ABSTRACT
A 48-year-old man was treated for heart failure at a nearby hospital, and echocardiography revealed thrombi in both ventricles. He was referred to our hospital for a detailed examination and treatment. Coronary angiography was performed, and the results were #2-3 50%, #5 50%, #6 100%, and #11 75%. Echocardiography revealed diffuse hypokinesis with an ejection fraction (EF) of 31%, which was indicative of old myocardial infarction. The left intraventricular thrombus was floating and adherent to the apex of the heart, and we judged that immediate surgical intervention was necessary to remove the thrombus and perform coronary artery bypass grafting. The right ventricular thrombus was removed through the tricuspid valve with an incision in the right atrium using a rigid endoscope to ensure that no thrombus remained behind. There were no perioperative embolic complications, and oral administration of direct oral anticoagulants (DOAC) was continued for one year after the operation. However, no recurrence of thrombosis was observed, and the prognosis was good.
ABSTRACT
We report a case of a 64-year-old woman who presented with symptoms for the common cold, for a medical examination. The chest X-ray showed enlargement of the heart, and echocardiography detected a mobile mass suggestive of a tumor 21×14 mm in the left ventricle. Because there was a risk of embolism, we decided to perform an operation. The tumor was elastic and soft and had a stalk arising from the wall of the left ventricle. We considered that it would be difficult to observe and expose the left ventricular tumor by direct vision. Therefore, we chose to perform a complete endoscopic resection. The tumor was determined histopathologically to be a papillary fibroelastoma. Here, we report the relatively rare benign tumor, a papillary fibroelastoma, and include a discussion of the literature.
ABSTRACT
The evaluation of coronary arteries has become easier, with regard to postoperative coronary artery bypass grafting (CABG) evaluation through the development of multidetector computed tomography (MDCT). In this study, MDCT and coronary angiography (CAG) were performed for graft assessment after CABG, and the usefulness and assessment capability of MDCT were examined. We examined the morphology of graft stenosis and obstruction in 63 cases (51 men, 12 women, mean age 66 years old) in whom comparison by MDCT and CAG was possible. We used 49 grafts for LITA and 65 grafts for SVG (mean number of anastomoses 2.8). The graft evaluation was possible in all cases in CAG, but it was difficult to evaluate due to artifacts in 5 cases in MDCT. MDCT is less invasive than CAG and is useful for early postoperative assessment of CABG. Also, MDCT allows evaluation of the anastomotic region which can be difficult to evaluate from many directions in CAG, by building an image by the VR, MIP and MPR method. It was particularly useful for evaluation of the form of the whole graft and anastomotic region form by the curved MPR method. Further advance in the evaluation of coronary and bypass graft will depend on future developments in scaning methods and instrument improvements.
