Hancock valve deterioration in tricuspid position for Ebstein's anomaly.

A 65-year-old woman with a Hancock valve implanted 25 years earlier for Ebstein's anomaly underwent a successful second tricuspid valve replacement with a Mosaic valve because of significant tricuspid regurgitation. At surgery, it was found that the Hancock valve had a cylinder-shaped hole and had lost its entire structure. Tricuspid valve dysfunction may be tolerated for a long time before surgery is contemplated.

Aortic valve stenosis associated with Bazin's disease.

Bazin's disease was first reported in 1861, and is described as erythema induratum or nodular vasculitis. The condition is seen occasionally in middle-aged women on the skin of the calf, and a relationship to a tuberculosis infection has been proposed. In the present patient, valvular lesions occurred simultaneously with Bazin's disease, with granulomatous changes being demonstrated by the aortic valve pathology.

Infective endocarditis associated with Sjogren's syndrome.

Sjögren's syndrome is one of the major autoimmune diseases, however infective endocarditis associated with Sjögren's syndrome has not previously been reported. A patient with Sjögren's syndrome associated with aortic valve regurgitation due to infective endocarditis, underwent successful aortic valve replacement. Patients with Sjögren's syndrome tend to be at a higher risk of intraoral infections due to diminished secretion of saliva. Particular care must be taken of Sjögren's syndrome patients as they can also be at an increased risk of infective endocarditis.

Pulmonary artery aneurysm with ascending aortic aneurysm concomitant with bilateral bicuspid semilunar valves.

Aneurysm of both the pulmonary trunk and the ascending aorta concomitant with bilateral bicuspid valves is very rare. The reason for the formation of aneurysm with bicuspid semilunar valve is still inconclusive. Surgical repair was performed successfully (ie, aortic valve replacement, graft replacement for the ascending aorta, and plication of the pulmonary artery). Pathology of the pulmonary artery wall did not demonstrate cystic medial necrosis. The hemodynamic turbulence by the bilateral bicuspid valve may cause the formation of aneurysms even at low pressure. This case demonstrates an explanation for aneurysm with the bicuspid valve.

Bacteriological evaluation of the cardiac surgery environment accompanying hospital relocation.

PURPOSE: Airborne bacteria in the environment are thought to be a cause of postoperative infection. With the relocation of our hospital, the operating room we had used for 35 years was replaced, changing the surgical environment for cardiac operation completely. We conducted this study to evaluate the bacteriological change in the surgical environment between the new and old operating rooms. METHODS: Airborne contaminants in the operating rooms were collected on blood agar plates, and samples of intraoperative salvaged blood from cardiac surgery were drawn from salvaged bags produced by Cell Saver 5 (Haemonetics, Braintree, MA, USA) in both the old (group O) and the new operating rooms (group N). These samples were cultured and evaluated bacteriologically. RESULTS: We collected nine samples of airborne contaminants from both group O and group N. The mean number of isolated bacteria colonies was 5.0 +/- 1.2 in group O, and 2.0 +/- 0.94 in group N (P < 0.001). Bacterial growth was detected in 85% of the salvaged blood samples from group O (n = 20) versus 60% from group N (n = 15) (P = 0.09). The mean bacteria count was 1.9 +/- 2.7 colony-forming units (cfu)/ml in group O versus 0.4 +/- 0.5 cfu/ml in group N (P = 0.032). CONCLUSION: Hospital relocation resulted in an improved operating room environment with less bacterial contamination of intraoperative salvaged blood.

Easy pulmonary vein isolation using epicardial cryoablation.

The maze procedure can be accomplished by several techniques with varying degrees of success. These techniques include cut-and-sew, endocardial cryoablation, and epicardial ablation using heat-producing devices. We describe our surgical modification of pulmonary vein isolation with cryoablation using an epicardial and endocardial approach. This simple and reliable technique, which does not need any special device, will assist in mitral valve surgery for patients with chronic atrial fibrillation.

A metastatic ball tumor in the right atrium originating from esophageal cancer: report of a case.

A metastatic ball tumor in the right atrium originating from esophageal cancer is extremely rare. A 53-year-old woman had two such tumors without any other types of metastasis. These tumors were associated with severe thrombocytopenia caused by the consumption of platelets. Even after repeated transfusions of platelets and fresh frozen plasma, the thrombocytopenia could not be controlled. Therefore, a surgical resection was performed to improve the thrombocytopenia and avoid sudden death due to a complete obstruction of the right ventricular outflow tract by the tumor. As the throm-bocytopenia did not recur postoperatively, the patient was discharged from hospital. She died, however, of multiple metastases with bilateral pleural effusions 5 months after the surgery.

Hospital and mid-term outcomes in elderly patients under-going off-pump coronary artery bypass grafting--comparison with younger patients--.

BACKGROUND: Clinical outcomes and problems following off-pump coronary artery bypass grafting (OPCAB) in elderly patients have not been clarified. METHODS AND RESULTS: The surgical results of elderly patients aged 75 years or older (n=50; 38 males, mean age, 78.8 years) were reviewed and compared with those of younger patients (n=95; 79 males, mean age, 63.0 years). The EuroSCORE score was 6.9+/-3.5 in the elderly group and 3.0+/-2.4 in the younger group (p<0.0001). There were no hospital deaths in either group. There was no significant difference in the postoperative complication rate except for atrial fibrillation (40.0% elderly vs 24.2% younger, p=0.0479). Postoperative intensive care unit and hospital stays did not differ. The frequency of blood transfusion was significantly higher in the elderly group (78.0% elderly vs 37.2% younger, p<0.0001). During the mean follow-up of 18.6+/-8.8 months, there was 1 sudden death in the elderly group, but no cardiac deaths in either group. The 32-month cardiac event-free and survival rates were similar for the 2 groups. CONCLUSION: OPCAB provides satisfactory clinical outcomes for elderly as well as younger patients.

The superiority of pulmonary function after minimally invasive direct coronary artery bypass.

OBJECTIVE: We determined whether minimally invasive direct coronary artery bypass (MIDCAB) leads to excellent postoperative pulmonary function, and which contributes more to this--minithoracotomy or avoidance of cardiopulmonary bypass. METHODS: Pulmonary function 1 week before and 2 weeks after surgery was evaluated in 8 patients undergoing MIDCAB (Group M), 10 undergoing off-pump coronary artery bypass (Group O), and 12 undergoing conventional coronary artery bypass grafting (Group C). Parameters were adjusted by their predicted values and postoperative values were expressed as a ratio to preoperative ones. RESULTS: Only Group M maintained postoperative vital capacity and forced expiratory volume in 1 second close to the preoperative level and thus, showed significantly better recovery than Groups O and C. No significant difference was seen between Groups O and C. CONCLUSIONS: MIDCAB provides better recovery of pulmonary function early postoperatively than other procedures thanks to minithoracotomy rather than avoidance of cardiopulmonary bypass.