", "stage 2″ and "stage 3″, accounting for 20 cases (71.5%), 6 cases (21,4%), 2 cases (7.1%), and 0 cases, respectively, in the HES group, and 22 cases (78.6%), 6 cases (21.4%), 0 cases, and 0 cases, respectively, in the crystalloid group (no significance: p = 0.3508). Conclusion: There was no significant difference in the occurrences or stages of AKI during the 30 days following cardiac surgery with cardiopulmonary bypass between patients administered with HES 130/0.4 or Ringer's bicarbonate.

A Case of Alport Syndrome Associated with Recurrent Stanford Type B Aortic Dissections.

Alport syndrome is often characterized by renal dysfunction and hearing loss due to abnormalities in type IV collagen production. In this study, we report a rare case of recurrent aortic dissections that developed in a young patient with Alport syndrome over a short period. We discuss the associations between Alport syndrome and aortic dissection with a literature review and emphasize the need for regular follow-up of patients with Alport syndrome for early detection of aortic disease.

Infective Endocarditis with a Left Ventricular Pseudoaneurysm Caused by Proteus mirabilis: A Case Report.

Infective endocarditis (IE) due to Proteus mirabilis is rare. Given that cases of IE complicated with a left ventricular pseudoaneurysm (LVP) caused by P. mirabilis have not been reported thus far, here we report a case of IE complicated with an LVP caused by P. mirabilis. An 83-year-old woman was admitted to our hospital for urinary tract infection, and P. mirabilis was detected in blood cultures. Transesophageal echocardiography and electrocardiogram-gated computed tomography revealed mitral regurgitation and a mass protruding from the mitral annulus on the dorsal side. We made a diagnosis of an LVP due to IE and performed mitral valve replacement and patch plasty of the mitral annulus. Thus, P. mirabilis can cause bloodstream infections and lead to IE, which may result in LVPs. .

First case of an invasive Bacteroides dorei infection detected in a patient with a mycotic aortic aneurysm-raising a rebellion of major indigenous bacteria in humans: a case report and review.

BACKGROUND: Bacteroides dorei is an anaerobic gram-negative bacterium first described in 2006. Because of the high similarity in mass spectra between B. dorei and Bacteroides vulgatus, discriminating between these species is arduous in clinical practice. In recent decades, 16S rRNA gene sequencing has been a complementary method for distinguishing taxonomically close bacteria, including B. dorei and B. vulgatus, at the genus and species levels. Consequently, B. dorei has been shown to contribute to some diseases, including type 1 autoimmune diabetes mellitus and atherosclerotic diseases. However, there are no reports on invasive infectious diseases caused by B. dorei. This report describes the first case of direct invasion and colonisation of human tissue by B. dorei, thus providing a warning regarding the previously proposed application of B. dorei as a live biotherapeutic for atherosclerotic diseases. CASE PRESENTATION: A 78-year-old Japanese man complained of intermittent chest/back pain and was diagnosed with a mycotic thoracic aortic aneurysm by enhanced computed tomography on admission. Despite strict blood pressure control and empirical antibiotic therapy, the patient's condition worsened. To prevent aneurysmal rupture and eliminate infectious foci, the patient underwent surgical treatment. The resected specimen was subjected to tissue culture and 16S rRNA gene sequencing analysis to identify pathogenic bacteria. A few days after the surgery, culture and sequencing results revealed that the pathogen was B. dorei/B. vulgatus and B. dorei, respectively. The patient was successfully treated with appropriate antibacterial therapy and after improvement, was transferred to another hospital for rehabilitation on postoperative day 34. There was no recurrence of infection or aneurysm after the patient transfer. CONCLUSIONS: This report describes the first case of invasive infectious disease caused by B. dorei, casting a shadow over its utilisation as a probiotic for atherosclerotic diseases.

Persistence of constrictive pattern despite improvement in symptoms after the waffle procedure: A case report of constrictive pericarditis.

Constrictive pericarditis (CP) is an uncommon disease characterized by clinical signs of right-sided heart failure subsequent to loss of pericardial compliance. Although pericardiectomy is the accepted treatment for improving cardiac hemodynamics in CP, some patients fail to improve after pericardiectomy. We herein report a case of CP that showed some physical and hemodynamic features with a constrictive pattern that persisted despite the improvement in heart failure symptoms after pericardiectomy. A 61-year-old man was diagnosed with CP 7 months after the onset of symptoms of shortness of breath and edema in the legs. The waffle procedure was performed using an ultrasonic scalpel. Post-operative cardiac catheterization demonstrated a dip-and-plateau pattern in both right ventricular (RV) and left ventricular (LV) pressures, but the RV and LV end-diastolic pressures improved. Moreover, Doppler echocardiography showed an improvement in the change in mitral and tricuspid early velocities with respiration. Decrease in intraoperative right atrial pressure and respiratory variability in LV and RV inflow on echocardiography are important predictors of improvement in post-operative heart failure symptoms. Learning objective: Decrease in intraoperative right atrial pressure and respiratory variability in left ventricular and right ventricular inflow on post-operative echocardiography are important predictors of improvement in heart failure symptoms even if some hemodynamic features characterizing constrictive pericarditis (dip and plateau pattern, Friedreich's sign) persist.>.

A Case of Superior Mesenteric Venous Thrombosis Managed by Thrombectomy without Bowel Resection.

We present a case of superior mesenteric venous thrombosis (SMVT) treated successfully with thrombectomy without bowel resection. A 73-year-old female was referred to our hospital with complaints of stomach ache. The patient was diagnosed with SMVT with impending bowel necrosis and underwent an emergency operation, after computed tomography (CT) revealed a thrombus in the superior mesenteric vein (SMV) extending to the splenic vein, ascites, and extremely edematous intestines. The intestines were not necrotic though highly congested. To avoid massive bowel resection, aggressive thrombectomy was performed. Postoperative CT confirmed resolved SMV and improved bowel edema. Prompt thrombectomy should be considered in such cases.

A case of myelodysplastic syndrome with t(10;18)(q26;q21).

An 82-year-old male was admitted. Pancytopenia, a slightly low white blood cell count (3400/µL), and low levels of red blood cells (2.65 × 106/µL), hemoglobin (10.4 g/dL), and platelets (118,000/µL) were observed. Bone marrow aspiration was performed, revealing hypocellular bone marrow and normal blast levels (0.6%) with no dysplasia. G-banding chromosome analysis revealed the karyotype 45,X,-Y[3]/45, idem, t(10;18)(q26;q21)[13]/46,XY[4]. The patient was diagnosed with myelodysplastic syndrome, unclassified (MDS-U). This is the first case report demonstrating a patient with the chromosomal translocation, t(14;18)(q32;q21), which is extremely rare. This chromosomal aberration was critical for the diagnosis of MDS in this patient.

[Aortic Root Pseudoaneurysm due to Avulsion of Aortic Valve Commissure Following to Infective Endocarditis;Report of a case].

A 40-year-old man presented to our hospital with fever and slight palpitation. The echocardiogram revealed bicuspid aortic valve, massive aortic regurgitation, and aneurysm of Valsalva sinus. Operative findings showed an aortic root pseudoaneurysm originating just below the avulsion of the right to left commissure. The orifice was closed with a part of a woven vascular graft, and the aortic valve was replaced with a mechanical valve. There was no sign of marked inflammation, although pathophysiologic findings indicated infective endocarditis. His postoperative course was uneventful.

Left Ventricular Blood Flow Dynamics In Aortic Stenosis Before And After Aortic Valve Replacement.

Surgical intervention for aortic valve stenosis (AS) has been established; however its diagnosis based on echocardiographic assessment is still limited by aortic valvular velocity, aortic valvular pressure gradients, and color Doppler imaging. Echo-dynamography (EDG) is a method to determine intracardiac flow dynamics, such as two-dimensional blood flow velocity, vortex, and dynamic pressure. These flow dynamics may be influenced by left ventricular (LV) wall motion and the resistance in LV outflow caused by AS. The objective of the present study was to assess the changes and differences in LV vortices and vorticity before and after AS surgery. Five patients who underwent aortic valve replacement surgery for AS and five control patients were included. Besides routine echocardiographic measurement, EDG was applied to determine the two-dimensional blood flow vector and vorticity. The LV vortex flow in the isovolumetric contraction phase had multiple formations in preoperative cases. The clockwise vortex was found in all cases postoperatively; the vortex formation showed no significant difference between postoperative and normal control groups. EDG may serve important information on LV flow dynamics, non-invasively.

[Leg amputation for severe lower limb ischemia caused by type A acute aortic dissection; report of a case].

A 41-year-old man underwent total arch replacement and aorto-bifemoral bypass owing to type A acute aortic dissection complicated by ischemia of both lower extremities. Just after the operation, he developed myonephropathic metabolic syndrome due to severe ischemia of the right leg, and hemodiafiltration was performed. However, the serum potassium was elevated to an uncontrollable level. Ligation of the right femoral artery and the right branch of the bypass graft was performed one hour after the transfer to intensive care unit (ICU), and the serum potassium dropped to a normal level. He underwent amputation of the right lower limb above the knee on the 13th postoperative day, and was discharged after long-term rehabilitation.

Aortic valve replacement in an elderly patient with factor XI deficiency.

Factor XI (FXI) deficiency is rare and associated with bleeding after surgical procedures. We report a case of an 80-year-old woman with severe aortic valve stenosis. FXI deficiency was diagnosed due to prolonged activated partial thromboplastin time. Aortic valve replacement was performed using a porcine bioprosthetic valve. Intra-operation bleeding was controlled by the transfusion of a fresh frozen plasma. The postoperative course was uneventful.

[Minimally invasive cardiac surgery with the aid of three-dimensional computed tomography(3DCT) image projection on the body surface].

Port-access minimally invasive cardiac surgery (MICS) is complicated by limited skin incision and surgical field. In order to optimize the set-up and port placement in this surgery, we have employed image overlay technique prior to operation consisted of three-dimentional computed tomography (3DCT)image projection on the patient surface. With the aid of this technique, we successfully performed port-access MICS in 12 patients and mitral valve replacement in 1 patient with severe mediastinal displacement after previous pneumonectomy. Image overlay projection could allow surgeons to view underlying anatomical structures virtually and obtain a good operative field. Our proposed technique would be expected to make port-access MICS easier and probably safer in this particular circumstance.

Surgical treatment for an asymptomatic and unruptured sinus of Valsalva aneurysm: report of a case.

A 70-year-old male underwent a transthoracic echocardiography as a screening test for hypertension and an unruptured aneurysm was detected in the right sinus of Valsalva. The right sinus of Valsalva aneurysm obstructed the right ventricle outflow tract but he did not have any symptoms. The sinus of Valsalva aneurysm was treated successfully by a patch closure with a bovine pericardial patch.

[Redo ascending aorta replacement using a homograft for graft infection caused by methicillin-resistant Staphylococcus aureus; report of an emergently air-transferred case just after Great East Japan Earthquake].

We describe a case of replacement with a cryopreserved homograft for graft infection. A 48-year-old man had been performed ascending aorta replacement using woven dacron graft for type A aortic dissection. Two months ago, methicillin-resistant Staphylococcus aureus infection was suspected because of high-grade fever. Computed tomography (CT) scan revealed abscess formation around the prosthetic graft and redo operation using cryopreserved homograft was scheduled to avoid re-infection into mediastinum at Tohoku University Hospital, an institute cooperating with University of Tokyo tissue bank. However, Catastrophic Great East Japan Earthquake occurred the day before the scheduled date, and the patient could not have an operation at the institution. He was transferred to our hospital by helicopter. Then homograft was successfully implanted in ascending aorta after complete excision of infectious graft.

[Papillary fibroelastoma on the pulmonary valve ; report of a case].

We present a rare case of papillary fibroelastoma arising from the pulmonary valve. A 45-year-old man had been suffered from palpitation. Transthoracic echocardiography clearly demonstrated a mobile rounded mass in the right ventricular outflow tract. He underwent surgical extirpation of the tumor. A fragile, yellow tumor on the pulmonary valve was recognized at operation. The pulmonary valve was repaired with autologous pericardium. Operation was performed successfully. The diagnosis as a papillary fibroelastoma was made by histopathological examination. The post-operative course was uneventful and echocardiography showed no residual tumor of the heart.

[Emergent surgical treatment for purulent pericarditis associated with cardiac tamponade; report of a case].

We describe a case of purulent pericarditis presented with cardiac tamponade. A 65-year-old man was admitted to our hospital with shock by cardiac tamponade and high grade fever. Transthoracic echocardiography revealed a large amount of pericardial effusion. Surgical drainage via median sternotomy was carried out in an emergent manner. Because culture of pericardial effusion showed positive for methicillin sensitive Staphylococcus aureus and thick white purulence covering over all pericardium, purulent pericarditis was diagnosed. Postoperative course was uneventful and discharged in a good condition. Special care should be taken of purulent pericaditis in differential diagnosis of cardiac tamponade.

Tracheal stenosis treated by division of the brachiocephalic artery: Report of a case.

Tracheal stenosis of the brachiocephalic artery (BCA) is rare, and no definitive treatment protocol has yet been established. Brachiocephalic artery compression of the trachea is also relatively rare. This report presents a case of tracheal stenosis treated by division of the BCA. A 29-year-old woman was admitted because of stridor. Computed tomography (CT) revealed tracheal stenosis caused by compression of the BCA. Brachiocephalic artery suspension or aortopexy was not indicated because she had a thoracic deformity. Therefore, the BCA was divided. The operation was achieved without complications such as ischemia of the right arm or stroke. The stenosis of the trachea was improved. Division of the BCA can be an effective alternative procedure when the tracheal stenosis is caused by the BCA.

[Successful repair of left ventricular laceration due to traumatic broken ribs].

A 27-year-old woman was hospitalized by emergency due to multiple blunt trauma by traffic accident. Computed tomography (CT) showed pericardial effusion. Because hematothorax and pericardial effusion appeared alternatively, thoracocentesis and pericardiocentesis were performed. Finally, the diagnosis of cardiac rupture was confirmed, and surgery was performed through median sternotomy. The left ventricular free wall was penetrated by the edge of a broken rib through the hole of the pericardium and the pleura. Broken ribs were considered to have penetrated the pericardium and caused cardiac rupture. The left ventricular rupture was repaired using direct suture technique under no cardiopulmonary bypass. The postoperative course was uneventful. The patient was discharged on the 52th day after the operation.