[Semi-acute Surgery for Ventricular Septal Perforation After Unsuccessful Intra-aortic Balloon Pumping Support:Report of a Case].

Ventricular septal perforation( VSP) after acute myocardial infarction( MI) is a serious condition that requires surgical treatment. However, good outcome is not always obtained. The mortality rate of VSP is particularly high in cases whom emergency surgery is performed early in the course of the disease, and the timing of surgery is known to affect prognosis. In this case report, the patient assisted with intra-aortic balloon pump. VSP closure surgery (a modified David-Komeda technique) underwent 8 days after MI onset. Except for mild residual shunt, the patient experienced no adverse event during postoperative course and was discharged 30 days after the surgery. This case illustrated timing of surgery as well as adequate mechanical cardiopulmonary assistance and surgical technique is important.

[Branched Thoracic Endovascular Aortic Repair for Aortic Arch Aneurysm Following Severe Combined Valvular Disease:Report of a Case].

A 79-years-old frail man with severe combined valvular disease was referred to our hospital. Furthermore, chest computed tomography( CT) showed a saccular aneurysm in the aortic arch. We chose two staged repairs for risk reduction. As a first stage double valve replacement and tricuspid annuloplasty were performed. Three months later, we performed successful branched thoracic endovascular aortic repair( TEVAR) used physician modified Najuta which had hydrogel-reinforced fenestrations to provide a more secure connection with the bridging graft than fenestrations alone. Staged surgery with branched TEVAR used physician modified Najuta is a useful strategy in patients who have complex cardiac disease combined with aortic arch aneurysm.

[Suspected Left Ventricular Pseudo-false Aneurysm of a Huge Size Combined with Sustained Ventricular Tachycardia;Report of a Case].

A 74-year-old man was transferred to our hospital for heart failure and ventricular tachycardia. Left ventricular aneurysm of a huge size( 6×9 cm) was found on the imaging test, and was suspected to be a pseudo-false aneurysm because of its thick wall with small orifice. Occulusion of the right coronary artery (#1) was revealed by coronary arteriography and the diskinetic aneurysm in the inferior wall was revealed by left ventriculography. The surgical treatment was needed, because of the high risk of rupture. He successfully underwent Dor operation with endocardial cryoablation and left ventricular ejection fraction (LVEF) was found to be improved by postoperative left ventriculography. He discharged on 56 days after operation. Ventricular pseudo-false aneurysm is rare and the treatment is controversial.

[Stenosis of the Right Coronary Limb of Interposed Artificial Graft 28 Years After Cabrol Technique;Report of a Case].

Cabrol technique is one of the modified Bentall procedures. However, it has become nearly obsolete over the years because of reports of stenosis, thrombosis, and occlusion of the interposed graft. A 76-year-old man, who had undergone Cabrol technique 28 years before, presented with worsening exertional dyspnea and, was diagnosed with mitral valve regurgitation and tricuspid valve regurgitation. Preoperative angiography revealed stenosis of the right limb of the interposed artificial graft, and he underwent coronary artery bypass grafting (CABG) in addition to mitral valve replacement (MVR) and tricuspid annuloplasty (TAP). Patients who underwent procedures such as Cabrol technique and Piehler technique using interposed artificial grafts reconstructing coronary arteries, should be regularly checked with imaging examinations.

[Aortic annulus repair with xenogeneic pericardial flap after extensive debridement in active prosthetic valve endocarditis associated with an aortic annular abscess].

Prosthetic aortic valve endocarditis(PVE) is one of the devastating diseases and some cases present with extensive annular destruction requiring complex surgical repair. We report 2 cases of PVE with more than one-half of aortic annular destruction after complete debridement of the infected tissue. In these patients we successfully performed mechanical valve implantation following annular repair using a square piece of xenogeneic pericardium that was soaked in highly concentrated vancomycin solution. To increase rigidity of an annulus, a square piece of xenogeneic pericardium was interposed into abscess cavity with some single interrupted sutures. Sutures were placed along the abscess cavity and tied to the fragile tissue carefully. Both patients were discharged from hospital and have been doing well without any signs of recurrent endocarditis at a year postoperatively. This procedure might enable us to avoid patch closure of the abscess cavity in some severe PVE patients.

Combination of familial Barlow's disease with bilateral axillary artery aneurysms in two brothers.

We encountered two brothers with a combination of Barlow's disease and bilateral axillary artery aneurysms who were operated on during their third decade of life. A symmetrical form of true bilateral axillary artery aneurysms is uncommon. Recurrent mitral regurgitation was presented in the older brother with an endocardial defect in the left atrium, suggesting connective tissue fragility. A hereditary connective tissue disorder was strongly suspected because of the similar presentation and an unusual cluster of pathologies in siblings. Careful follow-up is required to detect recurrence of mitral regurgitation or aneurysm formation in other vessels.

Multiple cardiac myxomas with pulmonary arterial obstruction and acute right heart failure.

Multiple myxomas in the ventricles, causing pulmonary obstruction, are extremely uncommon. We treated multiple myxomas, seemingly clinically malignant, which had caused acute right heart failure due to their position in the outlet of the right ventricle. The position of the myxomas obstructed the pulmonary artery. To prevent the right heart from failing, we proceeded with tumor resection with the cardiopulmonary bypass on a beating heart and added cryoablation. Following the removal of the tumor, symptoms improved drastically. The postoperative course was uneventful.

Solitary cardiac metastasis of rectal adenocarcinoma.

Solitary cardiac metastasis is rarely recognized. We report a case of solitary cardiac metastasis from a rectal adenocarcinoma that was manifested as superior vena cava (SVC) syndrome. Invasion of the deep cardiac structures was so severe that only its palliative resection and right atrial reconstruction were performed using a cardiopulmonary bypass to release the SVC obstruction. The postoperative course was uneventful and the patient was discharged home without any complications. Adjuvant chemotherapy could not be performed because of the renal dysfunction. Eleven months later, the patient died from multiple metastasis of adenocarcinoma. Even though the surgery was not curative, it might be effective for release from symptoms and for elongating life expectancy.

[Complex myxoma detected by syncope: a case report].

A 23-year-old man was admitted to our hospital for evaluation of syncope and intracardiac masses. Echocardiography revealed three masses in the right ventricle and one in the left ventricle. The largest mass, 4 by 5 cm, occupied the right ventricular outflow tract and prolapsed through the pulmonary valve orifice. Right ventricular systolic pressure was 65 mmHg. A soft mass, 4 by 5 cm, was found on the left subcostal abdominal wall and multiple pigmented spots on the face and trunk. Histological examination of the resected tumors, including the abdominal soft mass, were consistent with myxoma. The combination of multiple cardiac and abdominal wall myxomas and pigmented skin lesions in this young patient is considered to be a diagnostic feature of Carney complex.