Mitral Valve Replacement via Right Thoracotomy for Ischemic Mitral Regurgitation in a Patient with Prior Coronary Artery Bypass Grafting / 日本心臓血管外科学会雑誌

We report a case of redo mitral valve replacement via right thoracotomy for ischemic mitral regurgitation after coronary artery bypass grafting. An 81-year-old woman with a history of multiple coronary artery bypass grafting was admitted to our institute for treatment of severe ischemic mitral valve regurgitation. She had a history of repeated hospitalization for heart failure and complained of worsening dyspnea. Coronary angiography showed patent coronary grafts. Echocardiography revealed severe mitral regurgitation with leaflet tethering and posteroinferior wall asynergy. The patient underwent mitral valve replacement (Mosaic Bioprosthesis 27 mm) via right thoracotomy approach with ventricular fibrillation under moderate hypothermia. The ventricular fibrillation time was 57 min, and the cardiopulmonary bypass time was 126 min. The patient's postoperative recovery was uneventful. She was discharged on postoperative day 19. Right thoracotomy approach provided excellent exposure of the mitral valve and minimized the risk of repeat sternotomy, including injury of previous bypass grafts, injury of right ventricle and significant hemorrhage.

Successful Medical Treatment of Prosthetic Valve Endocarditis with a Perivalvular Abscess / 日本心臓血管外科学会雑誌

A 68-year-old man visited our hospital with a high fever with chills 4 years after aortic valve replacement. Streptococcal species were cultured with a venous blood culture. An echocardiogram and a cardiac computed tomography (CT) scan revealed a perivalvular abscess (11 mm×15 mm). Because his prosthetic valve functioned well, he was treated with intravenous ampicillin and gentamicin. Cardiac CT scan performed at 6 weeks showed the perivalvular abscess to have disappeared and he was discharged from the hospital. He is free from recurrence of the abscess 20 months after the initiation of therapy.

Early Postoperative Descending Aortic Rupture Following Ascending Aorta Replacement for Acute Type A Aortic Dissection / 日本心臓血管外科学会雑誌

We report the findings in an 82-year-old man diagnosed with acute type A aortic dissection. Computed tomography scan showed that the primary entry site was located in the ascending aorta. This finding was confirmed intraoperatively, and emergency ascending aorta replacement of ascending aorta was performed. He subsequently died on postoperative 7 day due to descending aortic rupture. During autopsy, another entry site was found at the root of the brachiocephalic trunk with a patent false lumen, which might have led to the descending aortic rupture.

A Case of Recurrent Rhabdomyosarcoma 11 Years after Radical Surgical Resection / 日本心臓血管外科学会雑誌

The prognosis of rhabdomyosarcoma is poor, and its estimated survival is less than year even after radical resection. We report a patient with recurrent rhabdomyosarcoma 11 years after obtaining remission by radical surgical resection and chemotherapy.

Repair of Unicuspid Aortic Valve and Mitral Valve Aneurysm Secondary Involved with Intectious Endocarditis / 日本心臓血管外科学会雑誌

A 25-year-old man with a previous diagnosis of congenital bicuspid aortic valve presented with a fever of unknown origin for 3 months. Transthoracic echocardiography revealed vegetation on the mitral valve leaflet. Transesohageal echocardiography revealed severe aortic regurgitation and a mitral valve leaflet aneurysm. Despite intensive antibiotic therapy, his clinical condition did not improve, so he underwent aortic and mitral valve repair. The aortic valve was shown to be unicuspid intraoperatively. We made a new commissure, then mitral valve aneurysm was resected and a new leaflet was made using the pericardium. There was almost no regurgitation seen on postoperative echocardiography.

A Case of Aortic Valve Plasty for Non-coronary Cusp Fracture after Infective Endocarditis / 日本心臓血管外科学会雑誌

A 20-year-old male was referred to our hospital to undergo operative treatment due to aortic valve insufficiency which had gradually worsened. The patient's chief complaint was a loss of breath upon effort which had progressively worsened after undergoing aortic valve plasty (AVP) for aortic valve insufficiency with infective endocarditis at another institution. AVP by the cusp extension method had been performed because of the patient's youth and there had been no change in the morbid state, except for the presence of a non-coronary cusp. In addition, the aortic valve insufficiency was controlable and postoperative course was also excellent. The cusp extension method was therefore considered to be an appropriate procedure for this case since it would allow the patient to return it to a state with a more normal heart, since the valve organization after this procedure would be able to reach a maximum level.

A Case of Infective Endocarditis with Incarcerated Vegetation in Mitral Orifice / 日本心臓血管外科学会雑誌

A 69-year-old woman was admitted with fever and dyspnea. We diagnosed the congestive heart failure due to infective endocarditis (IE) with mitral valve regurgitation and stenosis. We immediately started medical therapy in order to control both the heart failure and the infection. However, we had to semi-emergency mitral valve replacement additionally perform a days after the initial hospitalized due to a progression of the heart failure. The operative findings showed an area of vegetation to be incarcerated in the mitral orifice. In cases of IE which are associated with mitral stenosis, we therefore should consider the possibility that vegetation may be present in the mitral orifice and closely follow such patients by echocardiography.

Two Cases of False Aneurysm Rupture Induced by Nonvascular Tumor / 日本心臓血管外科学会雑誌

We presented here 2 cases of rare nonvascular tumor involving the aorta. Case 1: A 69-year-old woman. She presented leg edema and dyspnea on admission. Computed tomography revealed abdominal aortic aneurysm perforating left common iliac vein. Abdominal aortic aneurysm replacement and fistula closure were done on an emergency basis. Immunohistologic examination revealed that malignant mesothelioma invaded the aortic wall. Case 2: A 47-year-old woman presented with dyspnea. Enhanced computed tomography revealed rupture of the descending aortic aneurysm (saccular type). Aortic replacement was done on an emergency basis. One year after the operation, computed tomography revealed a giant mass (160×70mm) surrounding the descending thoracic aorta. On biopsy, malignant schwannoma was found to invade the descending aorta. Sometimes nonvascular tumors form aneurysms. So we should be careful in diagnosis before operation.

Replacement of a Degenerated Mitral Bioprosthesis Using a Valve-on-Valve Technique / 日本心臓血管外科学会雑誌

A 79-year-old woman had received implantation of a pace maker for sick sinus syndrome at age 64 and tricuspid valve annuloplasty and Maze at age 68. Furthermore, she underwent tricuspid valve and mitral valve replacement with a bioprosthesis because of tricuspid valve and mitral valve regurgitation at age 73. She was referred to our institution for congestive heart failure in November 2005, because her bioprostheses at the mitral and tricuspid positions had shown significant regurgitation due to the degeneration of the prostheses, which required rereplacement. Because 1) surgical treatment of the heart had been performed twice in the past, 2) the general condition was not good owing to cirrhosis and hypothyroidism and 3) the durability of bioprostheses is short, we performed mitral valve re-replacement by using the “valve-on-valve” technique for reducing the invasion of surgical therapy. She had a satisfactory postoperative course. The “valve-on-valve” technique is a useful option for the re-replacement of bioprosthesis because it obviates the need for removing the sewing ring of the previous bioprosthesis.

A Case of Aortic Valve-Sparing Operation for Unruptured Aneurysm of Valsalva's Sinus / 日本心臓血管外科学会雑誌

A 49-year-old woman was found to have unruptured Valsalva's sinus aneurysm. All of the sinuses were involved in the anuerysmal dilatation and the aortic valve was intact with no aortic insufficiency. Aortic root reconstruction surgery (root remodeling operation) was successfully performed and the histopathology of the aortic wall showed healed aortitis. Her postoperative course was uneventful. Valve-Sparing surgery can be one option, even in cases with aortitis.

Surgical Treatment for an Endovascular Stent Infection in the Descending Aorta / 日本心臓血管外科学会雑誌

We report a rare case with infection of a stent-graft. A 82-year-old man, who had undergone endovascular stent grafting to repair the descending aortic aneurysm 2 years previously, was admitted with high-grade fever. The blood culture detected methicillin-resistant <i>Staphylococcus aureus</i> (MRSA). Endoleak due to stent-graft infection was diagnosed and operation for synthetic graft replacement was performed. The synthetic graft was infiltrated in Rifampicin prior to the graft replacement to prevent re-infection. Additionally, the graft was covered with the greater omentum. He was discharged on the 45th day after surgery without any problems. One year follow-up showed no sign of re-infection of the graft.