Nonbacterial Thrombotic Endocarditis Presenting as a Mass in the Right Atrium Diagnosed by Open Chest Surgery: A Case Report.

Nonbacterial thrombotic endocarditis (NBTE) is a condition that results in the development of vegetation on cardiac valves that are devoid of inflammation and bacteria. We herein report a 60-year-old man who transferred to our hospital because of a systemic embolism and heart failure. A mass in the right atrium and vegetation on the mitral valve were observed. He was first diagnosed with infectious endocarditis according to the Duke criteria. During treatment, however, the patient was diagnosed with antiphospholipid syndrome and cancer. After four weeks of antibacterial therapy, the patient underwent open chest surgery, and the postoperative histological diagnosis was NBTE.

A case of cardiopulmonary arrest due to left ventricular free wall rupture successfully treated with sutureless repair supported by venoarterial extracorporeal membrane oxygenation.

Extracorporeal membrane oxygenation for cardiopulmonary arrest due to left ventricular free wall rupture is considered effective, because it enables rapid cardiopulmonary support and introduction of targeted temperature management.

[Cardiac Strangulation Induced by Epicardial Pacemaker Leads Causing Heart Failure;Report of a Case].

A 5-year-old girl has a history of epicardial VVI-pacemaker implantation due to congenital heart block at the age of 2 months. Five years later, she developed heart failure at the same time of battery depletion. The chest X-ray indicated the loop formation of the epicardial leads and the echocardiogram demonstrated paradoxical movement of ventricles. The 3-dimensional computed tomography finally revealed strangulation of biventricular apex caused by loop of the leads. She underwent reoperation. Cardiac strangulation was relieved by total removal of the loop and repositioning of right atrial and ventricular electrodes in a gentle curve of the leads. She was discharged and doing well. Cardiac strangulation is a rare, but it can be lethal. Therefore epicardial pacemaker leads should not be positioned around the ventricle with excessive redundancy.

Endovascular Treatment for Kommerell's Diverticulum with a Right-Sided Aortic Arch.

We report a rare case of type A dissection involving a right-sided aortic arch with an aberrant left subclavian artery originating from Kommerell's diverticulum in a 76-year-old woman. Endovascular treatment for Kommerell's diverticulum including intimal tear of the dissection was performed. At the 5-year follow-up, the patient was doing well, with no endoleak or dilatation of the Kommerell's diverticulum.

Metagenomic analysis for detecting pathogens in culture-negative infective endocarditis.

Pathogen identification is important for proper diagnosis and optimal treatment of infective endocarditis (IE). Blood and valve cultures are the gold standard for detecting pathogens responsible for IE. However, these tests only detect culturable pathogens, and have low sensitivity, especially in patients previously treated with antibiotics. Culture-negative IE is still a major clinical problem and a diagnostic challenge. Recently, metagenomic analysis using next generation sequencing has been used to detect pathogens directly from clinical samples. However, there are very few reports of the use of metagenomic analysis for pathogen identification in culture-negative IE cases and the usefulness of this new method is unknown. Here, we report a case of successful pathogen detection with metagenomic analysis in a patient of culture-negative IE. The patient underwent valve replacement surgery and received antibiotics for 5 weeks and survived. Using metagenomic analysis of resected vegetation, we detected Abiotrophia defectiva, which is often associated with culture-negative IE due to its fastidious growth. This method may be useful for pathogen identification in future cases of culture-negative IE.

A Case of an Aortic Abscess around the Elephant Trunk.

A 52-year-old male patient with a history of total arch replacement using the elephant trunk technique for acute aortic dissection 4 years before visited our hospital with the chief complaint of persistent fever. Chest computed tomography (CT) suggested prosthetic vascular graft infection, which was treated surgically after chemotherapy. The first surgery consisted of debridement of an abscess around the vascular graft and in the aorta around the elephant trunk, and thoracic descending aorta replacement and vacuum-assisted closure (VAC) in view of the risk of bleeding from the peripheral region of the elephant trunk. One week later, omental filling was performed as the second step. This is a very rare case of aortic abscess around the elephant trunk that could successfully be managed by graft-conserving treatment.

Morphological Evaluation of Proximal Anastomosis by PAS-Port(®) System in Patients with Long-Term Patent Grafts.

PURPOSE: We examined grafts employing for morphological analysis of early and long-term results on proximal anastomosis with the PAS-Port(®). METHODS: One hundred and four patients treated by OPCAB with PAS-Port(®) were performed postoperative MDCT. Morphological evaluation of the proximal anastomotic region was classified into three groups (A; graft was anastomosed almost perpendicularly to the aortic wall, B; graft was same type A, but subsequently curved to form an acute angle with the aortic wall, C; graft take off acute angle with the aortic wall) evaluated on planar and sagittal sections. RESULTS: One hundred twenty-six PAS-Port(®) were used. Patency rate was 99.0% at discharge, 94.7% at 1 year, and no blockages were detected thereafter in patients examined. The morphology rate was A 50.6%, B 15.3% and C 34.1% on planar sections, and A 58.8%, B 10.6% and C 30.6% on sagittal sections. CONCLUSION: The morphological evaluation of grafts revealed the degree of freedom in graft design to be relatively high and long-term patency posed no particular problem even if the layout of the proximal anastomotic region involved a relatively acute angle. The PAS-Port(®) was considered to be a highly reliable device which performed appropriate proximal anastomosis and improved the patency of vein grafting to the aortic wall.

Interrupted aortic arch with massive saccular collateral aneurysm in an adult.

A 49-year-old man was diagnosed with an interrupted aortic arch (IAA), a massive saccular thoracic collateral aneurysm, ischemic renal insufficiency, and multiple abdominal collateral aneurysms. A bypass from the left subclavian artery to the descending aorta and thoracic collateral aneurysmectomy proceeded simultaneously through a posterolateral thoracotomy. The pressure gradient between upper and lower extremities disappeared and renal function was normalized. Thoracic collateral aneurysmectomy and a simultaneous bypass from the left subclavian artery to the descending aorta with postoperative normalization of ischemic renal insufficiency are extremely rare in adult patients with IAA, and the remaining abdominal collateral aneurysms require careful monitoring.

Endovascular abdominal aortic aneurysm repair in patients with renal transplants: reports of two cases.

The artery and vein of the transplanted kidney are generally anastomosed to the external iliac artery and vein, respectively. Therefore, in open abdominal artery aneurysm (AAA) repair in renal transplant patients, kidney ischemia due to a proximal aortic clamp is a serious problem. We successfully performed endovascular aneurysm repair (EVAR) of AAA without aortic clamping in two renal transplant recipient cases. The two patients were diagnosed with large AAAs following the renal transplant, and EVAR was performed. To protect the renal function, we used N-acetylcysteine premedication and hydration before the operation, and we could then reduce the iodine contrast medium by using echography of the artery during the operation. In this report, a case where EVAR with renal function protection is a useful treatment for renal transplant recipients with AAA is described.