[Stuck valve detected during aortic valve replacement; report of a case].

Aortic valve replacement, ascending aorta replacement and coronary artery bypass grafting were performed in a 61-year-old woman with aortic stenosis, ascending aortic aneurysm, and angina pectoris. However, immediately after surgery, transient hypotension and pulmonary hypertension repeated every few beats.Transesophageal echocardiography revealed a stuck valve, and reimplantation was carried out. The patient's postoperative course was uneventful. We present a case of successful treatment of valve dysfunction immediately after valve replacement.

[Surgical case of severe coronary artery obstructive disease with a giant coronary aneurysm; report of a case].

Coronary aneurysms in adults are rare. The natural history of such coronary aneurysms is unknown. Surgical treatment is often concomitant with the treatment of obstructive coronary lesions. However, the ideal treatment strategy is poorly defined. We herein present a case of successful treatment of a large coronary artery aneurysm with interposition of a reverse saphenous vein graft. This modality offers important benefits over other currently used surgical and percutaneous techniques, and should be considered as an effective option.

Long-term continuous entecavir therapy in nucleos(t)ide-naïve chronic hepatitis B patients.

BACKGROUND & AIMS: We determined the antiviral potency and viral resistance rate after 4 years of continuous entecavir treatment in patients with chronic hepatitis B (CHB) infection. METHODS: The cumulative rates of undetectable hepatitis B virus DNA (HBV DNA;<2.6 log(10) copies/ml), hepatitis B e antigen (HBeAg) seronegativity, seroconversion, alanine aminotransferase (ALT) normalization, and entecavir signature mutations were calculated in 474 nucleos(t)ide-naïve CHB patients (HBeAg-positive: 47%) on continuous entecavir treatment for 4 years. RESULTS: Median age was 47 years and follow-up period was 2.4 years, with 403, 281, 165, and 73 patients followed-up for at least 1, 2, 3, and 4 years, respectively. Incremental increases were observed in the rates of undetectable HBV DNA, HBeAg seroclearance and seroconversion, and ALT normalization, reaching 96%, 42%, 38% and 93%, respectively, by the fourth year. In all, 100% and 93% of patients negative and positive for HBeAg, respectively, had undetectable HBV DNA at year 4. Of 165 patients, HBV DNA was detectable in nine patients after 3 years. Multivariate analysis identified HBV DNA level (≤7.6 log(10) copies/ml, OR=15.8; 95% CI=43.1-79.9, P=0.001) as an independent predictor of undetectable HBV DNA at year 3. Five patients experienced virological breakthrough including two (0.4%) who developed entecavir-resistance mutations. CONCLUSIONS: Continuous treatment of nucleos(t)ide-naïve CHB patients with entecavir over 4 years was associated with 96% chance of undetectable HBV DNA and only 0.4% chance of emerging entecavir-resistant mutations.