A Case of Thrombectomy under Cardiopulmonary Bypass for a Left Atrial Appendage Thrombus in an Elderly Patient without Valvular Disease / 日本心臓血管外科学会雑誌

An 80-year-old woman who had been suffering from atrial fibrillation and recurrent cerebral infarction was admitted to our hospital. Transesophageal echocardiography revealed a giant mobile thrombus in the left atrial appendage. The patient underwent thrombectomy and left atrial appendage obliteration under cardiopulmonary bypass. Her postoperative course was uneventful. The patient showed no recurrence of the left atrial thrombus nor thromboenbolism postoperatively. Based on the present results, we recommend cardiac thrombus be investigated by transesophageal echocardiography in cases of atrial fibrillation accompanied by recurrent thromboembolism. This should be followed by thrombectomy under cardiopulmonary bypass, even in the elderly.

Late Aortic Dissection after Aortic Valve Replacement for Aortic Regurgitation with Slight Aortic Dilatation Successfully Repaired by the Bentall Procedure / 日本心臓血管外科学会雑誌

We report a 57-year-old male who suffered from ascending aortic aneurysmal dilatation complicated with acute localized dissection. He had received aortic valve replacement with a prosthesis for severe aortic regurgitation resulting from valve degeneration and annular dilatation 4 years previously at which time the maximal ascending aortic diameter had been 45mm so that a procedure for the aorta itself was not done. On the present occasion an aortogram showed a maximal aortic diameter of 90mm and localized dissection from above the right coronary ostium to near the connection to the brachiocephalic artery. A successful composite valve-graft replacement of the ascending aorta (Bentall procedure with Piehler's modification) was carried out on a semi-emergency basis. This experience with this case implies that certain intervention for associated moderate aortic dilatation should be considered when an aortic valve replacement is performed.