Surgical Repair of Tetralogy of Fallot in a Quinquagenarian / 日本心臓血管外科学会雑誌

<p>The patient was a 57-year-old woman. Even though she had received a diagnosis of tetralogy of Fallot as an student of elementary school, she did not consent to undertake surgical repair. Consequently, she had been observed until age 56, although she suffered from atrial fibrillation during this period. She decided to undergo surgical correction as she suffered from severe heart failure. The surgical repair included Maze procedure, a patch repair of ventricular septal defect, a repair of the right ventricular outflow tract and a pulmonary valve replacement. The right ventricular pressure reduced to around two-fifths of high left ventricular pressure postoperatively, and she was discharged without any complication.</p>

Endovascular Repair of Recurrent Para-anastomotic Pseudoaneurysm of Occluded Potts' Shunt / 日本心臓血管外科学会雑誌

A 34-year-old female patient, who had undergone several operations relating to pulmonary atresia with ventricular septal defect (PA/VAD), was admitted to our hospital for recurrent massive hemoptysis requiring blood transfusion. She had undergone a Potts' shunt (systemic-pulmonary shunt) at age 3, and undergone intraaortic patch closure for paraanastomotic pseudoaneurysm of occluded Potts' shunt at age 28. Chest CT scan revealed an enhancement of this aneurysm surrounding ground glass like appearance of left lung lobe which indicated pulmonary bleeding. In order to avoid skeltonization of severe adhesion of mediastinal and left thoracic space due to several prior operations, endovascular repair of this pseudoaneurysm with debranching of left subclavian artery was performed. Postoperative course was uneventful and hemoptysis was disappeared. She was discharged at 8 postoperative day.

Initial Experience with Beating Heart Mitral Valve Repair via Mini-thoracotomy at a Single Institution / 日本心臓血管外科学会雑誌

Mitral valve reoperation through a median sternotomy is technically challenging and carries higher postoperative morbidity and mortality than the primary operation, especially for a patient with patent coronary bypass grafts. We here present 3 cases of mitral valve reoperation using the beating heart technique under normothermic cardiopulmonary bypass via a mini-thoracotomy. The reasons that precluded sternal reentry were as follows : previous coronary bypass and patent internal mammary artery grafts in 2 cases, and a history of mediastinal wound infection at the initial operation in 1 case. All cases were carried out via right mini-thoracotomy and cardiopulmonary bypass using arterial cannulation via the ascending aorta or the femoral artery, and venous cannulation via the femoral vein and the superior vena cava. Mitral valve repair was performed for 1 case, and valve replacement for 2 cases. Transfusion was not necessary, except for 1 case that had anemia due to hemolysis preoperatively. All patients were discharged without major complications. This technique is a safe and feasible option for a mitral valve reoperation that excludes re-sternotomy, extensive pericardial dissection and aortic clamping, thereby minimizing risks of bleeding, graft injury and myocardial damage.

Graft Replacement of Distal Arch Aneurysm after Branched Open Stentgraft Method due to Third Time Endoleak / 日本心臓血管外科学会雑誌

A 71-year-old man had undergone branched open stent grafting for a distal arch aneurysm in May 2006. He subsequently developed multiple episodes of postoperative endoleak successfully treated by TEVAR in January and November 2009. He visited our hospital complaining of back pain in May 2011. Chest computed tomography showed increasing size of the aneurysm and recurrent endoleak of the distal stent graft, and impending rupture of the aneurysm was diagnosed. Considering the technical difficulty of repair by TEVAR, we performed graft replacement of the aneurysm with removal of the previous stent graft. The postoperative course was unremarkable and he was discharged on postoperative day 11.

A Case of Spontaneous Rupture of the Ascending Aorta / 日本心臓血管外科学会雑誌

The patient was a 69-year-old man brought to the emergency room with severe chest pain. A contrast chest CT scan revealed a hematoma around the ascending aorta and a notch in the aortic wall, suggesting an intimal tear. An emergency operation was performed via standard median sternotomy under deep hypothermic circulatory arrest. Upon operation, there was a 2.0 cm intimal tear just above the right coronary leaflet, which was extended near the right coronary artery orifice. There was no specific evidence of aortic aneurysm or dissection, therefore a spontaneous rupture of the ascending aorta was diagnosed. The pathological finding was cystic medial necrosis Grade 2. His postoperative course was unremarkable and he was discharged 12 days after surgery.

Initial Experience with the MC³ Annuloplasty Ring for Tricuspid Regurgitation : Comparison to the Cosgrove-Edwards Ring / 日本心臓血管外科学会雑誌

The Edwards MC³ tricuspid annuloplasty system has recently become available commercially. Its anatomically correct design conforms to the three-dimensional tricuspid orifice and minimizes stress on sutures. We handled 71 patients with functional tricuspid regurgitation by open heart surgery and tricuspid valve repair between May 2005 and April 2007 in our institute. Cosgrove-Edwards annuloplasty rings were used for tricuspid regurgitation in 33 patients before October 2006. Among them, there were 30 mitral valve surgeries, 6 aortic valve surgeries, and 2 cases of atrial septal defect. Since then, we used the MC³ system in 38 cases, consisting of 30 mitral valve surgeries, 9 aortic valve surgeries, and 2 cases of atrial septal defect. Three patients died postoperatively with the Cosgrove-Edwards system, but there was no fatality with the MC³ system. The degree of tricuspid regurgitation was reduced from 2.6±0.58 to 0.34±0.46 (regurgitation severity scale: 0 to 4) in the patients with the MC³ ring at discharge. In the 33 patients with the Cosgrove-Edwards ring, it was from 2.8±0.67 to 0.92±0.99. The severity of tricuspid regurgitation in patients with the Cosgrove-Edwards ring and the MC³ ring about nine months postoperative was 1.5±1.2 and 0.42±0.50, respectively. The MC³ (rigid ring) system was more effective than the Cosgrove-Edwards (flexible band) system for decreasing tricuspid regurgitation in immediate and short-term postoperative periods.

Surgical Patch Treatment of SVC Syndrome Caused by Transvenous Pacemaker Lead / 日本心臓血管外科学会雑誌

A 56-year-old male had complained of serious facial edema 2 years after transvenous pacemaker implantation. Venography at admission showed complete occlusion of the left innominate vein and severe stenosis of the SVC. A 20mmHg pressure gradient was recognized between bilateral internal jugular veins and SVC. Various conservative therapeutic approaches had been ineffective, then surgical treatment was recommended. A median sternotomy was made, removing the pacing lead by a Locking Stylet easily and safely. The stenotic section was dilated, resecting the fibrous tissue in the thickened venous wall, and enlarged with a shaped pericardial patch. Symptoms diminished postoperatively. Histological findings revealed phlebosclerosis of the stenotic venous wall. This type of surgical approach is effective for lesions with irreversible occlusion or severe stenosis causing SVC syndrome and which do not respond to conservative therapy.