[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.

[Long Term Patency of Saphenous Vein Graft Using the Automated Proximal Anastomosis System Compared with the Hand-sewn Anastomosis System].

Backgrounds：The purpose of this study was to compare the long term patency of PAS-Port system with other hand-sewn anastomosis system. METHODS: From 2009 to 2018, a total of 79 anastomoses were done in coronary bypass surgery with PAS-Port system, and a total of 252 anastomoses with Enclose Ⅱ. Among them, 76 anastomoses with PAS-Port system (group P) and 246 anastomoses of enclose Ⅱ (group E) were evaluated using angiography or multislice computer tomography. We compared age, gender, emergency rate, hospital death and cerebral infarction between the 2 groups and evaluated the patency of the grafts from post-operative day 5 to year 10 to obtain their long term graft patency. RESULTS: Group P was significantly older, more male, and higher emergency rate. One patient in group P died of septic multiorgan failure and 1 died in group E of intestinal tract necrosis. Early patency rates of the graft were 97.4% in Group P and 93.9% in Group E. Long term patency rates were also comparable, but PAS-Port system showed tendency toward a higher rate of patency( log rank p=0.057). CONCLUSIONS: The long term patency rate of PAS-Port automated proximal anastomosis is comparable with that of hand-sewn anastomosis.

[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.

[The Third Operation for Prosthetic Valve Detachment Caused by Aortitis Syndrome without Aortic Ectasia;Report of a Case].

We report a surgical case of a 58-year-old woman with aortitis syndrome is presented. The patient had undergone aortic valve replacement (AVR) with a mechanical prosthesis. Five months later, re-AVR was performed because of prosthetic valve detachment and severe regurgitation. Five years after the re-operation, valve detachment with severe perivalvular leakage was noted again. The 3rd AVR was performed with a biological prosthesis. This time, the prosthetic valve was fixed by 2-0 Ticron sutures buttressed with a felt strip from outside of the aorta at the site of detachment. Administration of prednisolone has been continued for 16 years since the 1st operation. No valve detachment has been noted for 8 years since the 3rd operation.

[Surgical treatment of unroofed coronary sinus coexisting with paroxysmal atrial fibrillation; diagnosis by multidetector computed tomography; report of a case].

We experienced a rare case of an unroofed coronary sinus without a persistent left superior vena cava. A 55-year-old man, who was diagnosed with cerebral infarction, presented with suspected atrial septal defect (ASD) coexisting with paroxysmal atrial fibrillation. Before the operation, we diagnosed this case as coronary sinus ASD by contrast-enhanced coronary computed tomography (CT). There was a 20 mm segment of abnormal communication between the base of the left atrium and the roof of the coronary sinus. We repaired the defect by simple direct closure from the left atrium side, so that the coronary veins drained into the right atrium. The postoperative course was uneventful. Imaging played a crucial role in the diagnosis. Coronary CT angiography is well suited to help identify asymptomatic congenital heart disease.

[Ball thrombus induced by hibernating myocardium in the left ventricle; report of a case].

An 80-year-old man was admitted to our hospital for examination of a ball thrombus incidentally found in the left ventricle (LV). Coronary angiogram revealed severe triple vessel disease and LV dysfunction. Although LV wall motion in the septum and the apex was akinetic, there were no signs of myocardial infarction. It was diagnosed as an acute LV ball thrombus with hibernating myocardium due to ischemia of the left anterior descending coronary artery. Emergency coronary artery bypass grafting (CABG) and excision of the thrombus were performed. Two weeks after surgery, LV function improved and the patient was discharged from the hospital without any complication. A LV ball thrombus without myocardial infarction is rare, and thought to be caused by hibernating myocardium.

Ruptured aneurysm of the sinus of Valsalva with Wildervanck syndrome (cervico-oculo-acoustic syndrome), blepharoptosis and short stature: case report.

A 62-year-old woman was admitted to hospital because of nausea. A grade 5/6 continuous murmur was audible near the left sternal border at the second intercostal space. Chest X-ray showed cardiomegaly and bilateral pleural effusion. She was diagnosed as heart failure and a diuretic was prescribed. After remission of the heart failure, echocardiography showed shunt flow from the right coronary cusp to the right ventricle. Aortography revealed that an aneurysm of the right coronary sinus of Valsalva had ruptured into the right ventricle. Coronary angiography revealed a single coronary artery. Chest computed tomography revealed persistent left superior vena cava. Surgical repair was carried out and the patient made an uneventful recovery. In addition to these cardiovascular abnormalities, she had Wildervanck syndrome (Klippel-Feil syndrome, Duane syndrome and sensorineural hearing disturbance), blepharoptosis and short stature. This rare combination has not been reported previously.

Thoracoscopic sympathetic surgery for hand sweating.

Recently, thoracoscopic surgery has been shown to be effective for the relief of hand sweating. Although it is not fatal if left untreated, the treatment aim is to improve the quality of daily life. Therefore, it is important to understand the complaints of the patient, and provide an adequate explanation regarding postoperative sequelae. Surgeons should also recognize that thoracoscopic surgery might cause problems when performed, as the general risk of surgery remains. Many patients have been helped by the procedure, as their choices in life have expanded, and satisfactory results can be obtained when indication is determined by a full examination of the patients condition. Between December 1999 and September 2002, we performed thoracoscopic sympathetic surgery in 556 consecutive patients. Five-hundred seventeen (93%) of these complained of profuse hand sweating. Based on the new concept presented, we consider that this method of operation is an effective treatment.

Myocardial ischemic preconditioning during minimally invasive direct coronary artery bypass grafting attenuates ischemia-induced electrophysiological changes in human ventricle.

OBJECTIVE: Ischemic preconditioning (IPC) has been found to protect the myocardium in animal studies. However, clinical studies have been limited and the clinical effects of IPC are still uncertain. The purpose of this study was to assess whether IPC has any protective effect on the human myocardium during minimally invasive CABG (MIDCAB), by means of epicardial electrophysiological testing. METHOD: Forty-five patients with left anterior descending artery disease who underwent a MIDCAB procedure were evaluated. In the present study, the electrical potentials which were not affected by cardio-pulmonary bypass or cardioplegia were measured. The ratio of longitudinal to transverse conduction velocity (phiL /phiT), and QT, JT dispersions were measured using plaque electrodes in the preischemic state, during a 5-minute coronary occlusion, during the subsequent 5-minute reperfusion, during 5- and 10-minute anastomosis periods, and after anastomosis. RESULT: The phiL/phiT was 2.2 +/- 0.2 at baseline. Anisotropy was exaggerated during the 5-minute coronary occlusion (2.6 +/- 0.3). During anastomosis, conduction velocities were decreased, but showed no further deterioration (2.4 +/- 0.3, and 2.4 +/- 0.3, respectively). QT and JT dispersions were improved by reperfusion. CONCLUSION: The effectiveness of IPC during the MIDCAB procedure was confirmed electrophysiologically. Anisotropy and dispersions were minimized after IPC, therefore IPC demonstrated antiarrhythmic protective effects on the human myocardium.