[Cardiac Failure Developing Eleven Years after Coronary Artery Bypass Grafting;Report of a Case].

We report a rare case of cardiac failure for intrapericardial hematoma 11 years after coronary artery bypass grafting. A 59-year-old man was admitted to our hospital with cardiac tamponade. Echocardiography and computed tomography scan showed severe compression of the left ventricle(LV) by a large mass sized about 5×8 cm. Coronary angiography showed total occlusion at circumflex branch (Cx) #11. The mass was diagnosed with intrapericardial hematoma. We performed removal of hematoma in the pericardial cavity, and removed hematoma had 126 g. Considering that the patient had suffered from diabetes mellitus, the localized collection of the hematoma might be explained by possible slow oozing from LV free wall rupture after asymptomatic myocardial infarction at Cx area.

[Surgical treatment of innominate artery aneurysm using temporary bypass to prevent cerebral ischemia].

A 69-year-old woman had an innominate artery aneurysm that was adjacent to the right common carotid artery and the right subclavian artery. The patient had a dominant right vertebral artery and an underdeveloped circle of Willis. At surgery, the proximal site of the innominate artery, the right common carotid artery and the right subclavian artery were clamped with the temporary bypass between the ascending aorta and the distal site of the right brachial artery for maintaining the blood flow to the brain. The innominate artery aneurysm was resected, and a woven Dacron Y-shaped graft, 14×7 mm in diameter, was used for reconstructing the innominate artery, the right subclavian artery and the right common carotid artery. The postoperative course was uneventful and there was no postoperative neurological deficit. Temporary bypass for maintaining cerebral perfusion was useful in preventing cerebral ischemia.

Aortic valve repair with autologous pericardium for traumatic aortic valve regurgitation.

We present a case of successful aortic valve repair for traumatic aortic valve regurgitation. A 26-year-old male who had a history of motor-cycle accident months prior to admission, was referred to our hospital for surgical treatment of severe aortic valve regurgitation. Intraoperative inspection revealed a tear in noncoronary cusp, with otherwise preserved valvular anatomy. Aortic valvuloplasty was successfully performed with closure using an autologous pericardium patch. Intraoperative transesophageal echocardiogram confirmed absence of residual regurgitation.

Cryosurgical left-sided maze procedure in patients with valvular heart disease: medium-term results.

PURPOSE: We evaluated medium-term results of the left-sided maze procedure using cryoablation in patients with valvular heart disease. METHODS: We retrospectively evaluated 111 patients with valvular heart disease who underwent the cryosurgical left-sided maze procedure. The mean follow-up period was 36.8 ± 24.9 months, and the mean duration of atrial fibrillation was 5.6 ± 6.0 years. The primary surgical procedure was mitral valve replacement in 42 patients, mitral valve plasty in 28, aortic valve replacement in 25, and combined aortic and mitral replacement or plasty in 16. RESULTS: The 7-year actuarial survival rate was 82.9 ± 11.4% for patients in sinus rhythm and 87.0 ± 7.0% for patients with atrial fibrillation, showing no difference between the two groups (p = 0.236). At final follow-up, 86 out of 111 patients (77.5%) remained free from atrial fibrillation. Sinus rhythm was maintained in 26 of 42 patients (61.9%) in the mitral valve replacement group, 26 of 28 patients (92.9%) in the mitral valve plasty group, 15 of 17 patients (88.2%) in the aortic valve replacement group, and 18 of 24 patients (75.0%) in the combined aortic and mitral replacement or plasty group. The overall actuarial rate of freedom from atrial fibrillation at 5 years after surgery was 70.4 ± 6.0%. CONCLUSION: The cryosurgical left-sided maze procedure is a safe, simple, and excellent operation for medically refractory atrial fibrillation.

Electron beam cine CT-based evaluation of left atrial function after the maze procedure for mitral valve regurgitation.

OBJECTIVE: There has been little investigation of whether atrial function is equally restored by surgery in patients with mitral regurgitation (MR) and atrial fibrillation (AF) compared to patients in sinus rhythm (SR). PATIENTS AND METHODS: We evaluated left atrium (LA) volume-time curves obtained from electron beam tomography. The study involved 33 patients who had surgical treatment for MR with or without AF and 11 control patients. RESULTS: (1) In patients with SR, LA volume decreased significantly along with a resolution of early regurgitation postoperatively, and the reserve function was well maintained. The LA booster pump function was also well maintained before and after surgery. (2) In patients with AF that resolved after maze surgery, the LA volume was larger than that of the sinus group immediately after surgery, and it did not improve in postoperative periods. These patients had a lower reserve function and a much lower booster pump function despite restoration of SR. CONCLUSIONS: The maze procedure is suggested to be unlikely to achieve restoration of atrial function in patients with MR accompanied by AF, even if SR returns postoperatively. Because patients with SR demonstrated the same LA function as the control postoperatively, surgical indication should be considered for patients with severe MR while their atrial function and SR are maintained.

Patient-prosthesis mismatch may be irrelevant after aortic valve replacement with the 19-mm Perimount pericardial bioprosthesis in patients aged 65 years or older.

The prevalence of patient-prosthesis mismatch (PPM) and its influence on clinical midterm results were examined in elderly patients whose activity was supposed to be less than that of younger patients. We evaluated valve function and the effects of PPM on the midterm results of the 19-mm Carpentier-Edwards Perimount (CEP) pericardial aortic valve in patients aged 65 years or older. Between August 1996 and May 2005, 51 patients underwent aortic valve replacement with the 19-mm CEP valve. The mean follow-up was 2.4 +/- 1.8 years, involving a total of 134.4 patient-years. The mean age and body surface area at operation were 74.0 +/- 5.0 years and 1.41 +/- 0.14 m(2). There were two (3.9%) operative deaths. Three patients (5.9%) underwent enlargement of their small aortic annuli. The actuarial survival rate at 8 years, including operative mortality, averaged 90.2% +/- 4.7%. The freedom from thromboembolism, reoperation, and valve-related mortality averaged 75.0% +/- 21.7%, 97.8% +/- 2.2%, and 95.3% +/- 3.2%, respectively, at 8 years. High preoperative peak and mean transvalvular pressure gradients were significantly improved after the operation (peak, 93 +/- 35 versus 28 +/- 12 mmHg; mean, 58 +/- 19 versus 17 +/- 7 mmHg, respectively; P < 0.01). The mean left ventricular mass index was reduced from 192 +/- 44 to 142 +/- 46 g/m(2) at late follow-up (P < 0.01). The prevalence of PPM was low (17.6%) when an indexed effective orifice area of less than 0.85 cm(2)/m(2) was taken as the definition of PPM. The clinical results, postoperative pressure gradients, and reduction in left ventricular mass index were not different between the PPM and no-PPM groups. The 19-mm CEP valve produced satisfactory midterm clinical outcomes in patients aged 65 years or older whose activity was supposed to be less than that of younger patients, regardless of the presence or absence of PPM. Moderate PPM was rare and it did not adversely impact on the midterm results. The application of annulus enlargement could be limited to the small number of patients for whom the 19-mm CEP valves are not able to be inserted.

Cardioscopic guidance of linear lesion creation for radiofrequency ablation.

BACKGROUND: The broad use of catheter ablation of atrial fibrillation is limited by the difficulty inherent in creating transmural linear lesions under fluoroscopy. Therefore, we evaluated cardioscopy as a more accurate method of guiding the catheter for the placement of linear lesions. METHODS: Nineteen swine underwent endocardial ablation to create linear conduction block lesions in the right atrium under cardioscopy (group I, n = 13) or fluoroscopy (group II, n = 6). In both groups, the linear lesion was created between the superior and inferior vena cava, perpendicular to hexapolar electrodes placed on the epicardial surface. Each swine received two pairs of epicardial hexapolar electrodes: one pair to measure the conduction delay time across the ablated line and another pair for pacing. The time spent to complete the ablation, number of trials and effective ablations, ratio of effective ablations to trials, length of the lesion, conduction delay under pacing, and postmortem pathology were compared between the two groups. RESULTS: Statistically significant differences were found for the time required for ablation, ratio of effective ablation to total number of trials, and conduction delay. Histologic analysis revealed more homogenous, continuous lesions in group I. CONCLUSIONS: Cardioscopy facilitated the placement of a conduction block line more efficiently than ablation performed under fluoroscopy. Landmarks of tissue relevant to ablation are readily visualized by cardioscopy. Moreover, cardioscopy can be useful for the development of a guiding catheter for the ablation of atrial fibrillation.

A technique for the prevention of hoarseness during surgery for distal aortic arch aneurysm.

Hoarseness occurs frequently after surgery to repair distal aortic arch aneurysms when using only a median sternotomy approach. We describe a useful technique which protects the left recurrent laryngeal nerve during this procedure and reduces the incidence of postoperative hoarseness.