[Endocardial Blood Cyst in the Right Atrium:Report of a Case].

A 74-years-old man visited our hospital complaining chest discomfort, and he was diagnosed with variant angina. However, during close examination, a tumor with some small calcified nodules was accidentally pointed out in the right atrium. We carried out surgical removal to prevent embolism. A cystic tumor attached to the atrial septum was resected together with the atrial septum, and the defect was closed with a Dacron patch. The tumor size was 18×25×3 mm. Histologically, its wall was consisted of connective tissue, which was positive for CD34, negative for calretinin, and was diagnosed as an endocardial blood cyst. A core of the nodules in the cyst were calcified and they were phleboliths. Postoperative echocardiography detected no residual mass or atrial septal defect, and he was discharged uneventfully.

[Reconstruction Using a Saphenous Vein for Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery in an Adult;Report of a Case].

Anomalous left coronary artery from the pulmonary artery (ALCAPA) is an uncommon congenital heart disease. Such anomaly causes myocardial ischemia, heart failure, and sudden death. Most of such cases require surgical intervention. We report a successful surgical correction for ALCAPA in an adult. A 31-year-old woman with progressive exertional dyspnea was referred to our institution because of abnormal electrocardiogram showing ST depression( V3-V6). Computed tomography revealed the left main trunk (LMT) arising at the right lateral wall of the main pulmonary trunk. Interposition of a saphenous vein graft was performed between the ascending aorta and the LMT. The postoperative course was uneventful.

Outcomes after aortic valve replacement for aortic valve stenosis, with or without concomitant coronary artery bypass grafting.

OBJECTIVES: To assess the effects of concomitant coronary artery bypass grafting (CABG), we analyzed the outcomes after aortic valve replacement (AVR) for aortic stenosis (AS) with and without coronary artery bypass grafting (CABG) at our institution. METHODS: Between 2002 and 2014, 605 consecutive patients underwent AVR for AS. Of these, the 275 who received isolated AVR (Group A) and the 122 who received both AVR and CABG (Group AC) patients were enrolled, after the exclusion of 8 patients who underwent reoperation and 200 who received other concomitant surgery. AVR and all bypass anastomoses were performed under intermittent retrograde cold blood cardioplegia. Multivariate analysis was used to assess any association of concomitant CABG with morbidity and mortality. Kaplan-Meier analysis was used to assess all-cause mortality. RESULTS: No significant difference in 30-day mortality was found between Group A and Group AC (1.5% vs. 0.8%, P = 1.000). Nor did post-discharge survival differ significantly between the two groups (P = 0.20). Likewise, multivariate analysis showed that concomitant CABG was not associated with significantly greater in-hospital or mid-term mortality. Operative morbidities were comparable between the two groups, in terms of stroke (1.8% vs. 3.3%, P = 0.466), prolonged ventilation (4.0% vs. 5.5%, P = 0.565), deep sternal infection (1.8% vs. 3.3%, P = 0.466), and acute renal failure (0.4% vs. 1.6% P = 0.176). CONCLUSIONS: Concomitant CABG at the time of AVR was performed without increasing early- or mid-term mortality. This absence of increased risk deserves consideration when choosing between different treatment strategies.

Mitral and tricuspid valve surgery for Coffin-Lowry syndrome.

Coffin-Lowry syndrome is a rare X-linked disorder characterized by craniofacial and skeletal abnormalities, mental retardation, short stature, and hypotonia. An 18-year-old man with morphologic features characteristic of Coffin-Lowry syndrome was referred to our institution for valve disease surgery for worsening cardiac failure. Echocardiography showed severe mitral valve regurgitation associated with tricuspid valve regurgitation. Mitral valve implantation with a biological valve and tricuspid annular plication with a ring was performed. The ascending aorta was hypoplastic. Both the mitral papillary muscle originating near the mitral annulus and the chordae were shortened. The patient's postoperative course was uneventful and his cardiac failure improved.

Surgical text for orthotopic liver transplantation model with small-for-size graft in the pig: key techniques and pitfalls.

BACKGROUND: Challenges with small-for-size grafts are a critical issue in the liver transplantation field, and a reliable and reproducible animal model is required. METHOD: We performed 50 orthotopic liver transplantations in pigs with a 30% graft, and retrospectively investigated the learning curves. We modified our surgical procedures according to our experience. Here, we describe our current procedures in detail with retrospective evaluation of our experience. The artery to the right lateral lobe crosses the portal vein trunk. A 30% graft is taken using the right lateral lobe attached to a sufficient length of aorta. Hepatic venous plasty is undertaken on the back table to attach a venous patch to the anterior wall of the suprahepatic inferior vena cava, which has no extrahepatic margin. To minimize hypoperfusion to the digestive tract, an aorta-to-aorta anastomosis is performed in a side-to-end fashion in a minimal surgical field before suprahepatic inferior vena cava and portal vein reconstruction. A temporary transjugular portosystemic shunt is also inserted before suprahepatic inferior vena cava reconstruction. The recipient suprahepatic inferior vena cava is clamped at the intramediastinal level, including the margins of the diaphragm in the clamp. RESULTS: Although survival rate during first forty cases were under 0.2, a reasonable survival rate of 0.6 had been achieved after the experiences of forty cases. CONCLUSION: Precedent arterial reconstruction using an aorta-to-aorta anastomosis minimizes congestive damage and shortens operative time. Hepatic venous reconstruction should be completed without any outflow block, by using venous plasty and adequate clamping.

[Ruptured thoracic aortic aneurysm complicated by acute aortic dissection and aortic valve regurgitation; report of a case].

An 87-year-old man was found loss of consciousness after falling. He was found in a state of shock. Computed tomography showed rupture of aneurysm of the ascending aorta and aortic arch with acute aortic dissection. Echocardiography revealed aortic valve regurgitation and cardiac tamponade. As the result of emergency operation, a large hematoma in the mediastinum and pleural cavity as well as massive serous pericardial effusion were found. The dissection was seen in aneurysm of the ascending aorta and aortic arch with an intimal tear located in the aortic arch. After aortic valve replacement was performed, the ascending aorta and aortic arch were replaced, and reconstruction of 3 cervical vessel branches was performed under deep hypothermic circulatory arrest with selective cerebral perfusion. Despite the complex clinical state and serious condition in the elderly patient, emergency surgery saved the life of the patient without complications.

[Mobile mass in the descending aorta with multiple embolism].

A 46-year-old man was referred to our hospital for abdominal pain. Computed tomography (CT) revealed mobile mass in the descending aorta and multiple systemic embolism. Emergent operation was indicated. Under femoral vein to femoral artery bypass, removal of mobile mass was performed. We resected the mass with stem including aortic wall and closed the aortic defect with the pericardial patch. Postoperative course was uneventful. Histopathology of the mass was organized thrombus with inflammatory change.

Cardiogenic shock without cardiac tamponade caused by a subepicardial hematoma after percutaneous coronary intervention.

A 73-year-old man complaining of pain on effort was admitted to a hospital for a percutaneous coronary intervention (PCI) because of severe stenosis of the mid right coronary artery. During PCI, a coronary artery was ruptured, and the patient suddenly went into shock. Percutaneous pericardiocentesis was successfully performed, and cardiac tamponade was relieved. Despite the echocardiographic finding of no cardiac tamponade, the patient remained in the shock state. An emergency operation was performed. There was little pericardial effusion, but a large subepicardial and intramyocardial hematoma was present and was being compressed by the pericardium. Pericardial incision and off-pump coronary artery bypass grafting were performed. The patient was discharged on the 12th postoperative day. Decompression of the subepicardial hematoma by pericardiotomy ameliorated the condition of the patient, who was in cardiogenic shock. We thus report a rare case of subepicardial hematoma resulting in shock during PCI in which cardiac tamponade was not observed.

[Cylindrical patch repair for circumferential subvalvular abscess due to prosthetic valve endocarditis].

A 51-year-old male underwent aortic valve replacement and vascular prosthesis implantation due to an aneurysm of the ascending aorta combined with aortic regurgitation caused by the bicuspid aortic valve. Semi-emergency surgery was performed due to severe paravalvular leakage with prosthetic valve endocarditis 16 months after the 1st operation. The circumferential annular abscess cavities were closed with a cylindrical patch, and a mechanical valve was installed on the upper edge of the sutured cylindrical patch. A vascular prosthesis was reimplanted to the ascending aorta. Use of the cylindrical patch provides a good exposure of operative field to close circumferential annular abscess cavity.