[Resection of a Myxoma Orginating from the Coumadin Ridge with Superior Transseptal Approach:Report of a Case].

A 70-year-old man with a history of lacunar stroke about a year before was incidentally found to have primary cardiac tumor during the work up for orthopedic surgery. It uniquely originated from the coumadin ridge between the left upper pulmonary vein and the left atrial appendage. He underwent tumor resection under cardiopulmonary bypass with superior transseptal approach. It allowed enough surgical exposure for en-bloc resection of the tumor with minimal risk of tumor embolisms. The pathological report confirmed that the tumor was a cardiac myxoma. The postoperative course was uneventful with no stroke nor embolism complications. We experienced a rare myxoma orginating from the coumadin ridge and successfully resected it with superior septal approach.

[Early Clinical Outcomes of Robotic Mitral Valve Repair;Initial Twenty Cases].

We report the early results of our initial 20 consecutive robotic-assisted mitral valve repairs at our institution. A total of 20 patients (aged 55±10 years, 15 males) underwent robotic assisted mitral repairs by using da Vinci system. Successful mitral valve repairs were done in all cases. All patients received an annuloplasty band. Triangular resection were done in 2 cases and artificial chordae were used in 18 cases. There was no conversion to sternotomy intraoperatively. Three cases needed recross-clamping because of mitral regurgitation, mitral stenosis and the problem of venous canula. Cardiopulmonary bypass time and aortic cross-clamp time were 272±56 minutes, 153±41 minutes. There were no hospital mortality and major complications. Post-pump echocardiograms showed no/trivial mitral regurgitation in all cases. Robotic-assisted mitral valve repairs were done safely and the early results were acceptable in our series.

An Unusual Case of Bioprosthetic Mitral Valve Failure.

We report a case of sudden-onset pulmonary edema due to failure of a bioprosthetic mitral valve. Gross inspection revealed a leaflet tear at a stent post without calcification or pannus formation and no evidence of sutures. This case highlights the mechanical failure of a bioprosthetic mitral valve associated with missing sutures. (Level of Difficulty: Intermediate.).

Usefulness of 18F-fluorodeoxyglucose positron emission tomography/computed tomography angiography in a patient with blood culture-negative prosthetic valve endocarditis complicated with perivalvular abscess: a case report.

BACKGROUND: Prosthetic valve endocarditis (PVE) is a life-threatening systemic infection involving a high mortality rate and severe complications, including perivalvular abscess. Early diagnosis and detection of PVE continue to be challenging in clinical settings. CASE SUMMARY: A 64-year-old man with a history of mechanical aortic valve implantation 12 years prior was referred to our hospital with a major complaint of high fever and was admitted. Although results of three blood culture tests at admission were negative, transthoracic echocardiography, and transoesophageal echocardiography (TOE) were performed to exclude the possibility of PVE; both, however, were inconclusive. Subsequently, 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) was performed; revealing intense hyper-metabolism above the aortic valve prosthesis with a greater intensity at the posterior end, confirming a diagnosis of aortic PVE complicated with perivalvular abscess. DISCUSSION: Considering the intermediate suspicion of PVE despite negative TOE and negative blood culture tests, 18F-FDG PET/CT can play a central role in diagnosing PVE. However, this new imaging modality often fails to differentiate thrombi, soft atherosclerotic plaques, or foreign body reactions on the surface of prosthetic valves. In this report, we have successfully enhanced the diagnostic accuracy of 18F-FDG PET/CT by focusing on perivalvular involvement, which could be a key finding, because intense 18F-FDG uptake surrounding the aortic annulus was consistent with the thickened area within the aortic annular region observed in the TOE examinations.

[Surgical Treatment of Acute Infective Endocarditis after Transcatheter Aortic Valve Replacement].

Infective endocarditis (IE) after transcatheter aortic valve replacement (TAVR) is a rare complication, but has a high mortality. An 86-year-old female with symptomatic severe aortic stenosis underwent TAVR at our hospital and she was discharged without complication after 10 days. She was readmitted with high fever and acute heart failure 1 month later. Blood culture revealed Staphylococcus, and echocardiography showed vegetation on the septal cusp of the tricuspid valve and perforation at the membranous ventricular septum. We decided to perform emergency operation due to active infection and intracardiac complication despite appropriate antibiotic treatment. The infected valve was replaced with a bioprosthetic valve and the right ventricular (RV)-left ventricular (LV) communication was closed with a bovine pericardial patch. The patient received the antibiotics for 6 week and was transferred to the previous facility.