A giant left atrial myxoma causing left-sided heart failure.

This report presents a case study on giant left atrial myxoma. Transthoracic echocardiography showed a giant mass in the left atrium of a 53-year-old female patient causing functional mitral stenosis. Tumor resection was performed, and the pathological diagnosis confirmed the atrial myxoma. Postoperative echocardiography showed no evidence of any remaining mass and mitral stenosis.

Management of Arteriovenous Graft Infection.

Objective: Arteriovenous graft (AVG) infection influences the survival and quality of life of patients, causing life-threatening sepsis reducing dialysis access. This study aimed to evaluate an appropriate treatment strategy for AVG infection. Methods: We analyzed 61 cases involving AVG infections identified at a single center. The cases were divided into two groups based on the type of AVG and surgical methods, namely, currently used AVG (cAVG) (n=29) or abandoned AVG (aAVG) (n=32) and total graft excision (TGE) (n=10) or partial graft excision (PGE) (n=46). Results: There was a significant difference in lower procedure frequency (p<0.001) and longer procedure time (p=0.014) in the cAVG group. A significant difference in lower reinfection rate (p=0.009) was found in the TGE group. Multivariable analysis confirmed that aAVG significantly independently affected the reinfection rate (hazard ratio, 2.208; 95% confidence interval, 1.069-4.561; p=0.032). Staphylococcus aureus was the most frequent cause of AVG infection (61.5%); 77.5% of Staphylococcus aureus were methicillin-resistant Staphylococcus aureus. Conclusion: We found a higher risk of reinfection after PGE than TGE, and aAVG infection was associated with approximately two times higher likelihood of reinfection. These findings suggest that TGE should be considered for patients with AVG infections, particularly aAVG infections.

A case of dedifferentiated liposarcoma of the heart and stomach.

INTRODUCTION: Liposarcoma of the heart and stomach is rare. PRESENTAION OF CASE: We report a case of liposarcoma in both organs with dedifferentiated histology. A patient was referred to our hospital with anorexia and weight loss. Upper gastrointestinal tract endoscopy revealed 5-10-mm elevated lesions, and echocardiography and computed tomography showed tumorous lesions in the left atrium. Tumor resection and mitral valve replacement were performed, and biopsy was performed for the gastric tumor. Both the tumors were diagnosed as dedifferentiated liposarcoma. DISCUSSION: Liposarcoma - a mesenchymal malignant tumor that contains lipoblasts - is the second most common soft tissue sarcoma. The tumor occurs most frequently in the limbs and retroperitoneum and rarely originates in the heart and the stomach. CONCLUSION: Chemotherapy and radiotherapy are only adjunctive therapies but not es as standard treatment for cardiac tumors. Therefore, we believe that wide surgical resection was the best choice of treatment in the present case.

Successful repair of mesenteric ischemia in acute type A aortic dissection.

A 64-year-old man with acute type A aortic dissection had superior mesenteric artery occlusion and marked metabolic acidosis. By an emergency laparotomy, bypass grafting from the left external iliac artery to the superior mesenteric artery was performed with great saphenous vein. After deep sedation and antihypertensive management in the intensive care unit, the acidosis resolved, and central repair was carried out. At 10 months postoperatively, his course has been uneventful without mesenteric complications.

Right infarction response to coronary artery bypass and the Abiomed BVS 5000.

A 57-year-old man presented with acute right ventricular infarction. A percutaneous coronary intervention was undertaken, but he developed shock and required extracorporeal membrane oxygenator support. Coronary artery bypass was performed, and a Abiomed BVS 5000 was implanted as a right ventricular assist device. Circulation gradually stabilized, and the device was removed after 5 days. There no sign of heart failure or infection at 9 months post-surgery.

Vacuum-assisted closure therapy for salvaging a methicillin-resistant Staphylococcus aureus-infected prosthetic graft.

Infection of a vascular prosthesis after a bypass surgery is relatively rare. However, once developed, serious complications can occur, such as bleeding, sepsis, and organ ischemia, occasionally resulting in leg amputation or even death in some cases. The treatment of a vascular prosthesis infection involves the necessary removal of the infected graft; subsequently, an extra-anatomical bypass surgery is often considered. We herein report a case in which postoperative methicillin-resistant Staphylococcus aureus infection caused dehiscence of the femoral vessels and exposure of the graft vessel and anastomosed area. The infected tissue was surgically removed (debridement), and the patient's condition was successfully treated by the application of a nonadherent dressing and vacuum-assisted closure therapy combined with the bridging technique.

Circumaortic left renal vein associated with juxtarenal abdominal aortic aneurysm.

The patient was an 82-year-old man who was found to have a juxtarenal abdominal aortic aneurysm accompanied by a circumaortic left renal vein (CLRV). During dissection of the proximal anastomosis site the CLRV was injured, but was successfully repaired. A graft implantation was performed below the renal arteries. The incidence of CLRV is thought to be rare, however it is found in 7% of cadavers donated for anatomy. CLRV may cause unexpected bleeding by inadvertent dissection of the abdominal aorta. To prevent unexpected bleeding, surgeons should always keep in mind this potential risk when performing surgery.

Twelve years of experience with the ATS mechanical heart valve prostheses.

OBJECTIVE: The ATS Open Pivot mechanical heart valve has been implanted routinely at our institution since 1999. The objective of this study is to retrospectively analyze our 12-year clinical results with ATS prostheses. METHODS: ATS Open Pivot mechanical valves were implanted in 268 adult patients between May 1999 and August 2010. We selected 259 subjects who could be adequately followed (follow-up rate 96.6 %). Aortic valve replacement was performed in 157 patients, mitral valve replacement (MVR) in 71, and double (aortic and mitral) valve replacements (DVR) in 31. Mean age at the time of implant was 58.8 ± 10.6 years. The gender ratio was 128 males/131 females. Mean follow-up was 4.4 ± 7.8 years, and the cumulative follow-up was 1144 patient-years (pt-yr). RESULTS: Early death within 30 days after the operation occurred in 5 (2.5 %) patients. Late death occurred in 27 patients including valve-related deaths in 13. The 10-year survival rate after the operation was 82.7 ± 2.9 %. The rate of freedom from valve-related death was 92.2 ± 2.2 %. The incidence of valve-related complications was 2.19 %/pt-yr. Of these, the incidence of thromboembolic events and that of bleeding complications were 1.22 and that 0.87 %/pt-yr. The incidence of valve thrombosis was 0.09 %/pt-yr. No structural valve deterioration was observed in any of the three operative procedure groups. CONCLUSIONS: Our 12-year experience with aortic and MVR using the ATS mechanical heart valve demonstrated low incidences of thromboembolic events, bleeding complications, and valve thrombosis.

'Clover technique' for tricuspid regurgitation due to pacemaker lead.

Whilst tricuspid regurgitation (TR) secondary to severe mitral regurgitation (MR) is a common problem, organic TR caused by pacemaker leads is also frequently encountered. In a 63-year-old patient who developed TR attributable to both MR and a pacemaker lead inserted 12 years previously, the regurgitation could not be controlled satisfactorily using a normal ring annuloplasty. Consequently, the 'clover technique' provided an efficient correction to the TR.

A rare case of infective endocarditis complicated by Trichosporon asahii fungemia treated by surgery.

The patient was a 58-year-old male. He consulted our hospital because of weight loss and fever. Computed tomography (CT) revealed renal infarction. Nine days after admission, CT showed hemorrhagic cerebral infarction in the right frontal lobe. A blood culture revealed streptococcus oralis, and echocardiography revealed vegetation in the mitral and aortic valves, suggesting infective endocarditis (IE). Fever (39 degrees C or higher) was noted 23 days after admission. A blood culture revealed Trichosporon asahii (T. asahii), suggesting T. asahii fungemia. An intravenous drip of fluconazole at 400 mg/day was initiated, and two-valve replacement was performed 34 days after admission. Following surgery, the patient became negative for beta-D glucan and was discharged 85 days after admission. We report the present case of IE complicated by T. asahii fungemia, which is rare in patients other than malignant blood disease or tumor patients, showing a poor prognosis in which survival was achieved by surgery.

Surgical repair for a coronary-pulmonary artery fistula with a saccular aneurysm of the coronary artery.

The patient, a 69-year-old woman, had been diagnosed with a heart murmur. A chest X-ray at a local clinic had shown an abnormal shadow. Since CT revealed a 3-cm-diameter mass close to the pulmonary artery, we performed a coronary angiography and diagnosed her as having a coronary artery aneurysm associated with a coronary-pulmonary artery fistula. We incised the aneurysm under cardiac arrest, the wall of which had three openings that were suture closed from the inside and outside. The coronary-pulmonary artery fistula was suture closed. A postoperative angiography confirmed the disappearance of the coronary artery aneurysm and the abnormal blood vessels. The patient had an uneventful postoperative course and was discharged on postoperative day 15. We report a rare case of coronary-pulmonary artery fistula with a coronary artery aneurysm for which surgery was followed by an uneventful postoperative course.

Triple-valve treatment for prosthetic valve endocarditis occurring 20 years after implantation of a Carpentier-Edwards pericardial bioprosthesis in the aortic valve.

A 68-year-old woman had undergone aortic valve replacement and open commissurotomy 20 years previously. At the beginning of 2008, fever, cold, and heart failure symptoms were noted. On blood culture, Streptococcus oralis was detected three times. Surgery was performed under a diagnoses of prosthetic valve endocarditis in the aortic valve, mitral stenosis and insufficiency, and tricuspid insufficiency. Techniques consisted of additional aortic valve replacement, mitral valve replacement, and tricuspid annuloplasty. Vegetation was macroscopically and pathologically observed in the extirpated Carpentier-Edwards pericardial bioprosthesis that had been placed in the aortic valve. There was no postoperative recurrent inflammatory response. The patient was discharged 32 days after surgery.

Cardiac nociceptors innervated by vagal afferents in rats.

It is reported that cardiac afferent information is transmitted through at least three different pathways to the CNS: sympathetic, parasympathetic, and somatic; however, there are few studies concerning the role of afferent fibers of vagus nerves for eliciting cardiac sensation including pain. Especially, receptive field properties innervated by single vagal nerve fiber and mechanical threshold of nociceptors on the cardiac surface are not yet quantitatively studied. Therefore, in this study, we systematically investigated characteristics of vagal units innervating cardiac nociceptors in rats. Using anesthetized and artificially ventilated rats, 37 single unit recordings were made from fine nerve filaments of the left vagal nerve. For quantitative mechanical stimulation, the cardiac surface was stimulated by a von Frey type device. In addition, bradykinin was used for checking the chemical sensitivity of the nociceptor. Electrical stimulation was used to estimate the conduction velocity of the recorded nerve fiber. All units recorded from the vagal nerve were either Adelta- or C-polymodal nociceptors. About 70% of the afferents had conduction velocities in the C-fiber range. In 60% of the units, the peripheral receptive field covered spot-like areas, but we also found larger and continuous receptive fields. Our results show that a majority of nociceptors innervated by vagal afferents are the C-polymodal type with spot-like receptive fields. We consider it to relate to the ambiguous and dull pain of angina pectoris.

Mitral valve repair in patients with infective endocarditis.

BACKGROUND: The goal of the present study was to investigate the feasibility of mitral valvle repair in patients with infective endocarditis (IE). METHODS AND RESULTS: Twenty-one patients who had undergone mitral valve surgery for IE were reviewed. Valve repair was performed in 8 patients with active and in 6 patients with healed endocarditis: 6 of these 14 patients were New York Heart Association (NYHA) functional class III or IV preoperatively. Valve replacement was performed in 5 patients with active endocarditis and in 2 with healed endocarditis: 6 of these 7 patients were NYHA functional class III or IV preoperatively. Repair techniques included annuloplasty (n=13), resection-suture (n=13), chordal transfer (n=2), and closure of the perforation (n=3). In the valve replacement group, 6 patients required concomitant aortic valve replacement. In the valve repair group, 1 patient died and 1 patient required reoperation for recurrent mitral regurgitation. Postoperative echocardiography demonstrated no (n=8) or mild (n=4) mitral regurgitation at the last follow-up examination. In the valve replacement group, 1 patient died and 1 patient required reoperation because of a paravalvular leak. No cases of recurrent infection occurred in either group. CONCLUSIONS: Mitral valve repair in patients with IE is feasible and has low morbidity.