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1.
Gen Thorac Cardiovasc Surg ; 59(7): 488-90, 2011 Jul.
Article in English | MEDLINE | ID: mdl-21751110

ABSTRACT

This report documents the sudden onset of aortic regurgitation (AR) by an exceptional cause. A 68-year-old woman suddenly experienced general fatigue, and AR was diagnosed. One year later, we performed aortic valve replacement. At surgery, three aortic cusps with a larger noncoronary cusp had prolapsed along with a free-floating fibrous band that had previously anchored the cusp to the aortic wall. Its rupture had induced the sudden onset of AR. There was no sign of infectious endocarditis. We performed successful aortic valve replacement.


Subject(s)
Aortic Valve Insufficiency/etiology , Aortic Valve Prolapse/etiology , Aortic Valve/abnormalities , Heart Defects, Congenital/complications , Heart Rupture/etiology , Aged , Aortic Valve/pathology , Aortic Valve/surgery , Aortic Valve Insufficiency/diagnosis , Aortic Valve Insufficiency/surgery , Aortic Valve Prolapse/diagnosis , Aortic Valve Prolapse/surgery , Female , Fibrosis , Heart Defects, Congenital/diagnosis , Heart Rupture/diagnosis , Heart Rupture/surgery , Heart Valve Prosthesis Implantation , Humans
2.
Ann Thorac Cardiovasc Surg ; 17(3): 316-9, 2011.
Article in English | MEDLINE | ID: mdl-21697801

ABSTRACT

A 73-year-old woman with a 10-year history of myelodysplastic syndrome (MDS) had severe aortic regurgitation (AR) and an ascending thoracic aortic aneurysm (TAA) with a maximum diameter of 55 mm. By retrograde cerebral perfusion (RCP) in the patient under deep hypothermic circulatory arrest (DHCA), we replaced the ascending aorta graft and aortic valve. After surgery, we periodically administered granulocyte colony-stimulating factor (GCSF) with platelet aggregation. On postoperative day 20, the patient had a duodenal ulcer. On postoperative day 22, she had a subarachnoid hemorrhage, which was treated, nonoperatively, with a hemostatic agent. On postoperative day 126, she was discharged without sequelae, and 1.5 years after the surgery, she has had neither heart failure nor deterioration of MDS.


Subject(s)
Aortic Aneurysm, Thoracic/surgery , Aortic Valve Insufficiency/surgery , Blood Vessel Prosthesis Implantation , Circulatory Arrest, Deep Hypothermia Induced , Heart Valve Prosthesis Implantation , Myelodysplastic Syndromes/complications , Aged , Aortic Aneurysm, Thoracic/complications , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Valve Insufficiency/complications , Aortic Valve Insufficiency/diagnostic imaging , Aortography/methods , Blood Vessel Prosthesis Implantation/adverse effects , Circulatory Arrest, Deep Hypothermia Induced/adverse effects , Duodenal Ulcer/etiology , Duodenal Ulcer/therapy , Female , Granulocyte Colony-Stimulating Factor/administration & dosage , Heart Valve Prosthesis Implantation/adverse effects , Humans , Myelodysplastic Syndromes/therapy , Platelet Transfusion , Severity of Illness Index , Subarachnoid Hemorrhage/etiology , Subarachnoid Hemorrhage/therapy , Tomography, X-Ray Computed , Treatment Outcome , Ultrasonography
3.
Gen Thorac Cardiovasc Surg ; 59(5): 344-6, 2011 May.
Article in English | MEDLINE | ID: mdl-21547629

ABSTRACT

A 72-year-old woman complaining of dyspnea on effort was diagnosed as having mitral regurgitation (MR). Asymptomatic jaundice had initially been noticed during primary school, and an examination had shown hyperbilirubinemia. After the diagnosis of constitutional jaundice, she had remained well without further examination or medical treatment. Laboratory data showed a total serum bilirubin (TB) level of 12.2 mg/dl and a direct bilirubin level of 0.6 mg/dl. Transesophageal echocardiography showed severe MR, and we replaced the mitral valve. Postoperatively, genetic analyses identified constitutional jaundice as Gilbert's syndrome with Y486D mutation. The TB level gradually decreased. Four years after operation she is doing well with moderate hyperbilirubinemia and a TB level of 5 mg/dl. She is free from heart failure.


Subject(s)
Gilbert Disease/complications , Heart Valve Prosthesis Implantation , Mitral Valve Insufficiency/surgery , Aged , Bilirubin/blood , Biomarkers/blood , DNA Mutational Analysis , Echocardiography, Transesophageal , Female , Gilbert Disease/blood , Gilbert Disease/diagnosis , Gilbert Disease/genetics , Glucuronosyltransferase/genetics , Glucuronosyltransferase/metabolism , Humans , Mitral Valve Insufficiency/diagnostic imaging , Mitral Valve Insufficiency/etiology , Mutation , Severity of Illness Index , Treatment Outcome
4.
Gen Thorac Cardiovasc Surg ; 59(3): 181-3, 2011 Mar.
Article in English | MEDLINE | ID: mdl-21448795

ABSTRACT

A-79-year-old woman underwent percutaneous coronary intervention (PCI) to the right coronary artery (RCA) for effort angina, followed by intravascular ultrasonography (IVUS) to ascertain stent expansion. The IVUS catheter became entangled in the stent and could not be withdrawn from the outside. The patient was transferred to our hospital for its surgical removal. For the emergent surgery, we opened the stent region in the RCA and directly removed the IVUS catheter with the twisted stent. Additional coronary artery bypass grafting (CABG) involving three vessels was performed. She was discharged 42 days after surgery.


Subject(s)
Angioplasty, Balloon, Coronary/instrumentation , Cardiac Surgical Procedures , Catheters/adverse effects , Coronary Artery Disease/therapy , Device Removal , Stents , Ultrasonography, Interventional/adverse effects , Aged , Coronary Angiography , Coronary Artery Bypass , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/surgery , Equipment Design , Female , Humans , Prosthesis Design , Treatment Outcome , Ultrasonography, Interventional/instrumentation
5.
Gen Thorac Cardiovasc Surg ; 56(9): 462-4, 2008 Sep.
Article in English | MEDLINE | ID: mdl-18791673

ABSTRACT

An 80-year-old woman had undergone initial mitral valve replacement using a Björk-Shiley mechanical valve owing to mitral stenosis 25 years earlier. Suddenly, she had anemia and an increased lactic dehydrogenase (LDH) level. Transesophageal echography (TEE) showed perivalvular leakage. In a redo operation, two side-by-side stitches of the valve on the posterior annulus were loosened without cutting and the sewing cuff at that site was floated over the annulus, leading to the perivalvular leakage. The valve was easily removed; and round, hard, degenerative calcified tissue composed of remnant mitral valve in the suture site during the initial operation was found just under the sewing cuff. After resection of this calcified round tissue, a 25-mm bioprosthesis was put in place. Her postoperative recovery was uneventful, and 47 days after surgery she was discharged without perivalvular leakage or anemia.


Subject(s)
Heart Valve Prosthesis Implantation/instrumentation , Heart Valve Prosthesis , Mitral Valve Insufficiency/etiology , Mitral Valve Stenosis/surgery , Prosthesis Failure , Aged, 80 and over , Anemia, Hemolytic/etiology , Calcinosis/etiology , Device Removal , Echocardiography, Transesophageal , Female , Heart Failure/etiology , Heart Valve Prosthesis Implantation/adverse effects , Humans , Mitral Valve Insufficiency/diagnostic imaging , Mitral Valve Insufficiency/surgery , Mitral Valve Stenosis/diagnostic imaging , Prosthesis Design , Reoperation , Time Factors , Treatment Outcome
6.
Circ J ; 72(9): 1547-9, 2008 Sep.
Article in English | MEDLINE | ID: mdl-18724039

ABSTRACT

A 61-year-old man, who had suffered congestive heart failure following a large transmural acute myocardial infarction (AMI) of the anterior wall, developed a mobile ball-like thrombus in the left ventricle (LV). On the third day after onset of AMI, when the patient had recovered slightly from congestive heart failure, we performed coronary artery bypass grafting and LV thrombectomy, then the fragile LV wall was successfully repaired using the infarction exclusion technique (David-Komeda procedure).


Subject(s)
Coronary Artery Bypass , Heart Ventricles/surgery , Myocardial Infarction/surgery , Thrombosis/surgery , Heart Ventricles/diagnostic imaging , Humans , Male , Middle Aged , Myocardial Infarction/complications , Myocardial Infarction/diagnostic imaging , Radiography , Thrombosis/complications , Thrombosis/diagnostic imaging
7.
Gen Thorac Cardiovasc Surg ; 55(6): 248-51, 2007 Jun.
Article in English | MEDLINE | ID: mdl-17642279

ABSTRACT

We report a 33-year-old woman who had a 60-mm thoracic aneurysm of the ascending aorta with Marfan syndrome and effort angina due to compression of the right coronary artery (RCA) by the aneurysm. Surgery was performed using the Bentall procedure and a coronary artery bypass graft to the RCA. Postoperatively, coronary angiography showed that the coronary flow of the RCA was restored by removing the aneurysmal compression. The patient was discharged without angina on postoperative day 21.


Subject(s)
Aortic Aneurysm, Thoracic/complications , Marfan Syndrome/complications , Myocardial Ischemia/etiology , Adult , Aortic Aneurysm, Thoracic/diagnosis , Aortic Aneurysm, Thoracic/surgery , Cardiopulmonary Bypass , Coronary Angiography , Female , Humans , Magnetic Resonance Imaging , Marfan Syndrome/surgery , Myocardial Ischemia/surgery
8.
Ann Thorac Cardiovasc Surg ; 12(2): 116-20, 2006 Apr.
Article in English | MEDLINE | ID: mdl-16702933

ABSTRACT

OBJECTIVES: Postoperative chylothorax in patients with a thoracic aneurysm is generally infrequent. We report a mode of surgery to reduce the incidence of paraplegia. We review our experience with chylothorax after resection of an aneurysm to find its cause and to evaluate the success of management. PATIENTS AND METHODS: For descending thoracic aneurysms, intercostal arteries in the aneurysm were exposed before incising the aneurysm and, they were only sacrificed no change in motor-evoked potentials (MEPs) occurred after temporary occlusion. Between January 2001 and December 2003, out of a total of 147 aneurysms including thoracic and thoracoabdominal, 4 consecutive patients (2.7%) with chylothorax were reviewed. RESULTS: The chylothorax was diagnosed 1.5 days after operation (range 1 to 2 days). All patients were initially treated by the cessation of oral intake. This treatment was successful for 2 patients and the remaining 2 required surgical intervention to control the fistula. Chylothorax was cured in all patients. CONCLUSION: We postulate that chylothorax is caused by injury of the thoracic duct or its branch during the exposing the intercostal arteries. In the management of chylothorax, early intervention is recommended when the volume of chylous fluid is not decreased by conservative treatment.


Subject(s)
Aortic Aneurysm, Thoracic/surgery , Aortic Dissection/surgery , Chylothorax/therapy , Evoked Potentials, Motor/physiology , Paraplegia/prevention & control , Postoperative Complications/therapy , Thoracic Surgical Procedures/methods , Aged , Aged, 80 and over , Chest Tubes , Chylothorax/etiology , Enteral Nutrition , Humans , Male , Medical Audit , Paraplegia/etiology , Postoperative Care/methods , Postoperative Complications/etiology , Thoracic Surgical Procedures/adverse effects , Time Factors , Treatment Outcome
9.
Jpn J Thorac Cardiovasc Surg ; 53(8): 448-51, 2005 Aug.
Article in English | MEDLINE | ID: mdl-16164259

ABSTRACT

We report a case of thoracoabdominal aortic aneurysm (TAAA) Crawford type I with high-risk factors. A 74-year-old woman, who had a history of myocardial infarction with severe left ventricular dysfunction, asthma, and hypothyroidism, underwent endovascular stent-graft replacement for TAAA and simultaneous surgical reconstruction of the visceral arteries to avoid thoracotomy and extracorporeal circulation. Postoperatively she suffered from weakness of the left leg, with suspected paraparesis, but recovered muscular strength to some extent and was discharged in a wheelchair on postoperative day 74.


Subject(s)
Aortic Aneurysm, Abdominal/surgery , Aortic Aneurysm, Thoracic/surgery , Blood Vessel Prosthesis Implantation/methods , Aged , Aortic Aneurysm, Abdominal/diagnosis , Aortic Aneurysm, Thoracic/diagnosis , Female , Humans , Vascular Surgical Procedures
10.
Jpn J Thorac Cardiovasc Surg ; 53(3): 133-7, 2005 Mar.
Article in English | MEDLINE | ID: mdl-15828292

ABSTRACT

OBJECTIVES: Coronary artery disease (CAD) and abdominal aortic aneurysms (AAA) commonly coexist. However, each disease treatment complicates the management of the other. In this study, we evaluate whether a simultaneous operation of AAA repair and off pump coronary artery bypass (OPCAB) would be safe and acceptable, compared with either procedure alone. SUBJECTS AND METHODS: We retrospectively reviewed all patients who underwent simultaneous AAA repair and OPCAB (AAA/OPCAB, n=18), compared AAA repair alone (AAA, n=239) and OPCAB alone (OPCAB, n=137) from June 1999 to December 2003. There were no significant differences with regard to age or gender, but the AAA/OPCAB group had significantly larger aneurysms (60.6 vs. 53.2 mm) and significantly lower ejection fractions (EF) (54.9 vs. 60.3%). RESULTS: The patients in the AAA/OPCAB group underwent a significantly longer operative time than AAA, OPCAB (403 vs. 360, 296 minutes, respectively), there was significantly greater blood loss (726 vs. 426, 462 ml), and more transfusion required (8.13 vs. 1.69, 2.8 units). The number of bypass grafts in AAA/OPCAB group (1-5 per patients) was significantly smaller (1.78 vs. 2.93). The AAA/OPCAB patients had a significantly longer hospital stay than the AAA (38 vs. 22 days), but was not significantly longer than the OPCAB. There were no significant differences with regard to the morbidity and mortality rate among the three groups. CONCLUSION: This study suggests that the simultaneous operation of AAA and OPCAB can be done with the same morbidity and mortality as independent surgical procedures.


Subject(s)
Aortic Aneurysm, Abdominal/surgery , Blood Vessel Prosthesis Implantation/methods , Coronary Artery Bypass/methods , Coronary Artery Disease/surgery , Aged , Aortic Aneurysm, Abdominal/diagnosis , Aortic Aneurysm, Abdominal/mortality , Blood Vessel Prosthesis Implantation/adverse effects , Cohort Studies , Combined Modality Therapy , Coronary Artery Bypass/adverse effects , Coronary Artery Disease/diagnosis , Coronary Artery Disease/mortality , Female , Follow-Up Studies , Humans , Male , Probability , Retrospective Studies , Risk Assessment , Severity of Illness Index , Survival Rate , Time Factors , Treatment Outcome
11.
Jpn J Thorac Cardiovasc Surg ; 52(8): 367-71, 2004 Aug.
Article in English | MEDLINE | ID: mdl-15384710

ABSTRACT

OBJECTIVES: Papillary muscle rupture following acute myocardial infarction (AMI), which rarely occurs, leads to catastrophic outcomes. We reviewed 6 patients who were diagnosed as having papillary muscle rupture. SUBJECTS AND METHODS: Between February 1986 and September 2002, 6 consecutive patients underwent mitral valve replacement (MVR) for acute mitral regurgitation due to postinfarction papillary muscle rupture (4 men and 2 women, mean age 67 years). Preoperatively, all were in New York Heart Association (NYHA) class IV. All patients had intraaortic balloon pumping, and one needed additional percutaneous cardiopulmonary support. Operations were performed within 1 to 19 days (mean 6.8) after the onset of AMI, and within 24 hours after papillary muscle rupture. Complete ruptures were found in 5 of 6 patients. Four patients had posterior papillary rupture and 2 patients anterior. All patients underwent MVR to preserve the posterior mitral leaflet. Concomitant coronary artery bypass grafting was performed in 5 of 6 patients (mean 1.6 grafts per person) and pulmonary venous isolation for atrial fibrillation in one patient. RESULTS: The cardiopulmonary bypass time ranged from 178 to 325 minutes (mean 236), and the aortic cross clamp time from 123 to 196 minutes (mean 155). Two patients died of low cardiac output syndrome. Of 4 operative survivors, 3 patients were in NYHA class I and one in class II. The mean follow-up term was 21 months. One patient with the pulmonary venous isolation has been in sinus rhythm. All survivors have been doing well without any valve related complications. CONCLUSION: Six patients underwent MVR for the papillary muscle rupture following AMI and the perioperative mortality rate was 33%. All survivors have been well with no cardiac events. We propose that in papillary muscle rupture following AMI emergent surgery should be undertaken as soon as possible, and that concomitant surgery should be performed as thoroughly as possible.


Subject(s)
Cardiac Surgical Procedures/methods , Cardiomyopathies/surgery , Mitral Valve Insufficiency/surgery , Myocardial Infarction/complications , Papillary Muscles , Aged , Aged, 80 and over , Cardiomyopathies/etiology , Female , Heart Valve Prosthesis Implantation/methods , Humans , Male , Middle Aged , Mitral Valve/surgery , Mitral Valve Insufficiency/etiology , Rupture, Spontaneous , Treatment Outcome
12.
J Cardiol ; 43(2): 81-6, 2004 Feb.
Article in Japanese | MEDLINE | ID: mdl-15017788

ABSTRACT

A 76-year-old man with previous antero-septal myocardial infarction and aorto-coronary bypass surgery developed exertional dyspnea. Echocardiography revealed diffuse left ventricular hypokinesis and aortic stenosis with a mean pressure gradient of 29 mmHg. Coronary angiography showed no significant lesions in the bypass grafts and total occlusions of the proximal left anterior descending artery and mid circumflex artery. Dobutamine stress echocardiography was performed to evaluate the severity of aortic stenosis and left ventricular functional reversibility. Administration of dobutamine increased the mean pressure gradients to 48 mmHg and increased the stroke volume by 28% without change in aortic valve area of about 0.5 cm2. We considered that our patient had severe aortic stenosis with contractile reserve. After aortic valve replacement, he improved with better left ventricular function.


Subject(s)
Aortic Valve Stenosis/diagnostic imaging , Cardiotonic Agents , Dobutamine , Echocardiography, Stress , Ventricular Dysfunction, Left/complications , Aged , Aortic Valve/surgery , Aortic Valve Stenosis/surgery , Heart Valve Prosthesis Implantation , Humans , Male
13.
Jpn J Thorac Cardiovasc Surg ; 52(1): 45-7, 2004 Jan.
Article in English | MEDLINE | ID: mdl-14760993

ABSTRACT

We report an unusual case of subepicardial aneurysm (SEA) of the left ventricle. An 82-year-old man had undergone patch closure of a ventricular septal rupture due to anterior acute myocardial infarction. A postoperative left ventriculogram showed the presence of contrast medium outside the left ventricle, and urgent surgery was performed. The lesion was diagnosed as SEA, and was repaired before rupture.


Subject(s)
Heart Aneurysm/etiology , Heart Aneurysm/surgery , Myocardial Infarction/complications , Ventricular Septal Rupture/etiology , Aged , Aged, 80 and over , Humans , Male , Myocardial Infarction/surgery , Ventricular Septal Rupture/surgery
14.
Jpn J Thorac Cardiovasc Surg ; 51(12): 669-71, 2003 Dec.
Article in English | MEDLINE | ID: mdl-14717422

ABSTRACT

A 46-year-old female with alcoholic liver dysfunction was admitted for mitral regurgitation due to infective endocarditis. She underwent mitral valvuloplasty and resection of the vegetation without complication. After removal of the chest tube, late cardiac tamponade occurred and subsequently recurred. On the 64th day after mitral valvuloplasty, we performed redo median sternotomy with small laparotomy trying to reveal and repair injured lymphatic vessels in the pericardial space and successfully cured the leakage of lymph. The post reoperative course was uneventful and the patient was discharged 20 days after reoperation. We review a rare complication of recurrent cardiac tamponade of lymphatic leakage associated with liver dysfunction.


Subject(s)
Balloon Occlusion , Cardiac Tamponade/etiology , Cardiopulmonary Bypass , Catheterization , Liver Diseases, Alcoholic/complications , Liver Diseases, Alcoholic/therapy , Cardiac Tamponade/diagnosis , Female , Humans , Liver Diseases, Alcoholic/diagnosis , Middle Aged , Mitral Valve Insufficiency/complications , Mitral Valve Insufficiency/diagnosis , Mitral Valve Insufficiency/therapy , Pericardial Effusion/complications , Pericardial Effusion/diagnosis , Pericardial Effusion/therapy , Postoperative Complications/diagnosis , Postoperative Complications/etiology , Recurrence , Tomography, X-Ray Computed
15.
Jpn J Thorac Cardiovasc Surg ; 50(11): 484-6, 2002 Nov.
Article in English | MEDLINE | ID: mdl-12478870

ABSTRACT

A 31-year-old man with severe aortic regurgitation due to a defective bicuspid valve underwent surgery using modified Ross procedure. The right ventricular outflow tract (RVOT) was reconstructed with a 25 mm stentless xenograft valve sutured with a rolled equine pericardium. Oozy bleeding from the RVOT was controlled with an autologous pericardial patch and fibrin glue. Postoperative echocardiography showed no aortic regurgitation. No blood transfusion was required.


Subject(s)
Bioprosthesis , Pericardium/transplantation , Adult , Aortic Valve Insufficiency/surgery , Cardiovascular Surgical Procedures/methods , Heart Ventricles/surgery , Humans , Male , Transplantation, Autologous , Transplantation, Heterologous
16.
Jpn J Thorac Cardiovasc Surg ; 50(1): 43-5, 2002 Jan.
Article in English | MEDLINE | ID: mdl-11855100

ABSTRACT

A 26-year-old man who underwent aortic valve replacement for aortic regurgitation due to Takayasu's arteritis 2 years earlier experienced left amaurosis persisting for some minutes. Computed tomography showed aneurysmal dilation of the ascending aorta to a diameter of 60 mm and occlusion of the left carotid artery. Cardiac echography showed perivalvular leakage. Following administration of a calcium antagonist, the patient's amaurosis subsided and brain bloodstream scintigraphy showed no abnormalities. We resected the aneurysm instead of using Bentall's operation. Following an uncomplicated postoperative course, the patient was discharged 21 days after surgery and echocardiography has shown no perivalvular leakage to date.


Subject(s)
Aortic Aneurysm/surgery , Aortic Valve Insufficiency/surgery , Heart Valve Prosthesis Implantation , Postoperative Complications/surgery , Takayasu Arteritis/complications , Adult , Aorta/surgery , Aortic Aneurysm/etiology , Aortic Valve Insufficiency/etiology , Humans , Male , Takayasu Arteritis/surgery
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