[New prosthesis implant technique of aortic root abscess; circumferential transmural sutures].

A patient with aortic root abscess was successfully treated with a newly developed suture technique named "circumferential transmural sutures". This suture technique provides 1)a tight attachment of the prosthesis to the aortic wall and 2)a secure healing of infection by exposure of the abscess cavity to blood flow without complicated procedures. This technique would be a useful alternative for the aortic root abscess without left ventriculo-aortic disruption.

Percutaneous closure of post-infarction ventricular septal defect using an Amplatzer septal occluder.

A 77-year-old woman underwent percutaneous closure of post-infarction ventricular septal defect. The defect was successfully closed with a 20-mm Amplatzer septal occluder with a small residual shunt and Qp/Qs improved from 3.38 to 1.48. She was discharged 30 days after procedure. To our knowledge, this is the first case reported in Japan.

A Case of Simultaneous Endovascular Aneurysmal Repair (EVAR) and Coronary Artery Bypass Grafting (CABG).

A male patient with abdominal aortic aneurysm (AAA) and coronary artery disease was referred to our hospital. Coronary angiography showed multiple coronary lesions including the left main trunk. Computed tomography revealed a large AAA measuring 78 mm. To prevent aneurysmal rupture after coronary artery bypass grafting or cardiac complications after AAA repair, we performed simultaneous endovascular aneurysmal repair and coronary artery bypass grafting. The postoperative course was uneventful. Endovascular therapy and beating coronary artery bypass grafting is less invasive and may offer another promising option for the treatment of complicated case of AAA with severe coronary artery disease.

Left ventricular lipoma with pseudoaneurysm-like appearance.

We describe an extremely rare cardiac lipoma, with electrocardiographic changes in ST segments and T waves, suggesting ischemic heart disease. The abnormal electrocardiogram was identified during a routine physical examination of an asymptomatic 57-year-old man. Coronary angiography showed no stenotic or occlusive lesions in the coronary arteries except that the left anterior descending artery followed a winding course in the apical region. Left ventriculography revealed a pseudoaneurysm-like mass around the apical portion. Computed tomography and magnetic resonance imaging revealed a cardiac lipoma that communicated with the left ventricle and resembled a pseudoaneurysm. After complete resection of the lipoma and left ventricle patch plasty, the postoperative course was uneventful. Histologically, the tumor was an intramyocardiac lipoma with no evidence of malignancy. To our knowledge, we are the first to describe an intramyocardiac lipoma resembling a left ventricle pseudoaneurysm.

Use of a Matsui-Kitamura stent-graft for endovascular repair of patent ductus arteriosus in an adult patient.

Open surgical repair of patent ductus arteriosus is difficult in the case of elderly patients because of calcification of the duct and the possibility of rupture. Furthermore, endovascular repair with the use of a coil or an occluding device poses problems such as residual shunt or migration of the device. We describe a case wherein closure of a large patent ductus arteriosus in an adult patient was achieved using a Matsui-Kitamura curved nitinol stent-graft.

Outcome of percutaneous intrapericardial fibrin-glue injection therapy for left ventricular free wall rupture secondary to acute myocardial infarction.

Left ventricular free wall rupture (LVFWR) is a fetal complication of acute myocardial infarction. This study was conducted to test the feasibility of percutaneous intrapericardial fibrin-glue injection therapy (PIFIT) for LVFWR after acute myocardial infarction and to assess its clinical outcome. From January 2000 to December 2004, LVFWR was confirmed by echocardiography in 22 patients. Thirteen patients showing abrupt hemodynamic collapse failed to recover from resuscitation maneuvers and died <2 hours after LVFWR. The remaining 9 patients (5 women, mean age 73 +/- 10 years) underwent PIFIT. Pericardiocentesis was performed from the subxiphoid process, and a 6Fr pigtail catheter was introduced into the pericardial space. After bloody fluid was drained from the catheter, the fibrin glue was injected into the pericardial space. There were no complications relating to pericardiocentesis and PIFIT. One patient underwent surgical repair on the day of PIFIT because of uncontrollable bleeding from pericardial drainage. In-hospital death as a result of rerupture occurred in 2 patients on days 4 and 7 after PIFIT. Echocardiography during follow-up revealed no evidence of pseudoaneurysm or left ventricular restriction. On follow-up at a median of 4.0 years (interquartile range 3.1 to 4.8), 1 noncardiac death occurred at 3.3 months. The other 5 patients were free of cardiovascular events and in New York Heart Association functional class I. In conclusion, PIFIT is a simple, effective, and less invasive technique for the management of LVFWR and thus can be an alternative to surgical repair for LVFWR after acute myocardial infarction.

[Segmental mitral suture annuloplasty combined with resection--suture technique for posterior leaflet prolapse].

A segmental mitral suture annuloplasty technique is consisted of double-layer sutures anchored in the fibrous trigone on the valve repair side and along the annulus to the midpoint of the posterior leaflet. This suture technique is an alternative of Paneth Burr method using only one-side of the procedure. We recommend this technique especially in cases of mitral regurgitation which can be repaired by a simple resection-suture technique for posterior leaflet, and not in cases of severe annular dilatation, rheumatic, or ischemic diseases. We have examined this technique in 40 cases over the last 8 years and the results showed no recurrence of the mitral regurgitation.