Multiple small tumor formation on both surfaces of the aortic valve cusps in Epstein-Barr virus-associated T/NK-cell lymphoproliferative disease: a case report.

A 41-year-old woman presented acute cerebral infarction. Transesophageal echocardiography revealed multiple masses only on both surfaces of the aortic valve cusps. There was no primary lesion outside the heart according to various examinations. After treatment for cerebral infarction, we replaced the aortic valve instead of preservation because the intraoperative histological examination reported that malignancy was highly suspected. Contrary to the rapid frozen section diagnosis, histological and immunohistochemical examinations failed to exhibit malignancy. The tumors were composed of atypical large lymphoid cells and they were assessed to be related to T-/natural killer-cells. Furthermore, Epstein-Barr virus related markers were also positive. Her three-year postoperative course was uneventful without chemotherapy. We report an extremely rare case of Epstein-Barr virus-associated T-/natural killer-cell lymphoproliferative disease which formed multiple small tumors on both surfaces of the aortic valve.

[Subdural Hematoma after Open Heart Surgery for Infective Endocarditis Presenting with Pre-operative Intracranial Hemorrhage Infarction;Report of a Case].

A 47-year-old woman with a history of radiation enteritis and implantation of a central venous port was admitted to our intensive care unit(ICU) suffering from high fever. She was diagnosed with active infective endocarditis due to catheter-related blood stream infection. Although echocardiography showed a large vegetation on the mitral valve, surgical therapy was postponed for 5 weeks because of intracranial hemorrhage infarction. On the 3rd day after mitral valve repair, she developed consciousness disturbance and computed tomography(CT) revealed acute subdural hematoma of the posterior cranial fossa. Fortunately, she fully recovered from the neurological complication without surgical intervention.

10-year results of On-X bileaflet mechanical heart valve in the aortic position: low target INR regimen in Japanese.

OBJECTIVES: This study was designed to establish clinical outcomes after aortic valve replacement (AVR) with On-X bileaflet mechanical heart valve. METHODS: Between 2006 and 2014, AVR was performed to 686 patients. Of them, 78 patients using On-X valve were enrolled. The mean age was 65 ± 11 years (ranged 33-85); 65% were men; and 81% were in sinus rhythm preoperatively. Calcific or degenerative tricuspid aortic valve was present in 73%. Concomitant procedures included coronary artery bypass grafting (22%), Bentall (8%), mitral valve procedure (3%) and other (9%). They postoperatively received lower dose warfarin [international normalized ratio (INR), 1.5-2.0] and 100 mg aspirin daily. The follow-up duration averaged 5 years (386.6 patient-years). The follow-up rate was 97.3%. RESULTS: In-hospital mortality rates were 3.8% (n = 3). Late mortality rates were 2.6% per patient-years (n = 10). Five-year Kaplan-Meier survival rates were 84%. Freedom from major adverse valve-related stroke and cerebral bleeding events was 93.3% (n = 5, 1.29% per patient-years) and 98.6% (n = 1, 0.26% per patient-years, mild subdural hematoma). The incidence of stroke was two patients of transient ischemic attack, two patients of paralytic event, one patient of asymptomatic stroke (self-interruption of anticoagulation). The median INR was 1.92 ± 0.53, ranged from 1.00 to 8.98 (n = 1181) and 51% of all measured INR values were in the therapeutic range of 1.5-2.0. CONCLUSIONS: AVR using On-X valve with low target INR regimen and low-dose aspirin resulted in a significantly low risk of bleeding.

A reoperation of thrombosed On-X valve detected by multidetector-row computed tomography.

A 62-year-old female patient underwent mitral valve replacement with a 31/33-mm On-X valve for ischemic mitral valve regurgitation. Three months later, transthoracic echocardiography incidentally showed a blocked leaflet with 6 mmHg of mean pressure gradient and 2.4 cm(2) of mitral valve orifice area. Transesophageal echocardiography could not detect thrombus. Electrocardiographically gated multidetector-row computed tomography (MDCT) clearly demonstrated a blocked leaflet in the close position and thrombus (2 cm in length, 0.4 cm(2) in area) attached onto the atrial aspect of the leaflet. These findings observed by MDCT were confirmed at reoperation. MDCT was useful diagnostic method for visualizing prosthetic valve thrombosis.

Mid-term results of 17-mm St. Jude Medical Regent prosthetic valves in elder patients with small aortic annuli: comparison with 19-mm bioprosthetic valves.

This study was designed to compare the mid-term outcomes after aortic valve replacement (AVR) between 17-mm mechanical heart valves (MV) and 19-mm bioprosthetic valves (BV) in elderly patients with small aortic annuli. Between 2000 and 2011, 127 consecutive patients (mean age 79 years; 87 % female) underwent AVR for aortic valve stenosis with a small aortic annulus. 19-mm BV (n = 67) was implanted. When the 19-mm BV did not fit the annulus, 17-mm St. Jude Medical Regent prosthetic mechanical valve (n = 60) was used instead of an aortic root-enlargement procedure. The follow-up rate was 94.0 % in the BV group, and 98.5 % in the MV group. No significant differences in survival rate and valve-related complications were found between the 2 groups. In-hospital mortality rates were 1.5 % (n = 1) in the BV group and 5.0 % (n = 3) in the MV group. Late mortality rates were 3.9 % per patient-years (p-y; n = 8) in the BV group, and 6.0 % per p-y (n = 10) in the MV group. Five-year Kaplan-Meier survival rates were 62 % in the BV group, and 72 % in the MV group (log-rank P = 0.280). Freedom from major adverse valve-related stroke and cerebral bleeding events was 92.5 and 98.5 % in the BV group, and 94.7 and 100 % in the MV group. AVR using 17-mm MV in elder patients with small aortic annuli provided equivalent mid-term clinical results to that with 19-mm BV.

Prevalence of occupational allergy in medical researchers exposed to laboratory animals.

Allergy to laboratory animals is a well known occupational hazard and remains a health concern for individuals in contact with lab animals. This study evaluates the prevalence of allergy symptoms among medical researchers exposed to laboratory animals. We analyzed data from a cross-sectional survey, involving subjects (n=169, 21-59 yr), working in Kochi Medical School, Japan. They were asked to fill out a questionnaire to evaluate symptoms related to contact with laboratory animals. The overall response rate was 86.2%. The prevalence of laboratory animal allergy was 17.6%. The symptoms most reported were allergic rhino-conjunctivitis and asthma. A small number of the subjects received education on the allergy issue and 62.5% of subjects with an allergy to laboratory animals claimed to have atopy. Protection from animal allergens should be a high priority for institutions using lab animals; providing continuous education to animal handlers would be meaningful to reduce and control exposure.