Saccular abdominal aortic aneurysm in adolescence with tuberous sclerosis.

Key clinical message: Abdominal aortic aneurysm complicated by tuberous sclerosis is rare, particularly in patients over the age of 10. It is important to screen for abdominal aortic aneurysm in adolescents diagnosed with tuberous sclerosis regularly. Abstract: A 15-year-old girl who was diagnosed with tuberculous sclerosis complicated with a saccular aortic abdominal aneurysm (AAA), measuring 19 × 18 mm in diameter. The patient underwent open repair of AAA using a 11 mm straight prosthetic graft. It is important to screen for AAA in adolescents diagnosed with tuberous sclerosis regularly.

Left ventricular apical aneurysm resection and mitral valve replacement for apical hypertrophic cardiomyopathy.

Key clinical message: Left ventricular apical hypertrophic cardiomyopathy with an apical aneurysm carries a risk of thrombosis and can also lead to atrial fibrillation and functional mitral regurgitation. Abstract: A 78-year-old woman underwent left ventricular apical aneurysm (LVAA) resection and mitral valve replacement for severe atrial functional mitral regurgitation. ApHCM can cause atrial fibrillation and atrial functional mitral valve regurgitation. LVAA resection in addition to mitral valve replacement was reasonable to prevent fatal complications associated with LVAA.

The progression of traumatic Stanford type A acute aortic dissection.

Key Clinical Message: Cardiopulmonary bypass for trauma patients carries the risk of bleeding from injured organs, while traumatic aortic dissection can progress rapidly. It is sometimes difficult to determine the optimal time for aortic repair in trauma patients. Abstract: An 85-year-old woman was diagnosed with traumatic ascending aortic dissection, right clavicle and left first rib fracture, and abdominal contusions after a vehicle accident. After admission, the aortic dissection progressed, and emergent surgery was performed. Although the risk of hemorrhagic complications needs to be evaluated, prompt aortic repair is required.

Annular rupture during transcatheter aortic valve replacement in a long-term corticosteroid user: a case report.

A 74-year-old woman with a history of interstitial pneumonia, who had been taking oral corticosteroids for the past 9 years, was diagnosed with severe aortic stenosis. The patient underwent transfemoral transcatheter aortic valve replacement (TAVR) with a balloon-expandable valve under local anesthesia. After deploying a 26-mm SAPIEN 3 valve with 1.5 ml less balloon inflation, transesophageal echocardiography revealed a hemorrhage in the aortic annulus. Intraoperative angiography revealed a small contrast leakage around the ascending aorta. Emergent surgical aortic valve replacement was performed successfully, with a tear at the non-left commissure closed using interrupted sutures. The patient was discharged on postoperative day 14 with no paravalvular leakage. Chronic corticosteroid use may be a risk factor for annular ruptures during TAVR. Careful balloon dilation may be necessary, especially when balloon-expandable valves are used in patients receiving long-term corticosteroids.

Intimal tear closure by false lumen stent graft placement for postdissection thoracoabdominal aortic aneurysm.

We report a false lumen (FL) stent graft technique to close the intimal tears at the visceral segment for a postdissection thoracoabdominal aneurysm after initial thoracic endovascular aortic repair. Following endovascular abdominal aortic repair, a stent graft was deployed in the FL, overlapping the main bodies from both previous repairs just after a bare metal stent was implanted in the FL proximal to the target lesion to prevent overdilation. A reentry tear at the iliac level was intentionally preserved to protect spinal cord perfusion and develop a collateral network and will be closed in the future staged procedure.

Repair of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) by sinus pouch technique.

A 5-month-old girl, weighing 5.3 kg, diagnosed ALCAPA underwent emergency surgery. The left coronary artery (LCA) originated from the posterior pulmonary artery (PA), and the left main trunk (LMT) was very short (1.5 mm), with moderate level of mitral valve regurgitation (MR). The distance from the origin to the pulmonary valve (Pv) was also short. A free extension conduit was created using adjacent sinus Valsalva flaps and implanted in the ascending aorta to avoid distortion of the coronary artery and the Pv.

Atrioventricular groove patch plasty in an infant with pulmonary stenosis after arterial switch operation: a case report.

A 9-month-old infant developed pulmonary stenosis (PS) after an arterial switch operation for transposition of the great arteries, accompanied by a Shaher Type 4 coronary anatomy. As the right coronary artery (RCA) ran across the anterior side of the right ventricle (RV), atrioventricular (AV) groove patch plasty was performed to relieve PS. The distance between the RCA and tricuspid valve was confirmed by preoperative-computed tomography. The AV groove was carefully incised, ensuring the position of the tricuspid valve, and maintaining a distance of 3 mm from the tricuspid annulus to avoid approaching the RCA. While suturing the monocuspid valve patch, only the endocardial side of the RV was sutured, and RCA injury was prevented. Thus, especially in patients < 1 year of age, careful incision of the AV groove and suturing only the endocardial side is important to avoid injuring the RCA in AV groove patch plasty.

Esophageal perforation and septic shock after accidental coin ingestion in elderly person.

An 88-year-old man ingested coins accidentally and developed mediastinitis and septic shock. Esophageal injuries by sharped-shape foreign bodies are often reported, but esophageal perforation by round coins is rare. Even rounded-shape foreign bodies that are unlikely to injure esophagus may lead to severe outcomes.

Left ventricular pseudoaneurysm secondary to recurrent mitral prosthetic valve endocarditis.

An 86-year-old man who had undergone two mitral valve replacements developed heart failure due to prosthetic valve infection and left ventricular pseudoaneurysm (LVPA). LVPA due to infective endocarditis is rare and caused by the abscess formation in the left ventricular myocardium. Infective endocarditis caused by enterococci requires attention to relapse.

Right anterior minithoracotomy for redo aortic valve replacement after coronary artery bypass grafting with bilateral internal thoracic artery: A case report.

A 63-year-old male, with a history of coronary artery bypass grafting using bilateral internal thoracic artery (ITA) grafts, underwent surgical aortic valve replacement (AVR). Avoiding the graft injury, we selected the right anterior minithoracotomy approach under cardiac arrest with systemic hyperkalemia with remaining bilateral ITA grafts open. Deep hypothermia was induced to obtain more reliable myocardial protection. We believe this strategy can be considered as a therapeutic option in patients requiring AVR but unsuitable for transcatheter AVR.

A laryngeal foreign body resembling cervical emphysema.

An 81-year-old woman was referred to our hospital with a chief complaint of chest discomfort; CT imaging suggested for cervical emphysema. However, direct observation revealed a grilled liver stuck to the larynx. Carefully taking the patient's history, especially diet, is important to diagnose a laryngeal foreign body correctly.

Alport syndrome: A case study of chronic type A aortic dissection.

A 39-year-old woman with a history of Alport syndrome was admitted to our hospital for heart failure due to severe aortic regurgitation. Computed tomography revealed a chronic type A aortic dissection that required valve-sparing aortic root replacement. The pathological examination demonstrated that elastic fibers in the tunica media of the aortic wall are torn and severely disorganized. Immunostaining showed fragmented alpha 5 chains, indicating Alport syndrome. These findings imply Alport syndrome may have connective tissue vulnerability, rendering patients susceptible to the development of aortic disease at a young age.

Large left atrial thrombus resection in a patient in sinus rhythm without mitral valve disease: A case report.

INTRODUCTION: Left atrial (LA) ball thrombi are often associated with atrial fibrillation (AF) and mitral valve disease (MVD). Differentiating between thrombi and LA tumors can be challenging. PRESENTATION OF A CASE: A 63-year-old man with a prior mesh insertion for abdominal incisional hernia was admitted with fever. He was diagnosed with an abdominal mesh-related infection requiring surgical debridement. Preoperative transthoracic echocardiography revealed a 39-mm smooth mass in the LA adherent to the atrial septum. The mass was suspected to be a cardiac tumor based on the morphology. The patient underwent mass resection. Pathophysiology revealed that the mass was a thrombus, necessitating anticoagulation therapy. No recurrence of thrombus formation was reported. DISCUSSION: In this case, a plausible factor causing the thrombus formation is the chronic mesh. Since LA thrombi can become free-floating or grow rapidly, early surgical intervention is essential to prevent thrombotic events or sudden death. CONCLUSION: An LA thrombus should be included in the differential diagnosis when an LA mass is detected. Prompt surgical resection prevents thrombotic events and improves patient outcomes.

Frank's sign with acute aortic dissection.

A 59-year-old man with a long smoking history presented with sudden back pain. Frank's sign was noticed in his bilateral ears, and computed tomography revealed Stanford type A acute aortic dissection. If young patients have Frank's sign, attention should be paid to aortic disease in addition to coronary artery disease.

A public health collaboration between medical professionals and Japan's professional football league for rubella awareness.

A public health collaboration between medical professionals and Japan's professional football league for rubella awareness.