[Tricuspid Valve Regurgitation and Right Heart Failure due to Perioperative Right Ventricular Myocardial Infarction].

We herein experienced 2 cases of severe tricuspid valve regurgitation (TR) and right heart failure after mitral valve surgery. In these cases, echocardiography showed a marked right ventricular dilatation and severe TR, which ware suspected to result from a right ventricular myocardial infarction at the time of the 1st operation. We considered the cause of right ventricular infarction to be an air embolism of the right coronary artery or inadequate cardioplegic perfusion to the right ventricle. Since these incidences, we have paid more careful attention to the de-airing of the left ventricle and aortic root and provided more frequent and strict delivery of antegrade and retrograde cardioplegic perfusion. Consequently, we have not since experienced any similar complications at our institute.

[Simultaneous operation for Ebstein's anomaly and lung cancer].

The number of patients with coexisting cardiac disease and lung cancer have been increasing. The issue of performing simultaneous pulmonary resection and cardiac surgery remains controversial. We report a patient who underwent simultaneous surgery for Ebstein's anomaly and lung cancer with a good outcome. The tricuspid valve replacement with bioprothesis and the closure of a foramen ovale for Ebstein's anomaly was 1st performed under cardiopulmonary bypass. The resection of the right upper pulmonary lobe and mediastinal lymph nodes followed. The postoperative course was uneventful.

Skeletonized harvesting improves the early-term and mid-term perfect patency of a radial artery graft.

OBJECTIVE: A radial artery (RA) graft is frequently used for coronary artery bypass grafting (CABG), but little information exists regarding the early- and mid-term patency associated with the harvesting procedure. The objective of this study is to compare the early- and mid-term patency of the RA graft obtained using non-skeletonized and skeletonized harvesting. METHODS: Altogether, 131 patients and 159 anastomoses were studied. In 85 patients the RA was harvested non-skeletonized (group A: procedures between September 2000 and November 2002), whereas in 46 patients the RA was harvested skeletonized (group B: procedures between November 2002 and April 2004). Angiography results were analyzed before discharge [A: postoperative day (POD) 14.7 +/- 2.9, 75 patients, 90 anastomoses; B: POD 13.7 +/- 1.9, 38 patients, 47 anastomoses], and after 1 year (A: POD 386.8 +/- 149.3, 44 patients, 51 anastomoses; B: POD 267.1 +/- 148.7, 11 patients, 13 anastomoses). RESULTS: There was no difference in patency between the two groups (group A vs group B, 96.7% vs 100%, P = not significant [NS], in the early-term, 96.2% vs 100%, P = NS, in the mid-term). However, the perfect patency rates for groups A and B were 86.7% and 98.1%, respectively, in the early-term (P = 0.034) and 77.5% and 100%, respectively, in the mid-term (P = 0.048). The location and severity of the target vessel did not influence the angiographic results. CONCLUSION: The early- and mid-term patency of RA grafts was excellent, and skeletonized harvesting improved the perfect patency rates at both time points.

Double-patch technique for postinfarction ventricular septal perforation.

A modified infarct-exclusion technique for postinfarction ventricular septal perforation is presented. The perforation is closed directly by a small patch next to the conventional patch, and biological glue is applied between the patches to induce stable polymerization. The patch stuck to the infarcted septum, and no residual shunt was observed in any patient because the wide adhesion prevents excessive pressure on the suture line. Seven of 9 patients in whom this method was used had good results. This technique appears suited for repair of ventricular septal perforations, especially those with extensive fresh infarction.